Methotrexate and etanercept-induced primary cutaneous CD4 positive small/medium-sized pleomorphic T-cell lymphoma

Abstract: Immunosuppressive drugs and biological agents may represent a potential risk of lymphoma development in patients with rheumatoid arthritis. But most cases are diffuse, large B-cell lymphomas. Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, a provisional entity in the 2005 WHO-EORTC classification of cutaneous lymphomas, is only described in a limited number of reports. To our knowledge, our case is a rare instance of primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, after associated treatment with methotrexate and etanercept, in a patient with moderate rheumatoid arthritis who had undergone an orchidectomy incorrectly.

Testicular calculus: A rare case

Testicular calculus is an extremely rare case with unknown etiology and pathogenesis. To our knowledge, here we report the third case of testicular calculus. A 31-year-old man was admitted to our clinic with painful solid mass in left testis. After diagnostic work-up for a possible testicular tumour, he underwent inguinal orchiectomy and histopathologic examination showed a testicular calculus.

Quiste epidermoide testicular: diagnóstico ecográfico preoperatorio y correlación radiopatológica / Testicular epidermoid cyst. preoperative ultrasound diagnosis and radiopathological correlation

The low incidence of testicular epidermoid cyst (1-2 percent of all testicular tumors), makes ultrasound findings the key to making, or at least suggesting, a precise preoperative diagnosis, thus making a conservative treatment possible. We present two cases with ultrasound diagnosis of epidermoid cyst, confirmed later after surgery. We review the literature, emphasizing the evaluation of the ultrasound images and their correlation with the anatomopathological findings.

La escasa incidencia del quiste epidermoide de testículo (1-2 por ciento de todos los tumores testiculares), hace de los hallazgos ecográficos la clave para realizar o al menos sugerir un diagnóstico prequirúrgico preciso, haciendo por tanto posible un tratamiento conservador. Presentamos dos casos con diagnóstico ecográfico de quiste epidermoide, confirmado posteriormente tras cirugía. Realizamos una revisión de la bibliografía, enfatizando en la valoración de las imágenes ecográficas y su correlación con los hallazgos anatomopatológicos.

Testis tumor associated to microlithiasis / Tumor de testiculo asociado a la microlitiasis / Tumor de testiculo associado a microlitiase

OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children. .

OBJETIVO: Discutir las implicaciones de la microlitíasis testicular en el niño con relación al riesgo oncológico implicado y la posibilidad de cirugía de preservación testicular en casos elegidos. DESCRIPCIÓN DEL CASO: Pre-adolescente presentando aumento microlitíasis testicular y aumento del testículo izquierdo, con lesión tumoral quística. La lesión fue resecada, con preservación del testículo y diagnóstico histológico de tumor dermatoide testicular. COMENTARIOS: La relación entre tumores de testículo y microlitíasis testicular es mal definida en niños y hay la necesidad de desarrollar protocolos de seguimiento específicos para esa franja de edad. .

OBJETIVO: Discutir as implicações da microlitíase testicular na criança com relação ao risco oncológico envolvido e a possibilidade de cirurgia de preservação testicular em casos escolhidos. DESCRIÇÃO DO CASO: Pré-adolescente apresentava microlitíase testicular e aumento do testículo esquerdo, correspondendo a tumor testicular cístico. Ressecou-se o tumor, com preservação do testículo. O diagnóstico histológico foi de tumor dermoide testicular. COMENTÁRIOS: A relação entre tumores de testículo e microlitíase testicular é mal definida em crianças e há a necessidade de desenvolver protocolos de seguimento específicos para essa faixa etária. .

La lepra y el testículo / Leprosy and the testis

Introducción. La afección testicular es frecuente en la lepra lepromatosa, daño que se incrementa cuando cursa con eritema nudoso leproso. Objetivo. Presentar un paciente con lepra lepromatosa y eritema nudoso leproso con grave compromiso testicular. Materiales y métodos. Se estudió un hombre de 28 años con lepra lepromatosa desde los 22, que durante la poliquimioterapia para la lepra presentó eritema nudoso leproso crónico que afectó ambos testículos y no respondió al manejo convencional. El dolor persistente obligó a practicar orquidectomía izquierda. Resultados. Este testículo presentaba atrofia tubular y fibrosis notorias, conglomerados de macrófagos espumosos, sin bacilos, hiperplasia focal de células de Leydig, endarteritis y arteritis linfocitaria y granulomatosa de vasos pequeños y medianos; estos cambios también estaban presentes en el epidídimo. Un estudio llevado a cabo dos años después de terminar su tratamiento y de la orquidectomía izquierda, demostró azoospermia, testosterona total normal, testosterona libre discretamente disminuida y hormonas lutropina (luteinizante) y folitropina (estimulante del folículo) elevadas. No había disminución de la libido ni de su actividad sexual. Se revisaron los conceptos generales sobre el eritema nudoso leproso y las alteraciones que la lepra produce en el testículo. Conclusión. La lepra lepromatosa puede conducir a hipogonadismo. Los programas de lepra deben contemplar esta complicación para corregir y evitar sus secuelas.

Introduction. Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. Material and methods. The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. Results. The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. Conclusion. Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.

Microsurgical testicular denervation for the treatment of chronic testicular pain initial results

INTRODUCTION: Chronic testicular pain remains an important challenge for urologists. Currently, the treatment plan is primarily empirical, with the first approach consisting of clinical measures. However, some patients remain in pain despite a conservative treatment protocol and, for them, it is possible to perform a surgical procedure that involves severing the scrotal and spermatic branches of the genitofemoral and ilioinguinal nerve fibers. METHODS: In our institution, 60 patients were evaluated and treated for idiopathic chronic testicular pain between January 2003 and July 2007. Priority was give to clinical treatment, which evolved from simple to more complex measures. Microsurgical treatment was performed on those who experienced no considerable pain relief (10 individuals in our study). RESULTS: Over a twenty-four-month follow-up period, 70 percent of patients showed complete remission and 20 percent exhibited partial relief from pain.

Surgical treatment of lymphedema of the penis and scrotum

INTRODUÇÃO: O linfedema peno-escrotal, independentemente da etiologia, é determinado pela redução do fluxo linfático com conseqüente aumento do volume do escroto e pênis. A evolução clínica da doença é caracterizada com extremo desconforto ao paciente, limitando a higiene local, a deambulação, o intercurso sexual e a micção em posição ortostática. OBJETIVO: Apresentar a experiência e resultados no tratamento da patologia com remoção dos tecidos comprometidos e correção peno-escrotal. MÉTODO: Foram tratados 17 pacientes com linfedema do escroto e pênis com a técnica de Charles modificada, que consiste na excisão da pele comprometida seguida de escrotoplastia e sutura mediana simulando a rafe escrotal. O pênis é recoberto com enxerto de pele parcial suturado em linha quebrada na face ventral. RESULTADOS: No seguimento dos pacientes, que variou entre 6 meses e 6 anos, constatou-se regressão dos sintomas e melhora das condições clínicas prévias. Um paciente submetido à linfadenectomia com radioterapia por câncer de pênis teve recidiva do linfedema escrotal. CONCLUSÃO: A técnica de Charles modificada no tratamento do linfedema peno-escrotal é facilmente reprodutível e possibilita com seus resultados melhor higiene local, melhor movimentação, micção em posição ortostática, retomada do intercurso sexual e, finalmente, melhor aparência à região comprometida com franca melhora da qualidade de vida.

Denervación testicular laparoscópica en el dolor crónico / Laparoscopic testicular denervation in the chronic pain

El dolor testicular crónico representa un desafío importante para el urólogo y es una afección de consulta frecuente. Cuando los métodos conservadores no dan resultado y no se encuentra un factor etiológico claro, la denervación testicular ha demostrado ser un método útil. Presentamos nuestra experiencia en 2 pacientes portadores de orquialgia crónica intratable que se resolvieron exitosamente con una denervación testicular laparoscópica. El abordaje laparoscópico en el tratamiento de la orquialgia crónica refractaria provee una denervación testicular nociceptiva completa y segura.

Accuracy of color Doppler ultrasonography in acute scrotal disorders in children

This study aimed to evaluate the role of color Doppler sonography in the diagnosis of acute scrotal disorders in 30 patients. During 20 months period, patients underwent pulsed Doppler sonography of both testes and the results were compared with surgical exploration. All patients with acute scrotal conditions including pain or swelling underwent Doppler sonography of both testes, followed by surgery and close clinical follow up for at least four months. Pulsed Doppler was performed with 7.5 or 10 Mhz transducer. In 30 patients, color Doppler was also used. The testicular artery was considered to patent if Doppler shift from branches within the parenchyma could be found. Color Doppler ultrasound was a useful adjunct in the evaluation of the acute scrotal conditions when the physical findings were equivocal. Pulsed Doppler with mechanical sectors scanner was more sensitive than color Doppler. Intermittent torsion was missed with Doppler. Although ultrasonography can replace clinical judgment, it may be very helpful in the unclear cases

Síndrome escrotal agudo: análisis de 147 pacientes / Acute scrotal syndrome: analysis of 147 patients

Entre los años 1989 y 1994 fueron tratados quirúrgicamente 147 pacientes con Síndrome Escrotal Agudo (SEA). La torsión de Hidátide de Morgagni fue la condición mas frecuente (75 por ciento), la torsión testicular ocurrió en 44 pacientes (30 por ciento) y el resto correspondieron a orquiepidimitis. El rango de edad fue de 2 días a 15 años. De los niños que sufrieron torsión testicular, 32 (73 por ciento) conservaron su gónada y en 12 de ellos fue necesaria la orquectomía. La orquidopexia contralateral se realizó en todos los casos. El diagnóstico clínico y la exploración escrotal precoz permiten la preservación testicular, en la mayoría de los pacientes con torsión testicular

Chronic orchalgia; a vexing problem: etiology and management

Thirty-five patients with chronic intrascrotal pain were studied. The duration of pain at presentation was 3-96 months [average 22.6 months]. Diagnostic work up showed that only 14 cases [40%] had an intrascrotal pathology explaining the chronic orchalgia. On the other h and, orchalgia was the result of referred pain from the upper urinary tract in 5 cases [14.3%] and a prostatic pathology in another 5 cases. Other causes of intrascrotal pain were sensory neuralgia in 2 patients and psychosomatic troubles in another 2 cases. Four cases [11.4%] remained where no cause for orchalgia could be identified. Treatment of the cases was either surgical, medical or by spermatic cord neural block. Complete pain relief was achieved in 16 cases [45.7%]. Partial improvement was reported by another 16 cases and 3 patients [8.6%] showed no improvement

Bilharziosis testicular / Testicular biharziosis

Se aportó un nuevo caso de schistosomiasis testicular a la literatura, se hizo especial énfasis en la forma tumoral de su presentación y la ausencia de otras manifestaciones urinarias

Quiste seroso simple congénito de testículo / Congenital benign simple serous cyst of the testis

Los tumores benignos de testículo en el niño son raros, pudiendo corresponder a lesiones tumorales o inflamatorias infecciosas, siendo los más frecuentes los quistes epidermoides. A continuación presentamos el primer reporte nacional de un quiste seroso simple congénito de testículo de un lactante de 10 meses de edad en el cual se realizó cirugía conservadora, con seguimiento de 8 meses

Estudo das malformaçöes de epidídimo encontradas em testículos retidos e sua provável significaçäo clínica / Epididymal abnormalities in undescended testis and its probable clinic significance

Os testículos de 66 pacientes com criptorquidia e ectopia testicular, compreendendo 82 órgäos, foram dissecados cirurgicamente e fotografados durante orquidopexia, para observar e classificar as alteraçöes de epidídimo e anexos encontrados. As modificaçöes anatômicas encontradas foram classificadas em alteraçöes do comprimento do epidídimo, separaçäo testículo-epididimal, angulaçäo do epidídimo, atresia do mesmo ou do vaso deferente e presença de alteraçäo no mesórquio. Encontraram-se apenas 20,7% dos testículos com aspecto normal. Os demais apresentavam uma ou mais malformaçöes de epidídimo, sendo de modo geral mais sérias e comuns nos testículos criptorquídicos do que nos ectópicos. Parece haver nos testículos retidos importantes anomalias no sistema de conduçäo espermática que poderia, em boa parte dos pacientes, comprometer a contribuiçäo desses testículos para a fertilidade