Cystic lymphangioma of the inguinal and scrotal regions in childhood - report of three cases.

BACKGROUND: [corrected] Cystic lymphangiomas are congenital lymphatic malformations that most commonly develop in the neck, axilla, mediastinum and retroperitoneum. Inguinal and scrotal lymphangiomas are extremely rare. CASES REPORT: We present the cases of three children with cystic lymphangiomas that were treated in our department during a two year period. The patients were all boys, aged 3.5, 9 and 13 years, and the location of the cystic lymphangioma was the scrotum, the inguinal region and the epididymis respectively. Clinical examination and ultrasonography described the lesions as cystic. Surgical excision of the lesions with a testis-sparing approach was performed in all three cases and histopathology set the diagnosis of cystic lymphangiomas. Complementary imaging of the regions adjacent to the excised lesions, excluded any extension or co-existing lesions. Post-operative period was uneventful and during a follow-up period of six months all patients were well with no signs of recurrence. CONCLUSIONS: Scrotal and inguinal cystic lymphangiomas are treated with surgical excision with care to preserve the intra-scrotal structures and the structures of the inguinal canal. Complete excision is necessary to prevent recurrence. Complementary imaging of the adjacent regions is necessary to identify any possible extension or co-existing lesions.

Paratubal cysts in young females as an incidental finding in laparotomies performed for right lower quadrant abdominal pain.

Paratubal cysts represent remnants of the paramesonephric or mesonephric duct, the former being more common. Most of them are asymptomatic, but they may rarely give rise to clinical problems due to enlargement or torsion. In this study, we looked for paratubal cysts or other pathological lesions of the right uterine adnexa in young females operated upon for right lower quadrant (RLQ) abdominal pain. Our material consisted of 338 white female patients aged 4-14 years. Laparotomy revealed only acute appendicitis in 283 cases, while 44 had acute appendicitis plus a coincidental paratubal cyst. Most of these cysts were smaller than 1 cm in diameter. However, 2 additional cases had torsion of a large paratubal cyst, while 5 had a ruptured corpus luteum. We suggest that a thorough search of the right adnexa for the presence of paratubal cysts during laparotomies performed for RLQ pain is a useful procedure. This approach also allows detection of other pathological lesions of the right adnexa that often produce symptoms similar to acute appendicitis.

Gross morphologic variations and histologic changes in cryptorchid testes

Cryptorchid testes are frequently accompanied by gross morphologic changes with regard to the size and shape of the testis, various degrees of detachment between the epididymis and testis, elongation of the caudal epididymis and vas deferens, as well as histologic changes. This study examined the gross and microscopic testicular, epididymal, and vas changes in relation to various parameters in 824 patients operated upon in our clinic during the last decade. The major findings were the following: (1) most patients (78.8%) were older than 4 years, and many older than 8 years (39.8%); (2) the frequency of abdominal undescended testes decreased with increasing age (P <0.1), while the frequency of suprascrotal testes increased with increasing age (P <0.001); (3) most of the undescended testes in a suprascrotal position were normal or had mild atrophy (78.7%), while those in intracanalicular, internal ring, and abdominal positions frequently presented moderate or severe atrophy (71,38%; (P <0.0001); and (4) most suprascrotal testes were either normal or had mild extension and looping of the epididymis (63.8%), while most of the intracanalicular, internal ring, and abdominal testes showed moderate or profound epididymal anomalies (63.4%; P <0.0001). We conclude that even though the necessity for early surgical correction of cryptorchidism is well established, these patients at least in our region, still tend to come very late to surgery, with consequent increased risks of infertility and malignant transformation.

Gross morphologic variations and histologic changes in cryptorchid testes.

Cryptorchid testes are frequently accompanied by gross morphologic changes with regard to the size and shape of the testis, various degrees of detachment between the epididymis and testis, elongation of the caudal epididymis and vas deferens, as well as histologic changes. This study examined the gross and microscopic testicular, epididymal, and vas changes in relation to various parameters in 824 patients operated upon in our clinic during the last decade. The major findings were the following: (1) most patients (78.8%) were older than 4 years, and many older than 8 years (39.8%); (2) the frequency of abdominal undescended testes decreased with increasing age (P <0.1), while the frequency of suprascrotal testes increased with increasing age (P <0.001); (3) most of the undescended testes in a suprascrotal position were normal or had mild atrophy (78.7%), while those in intracanalicular, internal ring, and abdominal positions frequently presented moderate or severe atrophy (71,38%; (P <0.0001); and (4) most suprascrotal testes were either normal or had mild extension and looping of the epididymis (63.8%), while most of the intracanalicular, internal ring, and abdominal testes showed moderate or profound epididymal anomalies (63.4%; P <0.0001). We conclude that even though the necessity for early surgical correction of cryptorchidism is well established, these patients at least in our region, still tend to come very late to surgery, with consequent increased risks of infertility and malignant transformation.

Neonatal inguinoscrotal hematocele.

Neonatal inguinoscrotal lesion, or hematocele of neonates, is attributed to trauma from the plastic clamp used to ligate the umbilical cord immediately after delivery. The pathogenesis is thought to be related to two factors: incorrect clamping technique, in which the clamp is eccentric or too distal, and the infant's position, lying over the clamp. This is a rare event that usually appears on the 2nd day of life, with very few reports recorded in the literature. The lesion does not have any complications, but may be easily confused with testicular torsion. We present two cases and review the literature.