Liposarcoma del cordón espermático simulando una hernia inguinal incarcerada / Liposarcoma of the spermatic cord mimicking an incarcerated inguinal hernia

INTRODUCCIÓN: Los tumores paratesticulares representan del 7%-10% de las masas intraescrotales. Los sarcomas abarcan el 90% de las lesiones malignas del cordón espermático y de éstas, aproximadamente, el 3%-7% son liposarcomas. CASO CLÍNICO: Presentamos el caso de un varón de 45 años, que consultó en urgencias por una masa inguinoescrotal derecha no reductible, diagnosticándose de hernia inguinal incarcerada. Se realizó cirugía urgente evidenciando una gran tumoración de aspecto lipomatoso, dependiente de cordón espermático. Se realizó orquiectomía y hernioplastía inguinal. La anatomía patológica, reveló un liposarcoma bien diferenciado de cordón espermático. Posteriormente, se realizó estudio de extensión, sin afectación a distancia y no precisó tratamiento adyuvante. Actualmente, tras dos años de seguimiento no ha presentado recidiva. DISCUSIÓN: Sólo alrededor de 200 casos han sido comunicados previamente en la literatura y sólo 61 de éstos se presentaron simulando una hernia inguinal incarcerada. Debido a la baja incidencia de esta patología es difícil de conocer la historia natural y llegar a conclusiones sobre los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con escisión amplia de los tejidos locales. El papel de la radio y quimioterapia aun es controvertido. CONCLUSIONES: Los sarcomas del cordón espermático son neoplasias raras con alta tasa de recurrencia local. Su manejo inicial es quirúrgico. Se requiere de un alto índice de sospecha clínica para el diagnóstico ya que las implicaciones oncológicas varían en función del tratamiento que, en ocasiones, es llevado a cabo por cirujanos generales al simular una hernia inguinal.

INTRODUCTION: Paratesticular tumors represent 7%-10% of intraescrotal masses. Sarcomas account for 90% of malignant lesions of the spermatic cord and of these approximately 3%-7% are liposarcomas. CLINICAL CASE: This is the case of a 45 year old male who consulted in the emergency department for a non-reducible right inguino-scrotal mass and was diagnosed with an incarcerated inguinal hernia. Emergency surgery was performed which revealed a large lipomatous tumor, originating from the spermatic cord. Orchiectomy and hernioplasty were performed. Histopathology revealed a well-differentiated liposarcoma of the spermatic cord. Later extension study was conducted, without distant affectation, and did not require adjuvant treatment. Today, after two years of monitoring has been no recurrence. DISCUSSION: Only about 200 cases have been previously reported in the literature and only 61 of these were presented mimicking an incarcerated inguinal hernia. Due to the low incidence of this disease it is difficult to know the natural history and draw conclusions on the results of treatment, which so far remains the radical orchiectomy with wide local excision of the tissue. The role of radiotherapy and chemotherapy is still controversial

Effects of traction on the spermatic cord of rats

PURPOSE: To determine whether tension in the spermatic cord of rats causes lesions in the testis, epididymis or vas deferens. METHODS: Forty Wistar rats were randomly allocated into four groups. A traction force of 1.6 Newton (N) in group I and 1 N in group II was applied to the right spermatic cord. Group III was the sham, and group IV served as the control. RESULTS: Testicular lesions occurred on the right side in 66.7% of the rats and on the left side in 46.1% of the rats. The testes showed a decreased number of Sertoli cells, necrosis and a decreased number of germ cells in the seminiferous tubules. Anatomopathological changes in the vas deferens were not identified. There was no decrease in the thickness of the muscle wall of the vas deferens. In the right epididymis, 71.8% of the animals showed a reduction and 5% showed an absence of intraluminal sperm. In the left epididymis, 37.5% of the rats showed a reduction. The volume and the final testicular weight of the right side in group IV was different from those in the other groups. CONCLUSIONS: Anatomopathological lesions were found in the testis and epididymis. .

Metastatic tumour of spermatic cords, epididymis and seminiferous duct from gastric carcinoma / Tumor metastásico de los cordones espermáticos, el epidídimo y el conducto seminífero a partir de un carcinoma gástrico

Metastatic tumour of spermatic cords, epididymis and seminiferous duct from gastric carcinoma has been recently reported but rarely seen. A case of metastatic tumour from gastric carcinoma in a 50-year old man is herein reported. The initial diagnosis was thickening of both spermatic cords. Needle biopsy of the spermatic cord, testicle and epididymis was performed. Pathological findings showed a gastric signet ring cell carcinoma. Thus, double radical orchiectomy was performed and metastatic signet ring cell carcinoma of the spermatic cord and testis was diagnosed through histological examination and immunohistochemistry. Physicians should be aware that gastric carcinoma is one of the possibilities for metastasis to the seminal duct.

El tumor metastásico de los cordones espermáticos, el epidídimo y el conducto seminífero a partir de un carcinoma gástrico ha sido reportado recientemente, pero pocas veces visto. En este trabajo se reporta el caso de un tumor metastásico a partir de un carcinoma gástrico en un hombre de 50 año de edad. El diagnóstico inicial fue el engrosamiento de los dos cordones espermáticos. Se realizó una biopsia con aguja del cordón espermático, testículos y epidídimo. Los resultados patológicos mostraron un carcinoma de células en anillo de sello. Por consiguiente, se realizó una orquiectomía radical doble, y el carcinoma metastásico en anillo de sello del cordón espermático y el testículo, fue diagnosticado mediante examen histológico e inmunohistoquímico. Los médicos deben tener presente que el carcinoma gástrico es una de las posibilidades de metástasis en los conductos seminales.

[Dermoid cyst of the spermatic cord: a rare case of benign inguinal lump]

Dermoid cyst of the spermatic cord is an extremely rare pathological state seen at the general surgery and the urological clinic. We present a case of a nineteen year old male who presented with a painless left groin lump, irreducible, and no cough impulse from childhood, both testes presented in the scrotum and were normal in size and shape. From the history, physical examination, ultrasound examination, we thought it was a lipoma, a hydrocele of the spermatic cord, or irreducible inguinal hernia. During the operation, suspicion of a dermoid cyst of spermatic cord occurred from a sebum and hair which discharged from the cyst during dissection of the cyst from spermatic cord. The final histopathological analysis established the diagnosis of dermoid cyst of spermatic cord

Imaging Findings of Angiomyxolipoma of the Spermatic Cord Mimicking Inguinal Hernia

We report the case in a 72-year-old man who presented with a right inguinal mass and with a one month history that was initially interpreted as an inguinal hernia. Ultrasonography (US) and computed tomography (CT) demonstrated a right inguinal mass, including myxoid and fat component, extending from the right spermatic cord to the right inguinal subcutaneous layer. Mass excision was performed, and the diagnosis turned out to be angiomyxolipoma. Angiomyxolipoma is a rare tumor and the preoperative diagnosis of this disease is very difficult. However, angiomyxolipoma of the spermatic cord should be considered in the differential diagnosis in patients with an irreducible inguinal mass. Imaging diagnosis, such as US and CT may help to make a preoperative diagnosis.

Pseudotumor fibroso do cordão espermático: relato de uma lesão infrequente / Fibrous pseudotumor of the spermatic cord: report of an unusual lesion

Os pseudotumores fibrosos são lesões incomuns que ocorrem geralmente em resposta a cirurgia, trauma, infecção ou inflamação. Relatamos um caso de paciente com 25 anos de idade que apresentou massa escrotal indolor. Realizou-se orquiectomia radical. O diagnóstico anatomopatológico foi de pseudotumor fibroso do cordão espermático.

Fibrous pseudotumors are uncommon lesions that mostly occur in response to surgery, trauma, infection or inflammation. We report the case of 25 year-old patient, who presented painless scrotal mass. A total orchidectomy was performed. The anatomopathological diagnosis was fibrous pseudotumor of the spermatic cord.

Primary lymphoma of the spermatic cord: A case report and review of the literature.

Primary lymphomas of the spermatic cord are extremely rare. To date, only 15 cases have been reported in the international literature. Herein, we report a new case of a primary lymphoma of the spermatic cord. A 73-year-old patient presented at the Urology Department, complaining of bilateral painful masses at the inguino-scrotal region. A computed tomography scan revealed spermatic cord tumor. A right inguinal orchidectomy was performed in order to establish a definitive diagnosis. Macroscopically, the tumor was restricted to the spermatic cord area, leaving unaffected the testis and the epididymis. The histopathological and immune-histological evaluation has indicated a diffuse large B-cell lymphoma. Postoperatively, the patient was investigated thoroughly but no further signs of the disease were found.

Ipsilateral testicular necrosis and atrophy after 1.080-degree torsion of the spermatic cord in rats / Necrose e atrofia do testículo ipsilateral após torção de 1080 graus do cordão espermático em ratos

PURPOSE: To assess the incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord, and 60 days after detorsion of the spermatic cord. METHODS: 42 rats were divided in 7 groups. Except for the control group, surgical torsion of the right spermatic cord was performed in all groups (T0). After 1, 2, or 4 hours of torsion, each group underwent either ipsilateral orchiectomy (groups OT1, OT2, and OT4), or detorsion of the spermatic cord and observation for 60 days (groups DT1, DT2, and DT4), before they were evaluated for the presence of testicular necrosis/atrophy. RESULTS: Only one rat (5.5%) in groups OT1, OT2, and OT4 had testicular necrosis, in comparison with six rats (33.3%) in groups DT1, DT2, and DT4 (p=0.04). The incidence of testicular necrosis/atrophy was not different between subgroups T1, T2, and T4, and the control group (p>0.05). There was, however, a tendency toward greater incidence of necrosis/atrophy in the rats in group DT4. CONCLUSION: The incidence of testicular necrosis/atrophy immediately after 1 to 4 hours of 1,080-degree torsion of the spermatic cord is 5.5%, in comparison with 33.3% sixty days after detorsion of the spermatic cord.

OBJETIVO: Avaliar a incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático e 60 dias após a destorção do cordão espermático. MÉTODOS: 42 ratos foram separados em 7 grupos. Exceto para o grupo controle, todos os animais foram submetidos à torção operatória do cordão espermático direito (T0). Após 1, 2 ou 4 horas de torção, cada grupo foi submetido a orquiectomia ipsilateral (grupos OT1, OT2 e OT4), ou destorção do cordão espermático e observação por 60 dias (grupos DT1, DT2 e DT4), antes de serem avaliados para a presença de necrose/atrofia testicular. RESULTADOS: Somente um rato (5,5 por cento) nos grupos OT1, OT2 e OT4 apresentou necrose testicular em comparação com 6 ratos (33,3%) nos grupos DT1, DT2 e DT4 (p=0,04). A incidência de necrose/atrofia testicular não foi diferente entre os subgrupos T1, T2 e T4 e o grupo controle (p>0,05). Houve, no entanto, uma tendência a maior incidência de necrose/atrofia nos ratos do grupo DT4. CONCLUSÃO: A incidência de necrose/atrofia testicular imediatamente após 1 a 4 horas de torção de 1080 graus do cordão espermático é de 5,5% em comparação com 33,3% sessenta dias após a destorção do cordão espermático.

Encysted hydrocele of cord in an adult misdiagnosed as irreducible hernia: a case report

A number of pathologies can present as groin swellings in adults. Among these, encysted hydrocele of the cord presenting as swelling in an adult is a rare. A case of encysted hydrocele of cord in 36 year old male mimicking as an irreducible hernia is reported. The diagnosis of hydrocele was made intraoperatively. An excision of the sac was performed

Metastatic tumor of the spermatic cord caused by an adenocarcinoma of the pancreas, case report

A metastatic tumor of the spermatic cord caused by an adenocarcinoma of the pancreas is uncommon. The authors report the case of a 48-year-old man admitted to Antananarivo Teaching Hospital [Madagascar] with a right inguinal mass and in a poor physical condition. Computed tomography and histological examination confirmed the diagnosis. Diagnosis and treatment are discussed based on a review of the literature

Prospective study on the effects of a polypropylene prosthesis on testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia

PURPOSE: To evaluate testicular volume and arterial flow in patients undergoing surgical correction for inguinal hernia, with polypropylene prosthesis. METHODS: This was an observational prospective clinical study on 39 male patients with unilateral inguinal hernia of types III A and III B according to the Nyhus classification who underwent surgical correction with implantation of a polypropylene prosthesis by means of the Lichtenstein technique. The patients were evaluated using Doppler ultrasound before the operation and selectively at the third and sixth months after the operation. The variables studied were testicular volume, systolic and diastolic velocity, resistance index and pulsatility index. RESULTS: No statistically significant alterations in the variables studied were observed over the course of time: testicular volume (p= 0.197); systolic velocity (p= 0.257); diastolic velocity (p= 0.554); resistance index (p= 0.998); and pulsatility index (p= 0.582). CONCLUSION: No alteration in testicular volume and arterial flow over a six-month period was observed among patients who underwent surgical correction for inguinal hernia using a polypropylene prothesis.

OBJETIVO: Avaliar o volume testicular e o fluxo na artéria testicular em pacientes operados de inguinal com prótese de polipropileno. MÉTODOS: Estudo clínico prospectivo observacional em 39 pacientes do sexo masculino portadores de hérnia inguinal tipo III A e III B na classificação de Nyhus os quais foram submetidos a hernioplastia inguinal com implantação de prótese de polipropileno com a técnica de Lichtenstein. Os pacientes foram avaliados com ultra-sonografia Doppler no pré-operatório; no 3° mês e no 6° mês de pós-operatório. As variáveis estudadas foram: volume testicular; velocidade sistólica e diastólica, o índice de resistividade e o índice de pulsatilidade. RESULTADOS: Não se observou alterações estatisticamente significantes nas variáveis ao longo do tempo: volume testicular (p=0,197); velocidade sistólica (p=0,257); velocidade diastólica (p=0,554); índice de resistividade (p=0,998); índice de pulsatilidade (p=0,582). CONCLUSÃO: Não se observou alteração no volume testicular e no fluxo sanguíneo da artéria testicular após seis meses nos pacientes submetidos à correção cirúrgica de hérnia inguinal com prótese de polipropileno..

Ectopic adrenal tissue in the spermatic cord in pediatric patients: surgical implications

OBJECTIVE: To study the incidence and relevance of ectopic adrenal tissue in pediatric patients who underwent groin surgical explorations. MATERIALS AND METHODS: We studied 1120 patients with groin surgical explorations during a period of 8 consecutive years. PatientsÆ clinical data and histological findings were analyzed. RESULTS: We found ectopic adrenal tissue in 13 patients in 1120 groin surgical exploration (1.16 percent). Of the 13 cases, 5 were diagnosed as having undescended testes, 6 inguinal hernia and 2 communicating hydrocele. Median age at diagnosis was 5.6 years. Histological sections showed adrenal cortical tissue with no medulla present. CONCLUSION: Based on the clinical implications of those adrenal rests it is mandatory the removal of this ectopic tissue whenever encountered during surgical interventions in the groin region in children.

Paratesticular leiomyosarcoma treated by enucleation

Spermatic cord leiomyosarcomas are rare tumors and standard treatment consists of radical orchiectomy and high cord ligation. We report a case of a paratesticular leiomyosarcoma successfully treated by enucleation. A 22-year-old man presented with a 6-months history of inguinal pain. Physical examination revealed a right paratesticular nodule about 0.5 cm in diameter. Inguinal exploration and nodule biopsy were performed. It was thought to be a benign epididymal nodule on a quick section and the tumor was enucleated and sent for paraffin section. Histology and immunohistochemistry were compatible with leiomyosarcoma. The patient was advised to undergo radical orchiectomy with high cord ligation. However, he refused surgery. An alternative approach with clinical, biochemical and radiological follow-up was adopted. The patient has been followed up for thirteen years and shows no evidence of disease.

Distension abdominal y edemas por quiste del cordon espermatico / Abdomina distention and edema due to spermatic cord cyst

La distensión abdominal es un síntoma común, siendo en general la presentación inicial de enfermedadessistémicas o desórdenes gastrointestinales. Otras causas son infrecuentes. Los quistesdel cordón espermático son poco frecuentes, pero aún más su ubicación intraabdominal, su tamaño habitual esinsuficiente para producir distensión. El paciente presentado en este caso es un varón con criptorquidia bilateraladmitido por distensión abdominal, interpretada inicialmente como síndrome ascítico edematoso. La ecografíainterpretó la distensión como ascitis tabicada, y la tomografía computada como debida a un gran quiste. En laexploración quirúrgica se diagnosticó un quiste gigante del cordón espermático de ubicación abdominal.

Abdominal distention is a frequentsymptom, being often the initial presentation of systemic diseases or gastrointestinal disorders. Othercauses are uncommon. Spermatic cord cysts are infrequent, abdominal location is even rarer, and the size ofthe cysts is usually not enough to produce abdominal distention. In our case a man with bilateral cryptorchidismwas admitted with abdominal distention and edema of the lower extremities initially interpreted as asciticedematoussyndrome. Ultrasonography interpreted abdominal distention as septate ascites, computed tomographyas a giant cyst. Exploratory surgery showed a giant spermatic cord cyst in the left spermatic cord.

Effects of the polypropylene mesh implanted through inguinotomy in the spermatic funiculus, epididium and testis of dogs

OBJETIVO: Investigar os efeitos da tela de polipropileno implantada por inguinotomia no funículo espermático, epidídimo e testículo de cães. MÉTODOS: Foram utilizados 18 cães (12-23 Kg) distribuídos em três grupos: Grupo A (n=7): lado esquerdo (com tela) e lado direito (sem tela); Grupo B (n=7): lado esquerdo (sem tela) e lado direito (com tela) e Grupo C (n=4): sem manipulação cirúrgica (Grupo controle). Após 60 dias, os animais foram submetidos a remoção bilateral do funículo espermático, do epidídimo e testículos e encaminhados para estudo histológico. Durante a re-operação foi realizada avaliação macroscópica. RESULTADOS: No lado com tela observou-se 100% de aderência à parede posterior do canal inguinal, assim como no funículo espermático. Observou-se congestão do plexo pampiniforme em três animais. Verificou-se reação inflamatória crônica e de corpo estranho em 100% dos funículos espermáticos. Do lado que não recebeu a tela observou-se reação inflamatória crônica em 71% dos animais. Todos os animais apresentaram reação inflamatória crônica no ducto deferente do lado com tela e em 11 animais no lado sem tela. Essas alterações não foram encontradas no Grupo C. Ocorreu uma redução estatisticamente significante na diferença de diâmetro do lúmen do ducto deferente no lado com tela. No epidídimo e testículo, as alterações macro e microscópicas não foram significantes, porém um animal apresentou redução acentuada da espermatogênese no lado com tela. CONCLUSÃO: A tela de polipropileno em contato com o funículo espermático de cães causa reação inflamatória crônica intensa e redução significante do diâmetro do lúmen do ducto deferente.

Leiomiosarcoma en cordón espermático: a propósito de un caso / Spermatic cord leiomyosarcoma: a case report

Presentar las manifestaciones clínicas, elementos diagnósticos y tratamiento de un paciente con leiomiosarcoma en el cordón espermático. Estudio descriptivo de caso clínico y revisión de literatura, de paciente de 44 años de edad, quien inicia enfermedad en mayo de 2004, cuando por chequeo médico se encuentra tumor localizado en el cordón espermático derecho (CED). Se practica ultrasonido que concluye tumor sólido de 1 x 2 cms en CED. Previa ligadura del CED, se realiza exéresis del mismo, con reporte anatomopatológico extemporáneo de tumor maligno, por lo cual se procede a realizar orquidectomía radical derecha. La muestra se envía a estudio inmunohistoquímico que reporta leiomiosarcoma del CED. Se refiere al paciente para tratamiento adyuvante. La escasez de casos reportados mundialmente de esta patología, resalta la importancia del estudio minucioso de estos casos y emplaza a unificar criterios para el tratamiento adyuvante y mejorar la sobrevida de estos pacientes

Pancreatic carcinoma: report of two cases presenting with unusual metastases.

We report two patients with adenocarcinoma of the body and tail of the pancreas who presented with features localized to the metastatic sites. A 67-year-old gentleman presented with right groin mass due to spermatic cord metastasis and later developed duodenal obstruction; the other gentleman was 69 years old and presented with change of bowel habit as a result of pelvic/pararectal metastasis.