Florid mesothelial hyperplasia of the tunica vaginalis mimicking malignant mesothelioma: a clinicopathologic study of 12 cases.

The tunica vaginalis is an embryologically derived mesothelium-lined outpouching of the peritoneal cavity, which may develop neoplastic mesothelial proliferations similar to, although much less commonly than, pleural or peritoneal surfaces. We herein report our experience with 12 cases of florid paratesticular mesothelial hyperplasia, highlighting the spectrum of morphologic changes seen and the utility of fluorescence in situ hybridization analysis of homozygous deletion of 9p21 as an adjunct diagnostic tool. All cases were referred because of concern regarding the nature of the mesothelial proliferation. The median age of patients at presentation was 44.5 years (range, 16 to 71 y). Ten of 12 patients clinically presented with hydroceles (2 of which were complicated by infection or hemorrhage), 1 with "paraepididymal cyst" and 1 patient with an epididymal cyst. In contrast to the normal tunica consisting of a thin fibrous wall lined by a monolayer of flattened bland mesothelium and no significant inflammation, all of our cases were characterized by background changes of fibroblastic organization and stromal chronic inflammation. In all cases, the mesothelial proliferation within the fibrous and inflamed stroma was sparse and consisted of linear arrays of widely spaced horizontally orientated simple nonbranching elongated tubules and small solid nests and cords that were well spaced apart. There was an abrupt linear demarcation of tubules at the deep aspect of the fibrous tissue, with no evidence of definite invasion into the submesothelial tissue. Fluorescence in situ hybridization for 9p21 was negative in all 5 cases in which tissue was available for analysis. Nine patients with extended follow-up were alive (median 8 y; range, 1 to 13 y). In summary, the proliferative changes seen in reactive mesothelial hyperplasia associated with hydroceles may be florid and mimic malignant mesothelioma. In particular, the entrapment of isolated mesothelial clusters within deep fibrous tissue may be the cause of significant diagnostic difficulty. There are, however, morphologic clues such as linear arraying of widely spaced architecturally simple cell clusters that may aid in the correct identification of the benignity of these proliferations.

Hematocele secondary to rupture of an abdominoscrotal hydrocele.

OBJECTIVE: To describe one case of hematocele secondary to rupture of an abdominoscrotal hydrocele in an adult patient. METHODS AND RESULTS: We report a huge hematocele in a patient with this unusual type of hydrocele that suffered a minimal scrotal trauma. It was a hydrocele that extended through the inguinal canal to the retroperitoneal space. CONCLUSIONS: Abdominoscrotal hydrocele is a rare condition in children and even rarer in adults. The presence of a hematocele requires early surgical treatment.

Adenocarcinoma of the rete testis with uncommon presentation as haematocele.

Adenocarcinoma of the rete testis was encountered in a 62-year-old man. The tumour was localised in the region of the testicular hilum as a greyish-white nodule that showed no involvement of the adjacent testicular parenchyma or the epididymis. On microscopical examination, there was a well-differentiated adenocarcinoma separated by fibrovascular stroma, entirely confined to the testicular hilum. This primary carcinoma of the rete testis presented as a haematocele.

[Attempted classification of scrotal contusions]. / Essai de classification des contusions scrotales.

We present a review of the literature and results of a survey involving 50 closed scrotal traumas. Based on this analysis, we propose an anatomoclinical classification of scrotal contusions based on what we consider to be the most appropriate therapeutic management.

[A case of chronic scrotal hematocele].

We report a case of chronic scrotal hematocele. A 94-year-old man complained of urine retention and a painless mass in the right scrotum. He had no history of trauma at the perinium. Tumor markers such as human chorionic gonadotropin, alpha fetoprotein and carcinoembryonic antigen were within normal limits. A transillumination test was negative. A right high orchiectomy was carried out after admission with the diagnosis of suspicion testicular cancer. The extracted mass measured 85 x 60 x 75 mm and contained old brownish black blood. The right testis was located separately from the mass and had a normal appearance. Microscopic examination revealed depositions of cholesterin crystals characteristic of chronic hematocele.

[A case of chronic scrotal hematocele].

A 60-year-old man visited our hospital because of a painless swelling of the left scrotal content which enlarged gradually for these five years. He had no history of trauma at the perineum. Tumor markers such as HCG, AFP and CEA were within normal limits. Left high orchiectomy was carried out after the admission under the diagnosis of suspicious testicular cancer. The resected mass, 16.5 x 12.5 x 9.5 cm in diameter and 900 g in weight, was encapsulated within the tunica vaginalis by a fibrous membrane and contained about 300 ml of reddish black liquid. The normally-appearing left testis was located separately from the mass. Microscopic examination revealed depositions of cholesterine crista in the wall, which are characteristic for a chronic hematocele.

Fibrous pseudotumor of the tunica vaginalis testis: imaging appearance.

Fibrous pseudotumor is a benign paratesticular tumor that typically presents as a painless mass of the hemiscrotum. Because this tumor can mimic a malignant process, it is usually not diagnosed preoperatively. We describe a case of fibrous pseudotumor of the tunica vaginalis, demonstrating the ultrasound and magnetic resonance image (MRI) appearance with pathologic correlation.

Platelet-derived growth factor inhibits bone regeneration induced by osteogenin, a bone morphogenetic protein, in rat craniotomy defects.

Platelet-derived growth factor (PDGF) is a potent moderator of soft tissue repair through induction of the inflammatory phase of repair and subsequent enhanced collagen deposition. We examined the effect of recombinant BB homodimer PDGF (rPDGF-BB) applied to rat craniotomy defects, treated with and without bovine osteogenin (OG), to see if bone regeneration would be stimulated. Implants containing 0, 20, 60, or 200 micrograms rPDGF-BB, reconstituted with insoluble rat collagenous bone matrix containing 0, 30, or 150 micrograms OG, were placed into 8-mm craniotomies. After 11 d, 21 of the 144 rats presented subcutaneous masses superior to the defect sites. The masses, comprised of serosanguinous fluid encapsulated by fibrous connective tissue, were larger and occurred more frequently in rats treated with 200 micrograms rPDGF-BB, and were absent in rats not treated with rPDGF-BB. The masses underwent resorption within 28 d after surgery. OG (2-256 micrograms) caused a dose-dependent increase in radiopacity and a marked regeneration of calcified tissue in a dose-dependent fashion within defect sites. However, OG-induced bone regeneration was inhibited 17-53% in the presence of rPDGF-BB. These results suggest that rPDGF-BB inhibited OG-induced bone regeneration and stimulated a soft tissue repair wound phenotype and response.

[A case of chronic scrotal hematocele and review of the literature].

A 38-year-old man visited our hospital because of swelling of left scrotal content. He had no history of trauma of scrotum, fever, pain or dysuria. Physical examination revealed a tumor larger than a fist in the left scrotum. Ultrasonography revealed an echogenic mass with echolucent area in the scrotum. Surgical extirpation of the left scrotal tumor was performed under the diagnosis of left testicular tumor. The mass was encapsulated by a white fibrous membrane and was 700 g in weight. The tumor contained 200 ml of dark brown pus-like material. Histological examination revealed deposition of cholesterine crista and infiltration of lymphocyte in tunica vaginalis with extremely atrophic testis, destructive spermatogenesis and atrophic epididymis. Twenty one cases of chronic scrotal hematocele have been reported in the Japanese literature. The age of the patients reported was 38 to 77 years old with a mean age of 65 years. Orchiectomy was done under the diagnosis of testicular tumor in 20 of the 21 cases. Our case was thought to be of an idiopathic chronic scrotal hematocele. The disease should be considered even in the absence of a particular cause such as injury and inflammation of scrotal content.

Chronic hematocele complicating renal failure and hemodialysis.

A patient with a recent history of genitourinary tuberculosis, chronic renal failure and hemodialysis presented with a slow growing scrotal swelling that had enlarged during the last 3 years. Physical examination and sonography were suspicious for testicular tumor, and surgical exploration and inguinal orchiectomy were performed. Ultimately the mass proved to be a chronic hematocele, a rare complication of uremic coagulopathy and hemodialysis. Because hematocele may clinically and sonographically resemble a testicular tumor, the proper management of a complex multiseptated scrotal mass without obvious history suggestive of hematocele is surgical exploration and orchiectomy. Awareness of this common presentation may obviate orchiectomy.

[A case of idiopathic chronic scrotal hematocele].

A case of chronic scrotal hematocele is reported. A 63-year-old male first noticed the painless swelling of his left scrotal contents about 30 years before he visited our clinic on September 16, 1987. Examination revealed a hard mass, 10 x 8 cm in diameter, in the left scrotum. The scrotum did not transmit light. Since it was impossible to exclude testicular tumor completely, we performed left high orchiectomy. The extracted mass contained old brownish black clotted blood and a normal testis. Histopathological examination revealed that the hematocele showed a dense, fibrous wall with hyalinization. Six cases of chronic scrotal hematocele including our case have been reported in the Japanese literature.

Aspiration cytology of palpable lesions of the scrotal content.

To date, we have studied 89 palpable lesions of the scrotum, testicle, and epididymis using fine-needle aspiration cytology (FNAC). Cystic lesions (48.3%) and inflammatory pathology (25.8%) were the most frequent findings. Tumors accounted for 11.2% of results, with a slight predominance of the malignant varieties. In this article, we describe the cytopathology of the main entities and discuss the principal problems of differential diagnosis, especially among inflammatory processes, seminomas, and embryonal carcinomas. The cytopathological pattern of the neoplasias is highly characteristic, and this permits their diagnosis with great precision. FNAC is essentially nontraumatic and easy to carry out, but it requires considerable practice in its execution and in the interpretation of the aspirates. We believe FNAC to be the technique of choice for the study of the pathology of the scrotal content, and we think that it should be employed on the patient's very first visit. The main advantage of FNAC is avoiding delays in diagnosis.

Quiste hemático de la orbita / The hematic cyst of the orbit

El quiste hemático es relativamente infrecuente. Su origen no es claro, pero ha sido descrito en asociación con trauma directo de órbita, hemorragia espontánea, discrasia sanguínea, linfangioma y hemorragioma cavernoso. Puede presentarse en cualquier grupo etáreo. Se reporta un caso de quiste hemático de órbita izquierda, sin antecedente traumático que clínicamente se diagnosticó como mucocele frontal izquierdo, describiéndose su tratamiento quirúrgico y el material histopatológico que concluye al diagnóstico definitivo

The pathological, ultrasonographic and computerized tomographic characteristics of chronic hematocele.

We report a case of a chronic hematocele and describe its characteristics. The specific pathological lesion of a chronic hematocele consists of several neovascular formations covered by layers of fibrin. These lesions give characteristic ultrasonic and computerized tomographic images, consisting of several sharply circumscribed small spherical areas of soft tissue. When correctly interpreted before the initiation of surgical treatment, these images will obviate an orchiectomy, which is not always necessary.

High-resolution ultrasonography of scrotal pathology.

A prototype high-resolution (10-MHz) real-time ultrasonic system was used to study 22 patients who were ultimately proved to have intra- and extratesticular tumors, scrotal fluid collections, and inflammatory processes. In 5 of 6 patients with primary testicular masses, there were areas of decreased echogenicity within the testis when compared with surrounding normal tissue. In general, the method was highly effective in differentiating and characterizing testicular and extratesticular processes.