Systematic review of bilateral epididymal leiomyomas - Review of PRISMA-guided evidence

Sep 28, 2026

Uploaded by Patrick

Systematic review updated the evidence on bilateral epididymal leiomyomas, aiming to estimate how many cases have been reported and to summarize management approaches across centres, alongside the authors’ own experience. Following PRISMA methodology, PubMed articles were searched for epididymal leiomyoma, data were extracted on presentation, diagnostics, treatment, histology, and follow-up, and non-English reports were excluded. From 120 records, 29 articles (32 patients) were analysed, most unilateral, with no recurrences reported.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Purpose

Method

Results

Conclusion

REVIEW DOI: 10. 1308/rcsann.2025.0022 Systematic review of bilateral epididymalleiomyomas Purpose Epididymal leiomyomas (LM) are rare benign tumours. Bilateral LM are even more uncommon and there are no management guidelines on LM. We performed a systematic review to update the number of epididymal LM cases reported, and to summarise how these tumours have been managed at different centres with a description of our own experience. Method The systematic review was performed according to the PRISMA guidelines. The PubMed database was searched for articles on epididymal LM. Data extracted included patients’ age, presenting complaint, diagnostic tests, management and follow-up. In addition, a case from our own institution was presented. Results The systematic search identified 120 articles of which 29 articles including 32 patients were analysed. There were 27 (84.4%) unilateral cases and 5 (15.6%) bilateral cases. Surgical treatments included lesion excision, n = 14 (43.8%); orchidectomy, n = 10 (31.3%); partial epididymectomy, n = 5 (15.6%); and total epididymectomy, n = 3 (9.4%) . Final histology revealed 21 LM (65.6%) and 11 leiomyoadenomatoid tumours (34.4%). At a median (interquartile range) follow-up of 14 (8–12) months, there were no cases of recurrence. Our patient, a 53-year-old man, presented with bilateral epididymal lesions for over 1 year and underwent ultrasound scan and positron emission tomography imaging. The imaging findings were indeterminate, hence an excisional biopsy on one side was performed which revealed an epididymal LM. Because LM are benign, further surgery on the contralateral side was not performed. Conclusion Testis-sparing surgery appears to be feasible and safe, limiting the morbidity of radical orchidectomy. Because epididymal LM are rare, a multidisciplinary assessment and management are advised. Keywords: Intrascrotal; Paratesticular; Epididymis; Leiomyoma; Tumour Introduction Paratesticular tumours, especially tumours of the epididymis, are rare. Epididymal tumours represent around 5% of all intrascrotal tumours and the majority (∼75%) are benign.1 Adenomatoid tumours are the most common tumours of the epididymis, representing around one-third of all paratesticular tumours. Leiomyomas (LM; 6%) are the second most common epididymal tumours.2 ,3 LM are benign tumours arising from mesenchymal cells responsible for smooth muscle formation, and patients usually present in their ﬁfth decade of life.4 LM can occur alone or mixed with adenomatoid components – leiomyoadenomatoid (LMA) tumours. Epididymal LM presenting bilaterally are extremely rare and fewer than ten cases have been reported in the literature. Moreover, there are no guidelines on the management of these tumours. A systematic review was performed to estimate the number of LM cases reported and to summarise how these rare tumours have been managed at different centres. Methods A systematic search was performed with reference to the PRISMA checklist5 to summarise how these tumours are managed by other centres (Supplementary Table 1 – available online) . A search of the PubMed database was performed on 10 March 2024 using the terms, (leiomyoma) AND (epididymis) . All manuscripts reporting unilateral or bilateral epididymal LM were included for abstract screening. Non-English articles were excluded. An up-to-date search was performed on 13 September 2024 and no further manuscripts were identiﬁed for inclusion. Abstract and full-text articles were screened by KHP and WGL, any conﬂicts were resolved between the two abstract screeners. Data extracted (KHP) included, age of the patient, KH Pang1,2,3 M Walkden1 A Haider1 P Sangster1,4 HM Alnajjar1,2 A Muneer1,2,5 WG Lee1,2,4 1University College London Hospitals NHS Foundation Trust, UK 2University College London, UK 3Chelsea and Westminster Hospital NHS Foundation Trust, UK 4St Peter’s Andrology Centre, UK 5NIHR Biomedical Research Centre, University

FAQs

Why was this systematic review conducted?

Bilateral epididymal leiomyomas are extremely rare and there are no management guidelines. The review was done to update the number of reported cases and summarize how they were managed across different centres.

How was the evidence collected and screened?

A systematic search followed PRISMA guidelines using PubMed (leiomyoma AND epididymis). Manuscripts reporting unilateral or bilateral epididymal leiomyoma were included, and non-English articles were excluded, with an up-to-date search completed on 13 September 2024.

What treatments were reported and were recurrences seen?

Surgical treatments included lesion excision, orchidectomy, partial epididymectomy, and total epididymectomy. At a median follow-up of 14 months, there were no cases of recurrence.

Sep 28, 2026

Uploaded by Patrick