Diagnosis and treatment progress of malignant mesothelioma of the tunica vaginalis testis / 现代泌尿外科杂志

Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare tumor. At present, there are still many disputes in its epidemiology, pathogenesis, selection of diagnostic methods, treatment and prognosis. Asbestos exposure, ionizing radiation and chromosome abnormalities are the risk factors of MMTVT. Immunohistochemistry, ultrasonography and electron microscope can be used for the diagnosis and aggressive surgery is the main treatment method. The development of endoscopic surgery, multi-disciplinary treatment (MDT), tumor targeted therapy and immunotherapy will bring more benefits to MMTVT patients.

Periorquitis meconial: A propósito de un caso / Meconium periorchitis: A case report

La periorquitis meconial es infrecuente. En el feto, está abierto el conducto peritoneo vaginal y, ante una perforación intestinal por cualquier causa (atresia intestinal, vólvulo, entre otras), se produce una peritonitis meconial. El contenido intestinal puede pasar hacia la cavidad vaginal escrotal. La peritonitis meconial puede resolverse espontáneamente y sin consecuencias. Restos calcificados de este evento pueden quedar en la cavidad peritoneal y/o en el escroto. En el recién nacido, se observará un hidrocele y una masa palpable intraescrotal, ecográficamente heterogénea y con calcificaciones. La periorquitis meconial o vaginalitis meconial se resuelve espontáneamente. Su desconocimiento podría llevar a cirugías innecesarias en el neonato. Se presenta el caso de un paciente de 33 días de vida con una masa escrotal, en quien se realizó una cirugía exploratoria. El diagnóstico anatomopatológico fue de periorquitis meconial.

Meconium periorchitis is uncommon. In the unborn child the peritoneum vaginal canal is open and, secondary to intestinal perforation due to any cause (intestinal atresia, volvulus, and others), meconium peritonitis occurs. The intestinal content reaches the scrotal vaginal cavity. Meconium peritonitis can heal spontaneously and without consequences. Calcified remnants of this event may remain in the peritoneal cavity and/or scrotum. In the newborn, a hydrocele and scrotal mass can be observed; the ultrasound will show a heterogeneous image with calcifications. Meconium periorchitis or meconium vaginalitis resolves spontaneously. The lack of awareness of this disease could lead to unnecessary surgery in the newborn. We present a 33 days old patient with a scrotal mass in whom surgery was performed with the pathological diagnosis of meconium periorchitis.

Litiasis en divertículo de uretra de localización intraescrotal / Lithiasis in urethral diverticulum of intraescrotal localization

Los divertículos uretrales en el varón son una patología rara que aparece, en su mayoría, después de realizar manipulaciones uretrales. Desde el punto de vista clínico, pueden ser sintomáticos o no sintomáticos. Las complicaciones ocurren en un 10% de los casos, siendo la más frecuente la litiasis. Cuando el divertículo está ocupado por cálculos, suele presentar una sintomatología mucho más evidente. La cistouretrografía es la técnica de elección en estos casos, ya que permite diferenciar los divertículos uretrales del resto de las lesiones quísticas parauretrales. El tratamiento de elección es la exéresis del divertículo y la uretroplastia. La abstención quirúrgica puede estar indicada solo en los divertículos asintomáticos de muy pequeño volumen. Presentamos un paciente de 44 años de edad que acudió al servicio de Urgencias por el desarrollo de una masa escrotal de gran tamaño con signos inflamatorios locales. Se confirmó quirúrgicamente el diagnóstico presuntivo de divertículo uretral gigante con litiasis en su interior, efectuado tras la evaluación imagenológica con radiografía simple, ecografía, tomografía computada y uretrografía retrógrada.

The male urethral diverticula are a rare condition, most of them being acquired after urethral manipulations. From the clinical point of view they may be symptomatic and asymptomatic; complications may occur in 10% of cases, being the lithiasis the most common. When the diverticulum is occupied by stones, it usually has a much more apparent symptomatology. Cystourethrography is the imaging technique of choice in these cases, allowing us to differentiate urethral diverticula from other paraurethral cystic lesions. The elective treatment is surgical excision of the diverticulum and urethroplasty. The surgical abstention may be indicated only in very small and asymptomatic diverticula. We present a case of a 44 year-old male who came to the emergency room for large scrotal mass with local inflammatory signs; the presumptive diagnosis of large urethral diverticulum occupied by stone done after performing several imaging techniques (plain radiography, ultrasound, computed tomography and retrograde urethrography) was surgically confirmed.

Meconium periorchitis: An unusual cause of newborn scrotal mass.

A case of meconium periorchitis in a 2-month-old boy is reported. The patient was delivered normally, only a scrotal mass was noted which became harder in weeks. Clinical and intrauterine ultrasonographic fi ndings were suggestive of a neoplasm and orchidectomy was performed. Microscopic examination revealed separate nodules of myxoid stroma with varying amounts of calcifi cation separated by fi brous septa. The unexpected diagnosis of meconium periorchitis was confi rmed. This condition is due to infl ammatory reaction from the meconium within the scrotal sac and resulted from an intrauterine perforation of the gastrointestinal tract. Since solid benign or malignant paratesticular masses cannot be differentiated by ultrasonography, tissue biopsy or fresh frozen tissue examination is required for diagnosis.

Evaluation of the Painless Scrotal Masses / 대한비뇨기과학회지

Painless scrotal masses are clinical syndromes composed of variable causes such as benign disease and testicular cancer. So, the methods of treatment are differ from each causes and in the case of testicular cancer, as its painless nature, the delayed treatment can be alter the methods of treatment and the prognosis. During 21 months, between June 1994 and March 1996, we evaluated the confirmed diagnosis, the method of treatment, the diagnostic method and the distribution of age from the 125 cases of 109 patients who are admitted to the hospital from the painless scrotal mass and underwent surgical treatment and pathologic typing, retrospectively. Of the 125 cases, 57 cases (46%) were below 20 years old and communicating hydrocele was most common case (51case) and 66 cases were age of over 20 years old. In 66 cases, 17 cases (25%) were chronic epididymitis, 15 cases (22.1%) were noncommunicating hydrocele and 9 cases (13.2%) were varicocele, respectively. Malignant neoplasm was distributed to the 1 case of pediatric group and 3 cases (4.4%) of adult group. Transillumination test, generally, revealed negative or equivocal finding except to hydrocele. On the ultrasonographic test (35 cases). most cases were identical or correspond to the postoperative diagnosis and 1 case was misdiagnosed (accuracy rate, 97.1%) but in the case of inflammatory disease, it was difficult to differentiate between specific and non-specific infection. We conclude that the work up for the painless scrotal mass should begin with careful physical examination, and when the physical examination, scrotal transillumination and scrotal ultrasonography show the equivocal finding, surgical exploration with inguinal incision will be necesssary to prevent sequelae or complication of malignant disease.

A Clinical Study on Intrascrotal Mass / 대한비뇨기과학회지

A clinical study was made on 57 patients (61 cases)of intrascrotal mass in the Department of Urology, Han Il Hospital, during the period from January, 1978 to December, 1981. The results were follows: 1. The incidence of intrascrotal mass was 11.5% of total admitted patients. 2. The most common population was 20-29 year of age giving the rate of 36.4% (18 patients). 3. 29 patients were affected in the right side, 24 patients in the left and 4 patients in both. 4. 39 cases were painless intrascrotal mass and 22 cases were painful. 5. The most common disease was hydrocele giving the rate of 45.9% (28 cases). Acute epididymitis was 23.0% (14 cases), tuberculous epididymitis 9.8% (6 cases), varicocele 6.6% (4 cases), others 14.7% (9 cases). 6. Of 61 cases, operation was performed in 43 cases and conservative management in 18 cases.