External validation of nomogram to predict inguinal lymph node metastasis in patients with penile cancer and clinically negative lymph nodes

ABSTRACT Introduction Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. Materials and methods We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-one-out, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. Results We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. Conclusions In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.

Inguinal ulcerated sebaceous carcinoma: an unusual presentation / Carcinoma sebaceo inguinal ulcerado: apresentacao incomum

Sebaceous carcinoma is a rare and aggressive skin tumor. It can be located in any area of the body, the most commonly involved area being the periorbital region. It does not entail a typical clinical presentation, which explains the often late diagnosis. The aim of this report is to outline the rarity of the disease and its atypical clinical description, since to this day, inguinal ulcers with clinical manifestation have not been reported. We present and discuss a case of sebaceous carcinoma with an unusual clinical presentation, in an elderly male patient. The precise approach to genital ulcers, as shown in this case, is a diagnostic challenge that requires a great deal of effort on the part of the clinician.

O carcinoma sebáceo é um tumor cutâneo raro e agressivo. Pode localizar-se em qualquer área do corpo sendo a região periorbital a mais comumente envolvida. Ele não tem uma apresentação clínica típica, o que explica o diagnóstico frequentemente tardio. O objetivo deste relato é apresentar a raridade da doença e uma descrição clínica atípica, uma vez que, até a presente data, não foi relatada úlcera inguinal como manifestação clínica. Apresentamos e discutimos um caso de carcinoma sebáceo, com uma apresentação clínica incomum em um paciente idoso do sexo masculino. A abordagem de úlceras genitais, como mostrado no presente caso, é um desafio diagnóstico que requer uma grande quantidade de esforço por parte do clínico.

Histología del anillo inguinal interno en pacientes con hernia inguinal indirecta: serie de casos observacional y descriptiva / Age associated changes in the histology of indirect inguinal hernia rings

Background: This study has the purpose to investigate the microscopic basic histological structure of the internal inguinal ring in patients operated on for primary indirect inguinal hernia. Patients and Methods: A sample of 72 consecutive male patients older than 15 years-of-age with unilateral inguinal hernia submitted to elective surgery was studied. The primary outcome measure was the histological findings of the internal inguinal ring. All samples were processed only by histochemical techniques. Patients were divided in 3 groups according to age. Group I: patients between 15 and 40 years-of-age. Group II: patients between 41 and 70 years-of-age. Group III: patients older than 71 years. Results: All samples from the internal inguinal ring were constituted by fibrous fascial tissue with elastic fibers which were thicker in younger patients and thinner in older patients. Adipose tissue between elastic fibers was absent in younger patients and was abundant in older patients. Vascular sclerosis was minimal in Group I, moderate in Group II, and important in Group III. Acute or chronic inflammatory cells were absent in all patients. Conclusions: The histological characteristics of the internal inguinal ring in patients with indirect inguinal hernia consist on reduced density and thickness of elastic fibers and increased adipose tissue between elastic fibers. Vascular sclerosis was more severe as the age of the patients increased. These histological changes were related to normal aging.

Introducción: El presente estudio tiene como objetivo investigar la estructura histológica básica del anillo inguinal interno en pacientes operados por hernia inguinal indirecta primaria. Pacientes y Métodos: Se estudió una muestra de 72 pacientes consecutivos mayores de 15 años de edad con hernia inguinal indirecta unilateral sometidos a cirugía electiva. El objetivo principal fue la histología básica del anillo inguinal interno. Las muestras fueron procesadas con técnicas histoquímicas. Los pacientes se dividieron en 3 grupos de acuerdo a la edad. Grupo I: pacientes entre 15 y 40 años de edad. Grupo II: pacientes entre 41 y 70 años. Grupo III: pacientes mayores de 71 años de edad. Resultados: Todas las muestras histológicas del anillo inguinal estuvieron constituidas por tejido fascial fibroso con fibras elásticas gruesas en pacientes jóvenes y delgadas en pacientes mayores. La esclerosis vascular fue mínima en el grupo I, moderada en el grupo II e importante en el grupo III. No se encontraron células inflamatorias agudas o crónicas. Conclusiones: Las características histológicas básicas del anillo inguinal interno consisten en fibras elásticas que disminuyen su densidad y se adelgazan con la edad y en un aumento simultáneo del tejido adiposo entre estas fibras. La esclerosis vascular se presenta y es más severa en la medida que la edad de los pacientes aumenta. Estos cambios histológicos se relacionan al envejecimiento normal.

Epithelioid malignant mesothelioma of tunica vaginalis with deciduoid features: An unusual malignancy clinically masquerading an inguinal hernia.

Paratesticular/scrotal and inguinal canal mass lesions in elderly patients may pose a diagnostic challenge to both the surgeon as well as the pathologist. In most cases, these represent hernial sacs with their contents, and true neoplasms like lipomas, rhabdomyosarcomas, and fibrous pseudotumors are infrequent. Malignant mesotheliomas arising from the tunica layers are rare cause of inguinal and paratesticular tumors. Herein, we report a case of an elderly patient who presented with an inguinal hernia which pathologically had features of deciduoid malignant mesothelioma.

Morfometria dos canais e anéis inguinais de fetos natimortos e cadáveres adultos humanos e sua relação com as hérnias inguinais / Morphometric analysis of inguinal canals and rings of human fetus and adult corpses and its relation with inguinal hernias

OBJETIVO: Avaliar as diferenças anatômicas na região inguinal de fetos e adultos do gênero masculino, assim como a existência de uma possível base morfológica para a maior incidência de hérnias inguinais à direita em crianças e adultos. MÉTODOS: Foram dissecados 20 fetos natimortos e 20 cadáveres humanos adultos in natura, todos do gênero masculino, comparando-se o comprimento do canal inguinal, o maior diâmetro dos anéis inguinais superficial e profundo em ambos os lados de cada cadáver e a existência ou não de superposição entre os anéis superficial e profundo. RESULTADOS: Não foram observadas, nos dois grupos, diferenças significativas na comparação das medidas dos anéis profundos e superficiais, assim como dos canais inguinais, com seus respectivos contralaterais em cada espécime. Entretanto, houve diferença significativa entre os diâmetros dos anéis inguinais homolaterais, sendo o anel superficial maior do que o profundo nos fetos (p = 0,0002) e nos cadáveres adultos (p < 0,0001). A razão canal inguinal/altura mostrou diferença significativa entre os grupos (p<0,0001), evidenciando que o canal inguinal em fetos é relativamente mais curto que em adultos. Foi observada, também, superposição dos anéis inguinais superficial e profundo ipsilaterais em dois fetos, porém não houve em nenhum dos adultos. CONCLUSÃO: A morfometria dos canais e anéis inguinais não justifica a maior incidência de hérnia do lado direito no gênero masculino.

OBJECTIVE: To evaluate the anatomical differences of fetus and adults concerning the inguinal region of male gender, as well as the presence of possible morphological basis for the higher incidence of inguinal hernias in the right side in both groups. METHODS: Twenty human stillborn fetuses and twenty in natura adult male corpses were dissected in order to compare the length of the inguinal canals, the longer diameter of the deep and superficial inguinal rings in both sides of each corpse, and the presence or not of overlap between the deep and superficial rings. RESULTS: No statistically significant differences were observed in both groups regarding the measures of the deep and the superficial rings, as well as the inguinal canals, when in comparison to the respective contralateral anatomical structures of each specimen. Nevertheless, there was a statistically significant difference between the diameter of homolateral inguinal rings, once the superficial ring was longer than the deep ring in fetus (p=0.0002) and adult corpses (p<0.0001). The ratio inguinal canal/height showed to be statistically different between both groups (p<0.0001), since the inguinal canal in fetus is shorter than in adults. It was also observed overlapping of homolateral superficial and deeper inguinal rings in two fetuses, but none in adults. CONCLUSION: Morphometric analysis of the inguinal canals and rings does not justify the higher incidence of hernias in the right side in the male gender.

Hydrocele of the canal of Nuck.

Hydrocele of the canal of Nuck is an uncomon and infrequently reported finding in women. A 24-year-old female presented with a painless left groin swelling which was soft, cystic, non-tender with 7.5 cm x 5 cm in measurement. It was more prominent in standing. Ultrasonography revealed an encysted echofree lesion in the left inguinal canal. On surgery, a cyst was found containing clear fluid in the inguinal canal which was dissected out and wound was closed in layers. The patient is doing well till date. Here one such case with diagnosis of hydrocele of the canal of Nuck is reported.

Enxerto autólogo de peritônio-fáscia-músculo, no canal inguinal de ratos / Peritoneal-fascia-muscle autologous graft in the inguinal canal of rats

OBJETIVO: Estudar um fragmento de tecido autólogo, constituído por peritônio-fáscia-músculo, implantado no nível da parede do canal inguinal e no funículo espermático de ratos a fim de verificar o comportamento histológico da pega e da integração tecidual. MÉTODOS: Trinta e seis ratos foram distribuídos em quatro grupos. Os ratos do grupo A, B, C e D foram submetidos a laparotomia mediana para obtenção dos espécimes a serem implantados. No grupo A, foi implantado tecido composto por peritônio e fáscia transversal na parede do canal inguinal. No B, o tecido implantado era acrescido de parte do músculo reto do abdome e implantado na parede do canal inguinal. No C, o tecido enxertado era semelhante ao do grupo A, agora enxertado no funículo espermático. No D, o tecido enxertado era semelhante ao grupo B, agora enxertado no funículo espermático. RESULTADOS: Após 21 dias de implante estes tecidos apresentavam histologicamente as seguintes alterações: os grupos A e C, tecido fibroadiposo com vasos dilatados, focos de fibrose e infiltrado linfoplasmocitário e os grupos B e D, tecido fibroadiposo com vasos dilatados, musculatura esquelética e focos de fibrose. A fibrose mostrou-se mais intensa nos grupos B e D. No grupo B, sempre encontramos o músculo esquelético, enquanto no grupo D este tecido estava presente em seis animais, quase que totalmente substituído por tecido fibroso em dois e ausente em um. CONCLUSAO: Todos os tecidos implantados sobreviveram e incorporaram-se no local, podendo ser útil na correção de defeitos do canal inguinal, nas situações em que o tecido autólogo estiver indicado.

Right inguinal region lipoma, case report

Lipomas are seen commonly in the surgical out patients. Inguinal region lipoma is a rare occurrence. A fifty years old man presented with pain in the inguinal region for two years and a mass in the inguinal region for three months. An ultra sound and CT scan confirmed a right pelvic mass extending into the inguinal region along the course of the psoas muscle. FNAC confirmed the diagnosis as a lipoma. Excision was successfully done. Histopathology confirms the diagnosis of lipoma

Age related changes in the elastic fiber system of the interfoveolar ligament

In order to evaluate age related changes of the elastic fiber system in the interfoveolar ligament, we studied the deep inguinal ring from 33 male cadavers aged from stillborn to 76 years. Selective and alternated staining methods for elastic fibers were performed to differentiate oxytalan, elaunin, and mature elastic fibers. We confirmed quantitative changes of the elastic fiber system with aging. There was a significant and progressive reduction of the oxytalan fibers (responsible for tissue resistance) and a significant increment in the mature elastic and elaunin fibers (responsible for tissue elasticity). Furthermore, there were structural changes in the thickness, shortness and curling of these mature elastic fibers. These changes induced loss of the elastic fiber function and loss of the interfoveolar ligament compliance. These factors predispose individuals to the development of indirect inguinal hernias that frequently emerge in adults and aged individuals, especially above the fifth decade

Condylome geant de buschke-loewenstein de la region perianale avec envahissement inguinal: a propos d'un cas

The giant condyloma acuminatum of the perianal region is a tumor characterised by its large size with the propensity to infiltratte into deeper tissues, contrasting with a microscopically benign pattern. The evolution after malignant transformation of condyloma and lymph node invasion is rare. However it is exceptionaly observed a lymph node invasion of microscopically benign condyloma acuminatum. The authors report a case of microscopically benign giant condyloma acuminatum of the perianal region associated with inguinal invasion, discovered in a 47 year-old man. Treatment consists in extensive surgery of the tumor and inguinal nodes, followed by a radiation therapy