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Gabriel H, Hammond NA, Marquez RA, Lopes Vendrami C, Horowitz JM, Casalino DD, Nikolaidis P, Miller FH, Bhatt S. Gamut of Extratesticular Scrotal Masses: Anatomic Approach to Sonographic Differential Diagnosis. Radiographics 2023; 43:e220113. [PMID: 36893051 DOI: 10.1148/rg.220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
The commonly taught tenet that intratesticular lesions are always malignant and extratesticular scrotal lesions are always benign is a simplistic statement that erroneously minimizes the significance of extratesticular scrotal masses and their diagnosis. Yet, disease in the extratesticular space is commonly encountered by clinicians and radiologists and is often a source of uncertainty in diagnosis and management. Given the embryologically rooted complex anatomy of this region, a wide range of pathologic conditions is possible. Radiologists may not be familiar with some of these conditions; further, many of these lesions can have a specific sonographic appearance, allowing accurate diagnosis that can minimize surgical intervention. Lastly, malignancies can occur in the extratesticular space-although this is less common than in the testicles-and proper recognition of findings that warrant additional imaging or surgery is critical in optimizing outcomes. The authors present a compartmental anatomic framework for differential diagnosis of extratesticular scrotal masses and provide a comprehensive illustrative display of many of the pathologic conditions that can be encountered to familiarize radiologists with the sonographic appearances of these lesions. They also review management of these lesions and scenarios where US may not be definitive in diagnosis and selective use of scrotal MRI can be helpful. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Helena Gabriel
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Nancy A Hammond
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Rocio A Marquez
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - David D Casalino
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Paul Nikolaidis
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Frank H Miller
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Shweta Bhatt
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
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Ebrahimtabar F, Shafi H, Ranaee M, Darzi MM. A rare case of primary malignant fibrous histiocytoma: a sarcoma of the kidney. BMC Urol 2019; 19:45. [PMID: 31164132 PMCID: PMC6549271 DOI: 10.1186/s12894-019-0471-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/03/2019] [Indexed: 11/14/2022] Open
Abstract
Background Primary malignant fibrous histiocytoma of the kidney (MFH) is an extremely rare tumor which is indistinguishable from its’ mimics in particular renal cell carcinoma (RCC) by clinical features and preoperative imaging evaluation. Due to its high predilection to local recurrence and distant metastases, early diagnosis has great value. Case presentation Herein, we describe a 62 year-old man with a 3-month history of abdominal discomfort and a palpable right loin mass whom computerized tomography (CT) showed a large heterogeneous solid mass in the right kidney. With the suspicious to RCC; the patient underwent radical nephrectomy. However, histopathological report revealed pleomorphic-storiform malignant fibrous histiocytoma. Immunohistochemistry study was also confirmed the diagnosis of MFH. Six month follow up showed no evidence of any recurrence. Conclusions The therapeutic options for MFH differ from other renal tumors, hence histopathology and immunohistochemistry studies are required to establish a definite diagnosis of the disease. Despite of progress made in clinical studies and advances in diagnostic modalities, early diagnosis of MFH has not achieved yet. Further studies and accumulated experience with renal MFH are required to determine the approach to prolong survival in selected cases along with management and prognostic factors of such tumors.
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Affiliation(s)
| | - Hamid Shafi
- Department of Urology, Faculty of Medicine, Babol University of Medical Sciences, School of Medicine, Babol, Iran.
| | - Mohammad Ranaee
- Department of Pathology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Mehdi Darzi
- Department of Urology, Faculty of Medicine, Babol University of Medical Sciences, School of Medicine, Babol, Iran
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Abad-Licham M, Carbajal-Vásquez D, Coral-González P, Cusma-Quintana T, Silva-Capuñay E, Astigueta-Pérez J. Sarcoma indiferenciado pleomórfico primario renal: reporte de caso y revisión de la literatura. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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4
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Wolfman DJ, Marko J, Gould CF, Sesterhenn IA, Lattin GE. Mesenchymal Extratesticular Tumors and Tumorlike Conditions: From the Radiologic Pathology Archives. Radiographics 2015; 35:1943-54. [PMID: 26517315 DOI: 10.1148/rg.2015150179] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Both benign and malignant tumors and tumorlike conditions can arise from the nonepididymal extratesticular tissues. Benign tumors are far more common than malignant tumors, with lipoma being the most common lesion found at this site. Several imaging features can help narrow the differential diagnosis of these lesions, including the presence of fat and imaging features suggestive of fibrous tissue. Lesions that contain fat represent lipoma, liposarcoma, or angiomyofibroblastoma (AMF)-like tumor. If enhancing soft tissue is present in conjunction with fat, the differential diagnosis narrows further to just liposarcoma and AMF-like tumor. Lesions that display magnetic resonance imaging characteristics compatible with fibrous tissue are likely to be fibrous pseudotumor. However, many of the lesions in this location have overlapping imaging findings, and surgical excision is most often necessary for accurate diagnosis. The ability to narrow the differential diagnosis with imaging, however, is helpful for the clinician for both treatment planning and patient counseling.
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Affiliation(s)
- Darcy J Wolfman
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (D.J.W., G.E.L.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (D.J.W., J.M., C.F.G.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (D.J.W., J.M., G.E.L.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Jamie Marko
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (D.J.W., G.E.L.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (D.J.W., J.M., C.F.G.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (D.J.W., J.M., G.E.L.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - C Frank Gould
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (D.J.W., G.E.L.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (D.J.W., J.M., C.F.G.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (D.J.W., J.M., G.E.L.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Isabell A Sesterhenn
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (D.J.W., G.E.L.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (D.J.W., J.M., C.F.G.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (D.J.W., J.M., G.E.L.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Grant E Lattin
- From the American Institute for Radiologic Pathology, 1010 Wayne Ave, Suite 320, Silver Spring, MD 20910 (D.J.W., G.E.L.); Department of Radiology, Walter Reed National Military Medical Center, Bethesda, Md (D.J.W., J.M., C.F.G.); Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, Md (D.J.W., J.M., G.E.L.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
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5
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Sarcoma pleomórfico indiferenciado renal primario: reporte de caso y revisión de la literatura. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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6
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Xu LW, Yu YL, Li GH. Malignant fibrous histiocytoma of the spermatic cord: case report and literature review. J Int Med Res 2012; 40:816-23. [PMID: 22613448 DOI: 10.1177/147323001204000249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This case study reports on a rare case of malignant fibrous histiocytoma arising in the right spermatic cord. An 80-year old male presented with a 2-week history of a right inguinal mass, with mild pain in the same region. Ultrasonography and computed tomography showed a mass arising from the right spermatic cord. A right radical orchiectomy was performed with wide dissection of the mass; the right testicle and epididymis were found not to be grossly involved. The patient had an uneventful postoperative course and recovered well. The patient and his family refused further adjuvant radiotherapy. There was no evidence of recurrence or metastasis during 20 months of regular follow-up. The diagnosis, histological classification, treatment and prognosis of this case are presented, together with a review of the literature.
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Affiliation(s)
- L W Xu
- Department of Urology, Affiliated Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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7
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Karki B, Xu YK, Wu YK, Zhang WW. Primary malignant fibrous histiocytoma of the abdominal cavity: CT findings and pathological correlation. World J Radiol 2012; 4:151-8. [PMID: 22590669 PMCID: PMC3351683 DOI: 10.4329/wjr.v4.i4.151] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2011] [Revised: 02/27/2012] [Accepted: 03/05/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To study computed tomography (CT) features of abdominal malignant fibrous histiocytoma (MFH) in various rare locations.
METHODS: We retroprospectively identified cases of MFH involving the abdominal cavity. Particular attention was paid to details regarding imaging features and histological types.
RESULTS: The study population consisted of seven men and one woman, with a mean age of 52.5 years. Seven patients had some physical symptoms, while one was incidentally detected. The sites of origin were liver (n = 3), greater omentum (n = 1), superior mesentery (n = 1), ileum (n = 1), right psoas muscle (n = 1) and right kidney (n = 1). With the exception of the ileum lesion, all were of huge size. The contour of the lesions was more or less clear. Foci of necrosis were present in six lesions (n = 6). On plain CT scan, all lesions were hypo to iso dense. The lesion in the greater omentum was cystic. One lesion (n = 1) showed significant enhancement and the cystic lesion showed mild peripheral enhancement. An abundance of blood vessels surrounding the mass was seen in two lesions (n = 2) and both were of the inflammatory variety. Pathological examination revealed storiform-pleomorphic variety (n = 4), inflammatory variety (n = 3) and myxoid variety (n = 1). Two of the patients with inflammatory MFH had a clinical presentation of fever and one was afebrile, however, blood investigations in all three showed leukocytosis.
CONCLUSION: Primary MFHs of the abdominal viscera and gastrointestinal tract are generally huge soft tissue masses containing areas of low attenuation and mild to moderate contrast enhancement.
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Abstract
The diverse embryological origins of the contents of the scrotum create an environment that fosters a wide variety of unusual pathologies. Most scrotal pathologies are discovered by the patient and are initially evaluated by a thorough physical examination and scrotal ultrasonography. Scrotal lesions can be broadly grouped by the anatomical location in which they develop; the clinician must consider a wide differential diagnosis based on this location. Solid testicular masses are considered germ cell tumors until proven otherwise, but numerous other possible pathologies exist, including ectopic tissue, metastasis, and other neoplastic growths. Rete testis lesions are classified as developmental, benign or malignant. Cystic lesions of the epididymis are most commonly benign, but malignant neoplasms can also be present. The paratesticular region has the broadest differential diagnosis, as it contains numerous distinct structures and is a common location for ectopic tissue and metastatic disease; a narrower range of lesions develop in the scrotal wall because of its simpler anatomy. Treatment options range from conservative observation to wide surgical excision and should be considered carefully; the aim of therapy is to remove malignant or potentially malignant tissue while minimizing effects on fertility and function.
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9
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Martín Martín S, Müller Arteaga C, García Lagarto E, Sanz Ruiz A, Rivero Martínez MD, Fernández del Busto E. [Malignant fibrous histiocytoma of the spermatic cord. Presentation of one case and literature revision]. Actas Urol Esp 2008; 32:745-8. [PMID: 18788492 DOI: 10.1016/s0210-4806(08)73923-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of malignant fibrous histiocytoma (MFH) of the spermatic cord. An 80-years-old man was admitted to the hospital with a left scrotal mass, related to a genital traumatism several months ago. Under the suspicion of a testicular tumor, left radical orchiectomy was performed. Histological examination of the tumoral mass revealed a malignant fibrous histiocytoma. The tumor was firmly adhered to the spermatic cord. MFH is an extremely rare, highly malignant connective tissue tumor, which may, occasionally, affect the male genital tract. There are no agreed treatment principles. The overall prognosis is poor.
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Affiliation(s)
- S Martín Martín
- Servicio de Urología, Hospital Clínico Universitario de Valladolid.
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10
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Akbar SA, Sayyed TA, Jafri SZH, Hasteh F, Neill JSA. Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics 2003; 23:1461-76. [PMID: 14615558 DOI: 10.1148/rg.236025174] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Extratesticular neoplasms are rare but clinically significant lesions that affect patients of all ages. These neoplasms are generally asymptomatic but may have potentially life-threatening sequelae. Lipoma is the most common primary benign paratesticular neoplasm and the most common tumor of the spermatic cord. Adenomatoid tumor is the most common tumor of the epididymis, followed by leiomyoma. In adult patients, it is imperative to consider sarcomas in the differential diagnosis of all solid tumors of the scrotum. The most common sarcomatous tumors in pediatric patients are embryonal sarcoma and rhabdomyosarcoma. Metastases, particularly from testicular, prostatic, renal, and gastrointestinal primary malignancies, can also occur. Mimics of paratesticular neoplasms including polyorchidism and splenogonadal fusion are rare but must also be considered for optimal management. Ultrasonography (US) is currently the imaging modality of choice. However, US findings are often variable and nonspecific and do not usually allow definitive characterization. Specific computed tomographic and magnetic resonance imaging findings with respect to tumor location, morphologic features, and tissue characteristics can aid in the evaluation of paratesticular neoplasms and help narrow the differential diagnosis.
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Affiliation(s)
- Syed Ali Akbar
- Department of Radiology, William Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA.
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11
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Magro G, Lopes M, Cosentino M, Cosentino V. Pleomorphic Malignant Fibrous Histiocytoma of the Spermatic Cord: An Unusual Site for Such a Tumor. Urologia 2003. [DOI: 10.1177/039156030307001-406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors report the clinico-pathological features of a rare case of pleomorphic malignant fibrous histiocytoma of the spermatic cord. A review on the topic is provided.
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Affiliation(s)
- G. Magro
- Dipartimento di Anatomia Patologica, Università di Catania
| | - M. Lopes
- Unità Operativa di Urologia, Azienda Ospedaliera Vittorio Emanuele, Gela (Caltanissetta)
| | - M. Cosentino
- Unità Operativa di Urologia, Azienda Ospedaliera Vittorio Emanuele, Gela (Caltanissetta)
| | - V. Cosentino
- Unità Operativa di Urologia, Azienda Ospedaliera Vittorio Emanuele, Gela (Caltanissetta)
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12
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Urdiales-Viedma M, Fernández-Rodríguez A, Martos-Padilla S, Pichardo Pichardo S. [Malignant fibrohistiocytoma of the spermatic cord]. Actas Urol Esp 2002; 26:581-4. [PMID: 12448177 DOI: 10.1016/s0210-4806(02)72832-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A malignant fibrous histiocytoma (MFH) of the spermatic cord is presented and a review of the literature has been performed. The patient here presented survived for eight years and is probably cured of his tumour. In general, MFHs of the spermatic cord have a good prognosis, even when they attain a big size. They have a worse evolution when satellite nodules are present. Although more experience is needed. It is our feeling, that a spermatic MFH smaller than 8 cm, without any satellite nodule and less than 25% nuclei positive to MIB-1 (cell proliferation marker), may have a conservative therapy, including only tumorectomy.
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Affiliation(s)
- M Urdiales-Viedma
- Sección de Anatomía Patológica, Hospital San Juan de la Cruz, Ubeda, Jaén
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13
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Orio PF, Dahiya R, Herman T, Thomas CR, Eng TY. Malignant fibrous histiocytoma of the spermatic cord: a case report. Am J Clin Oncol 2002; 25:227-9. [PMID: 12040277 DOI: 10.1097/00000421-200206000-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Malignant fibrous histiocytoma (MFH) of the spermatic cord represents an uncommon location for the most common soft-tissue tumor in adults. MFH of the spermatic cord is such a rare entity that only 28 case reports have been described in the literature to date. The rarity of MFH of the spermatic cord has made diagnosis, staging, and treatment difficult. Solutions to such questions will only be answered as our database continues to expand. Therefore, this case report is presented in hopes of lending statistical power to future analysis of the correct treatment planning, mortality rates, and prognostic indications of a relatively unknown subset of a common disease.
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Affiliation(s)
- Peter F Orio
- Department of Radiation Oncology, University of Texas Health Science Center San Antonio, USA
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14
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Lin BTY, Harvey DA, Medeiros LJ. Malignant fibrous histiocytoma of the spermatic cord: report of two cases and review of the literature. Mod Pathol 2002; 15:59-65. [PMID: 11796842 DOI: 10.1038/modpathol.3880490] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Malignant fibrous histiocytoma (MFH) of the spermatic cord is rare, and most published cases are single case reports that emphasize clinical presentation and management. We describe in detail the histopathologic features of 2 cases of high-grade storiform-pleomorphic MFH arising in the spermatic cord. Both tumors occurred in elderly men, 65 years and 70 years, and were 4 cm (Case 1) and 5 cm (Case 2) in greatest dimension. The tumor mass in Case 1 was associated with satellite tumor nodules. At last follow-up, in Case 1 the patient died of metastasis, and in Case 2, the patient is alive and well 46 months after diagnosis. Review of the literature reveals 33 additional cases published in English (17 cases) or Japanese (16 cases) that include histologic description. Including the 2 cases in this report, most of the tumors occurred in older (than 50 years) patients (28 of 35 cases, 80%) and occurred as solitary masses that ranged in diameter from less than 1 cm to more than 20 cm. Nine patients presented with satellite tumor nodules. Twenty-nine (83%) tumors were of the storiform-pleomorphic type, with 3 giant cell type, 2 inflammatory type, and 1 myxoid type. These features do not differ significantly from MFH in other anatomic sites. Clinical follow-up is available in 33 cases (3-174 months; mean, 31.5 months). Twelve patients developed recurrence and metastasis; at least 4 patients died of the disease. Tumor size does not predict the clinical progression; however, patients with progressive tumors were commonly associated with satellite nodules at time of presentation, an indication of early local metastasis.
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MESH Headings
- Aged
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Biomarkers, Tumor/analysis
- Fatal Outcome
- Genital Neoplasms, Male/chemistry
- Genital Neoplasms, Male/pathology
- Genital Neoplasms, Male/surgery
- Histiocytoma, Benign Fibrous/chemistry
- Histiocytoma, Benign Fibrous/pathology
- Histiocytoma, Benign Fibrous/surgery
- Humans
- Immunohistochemistry
- Male
- Muramidase/analysis
- Neoplasm Recurrence, Local
- Spermatic Cord/chemistry
- Spermatic Cord/pathology
- Spermatic Cord/surgery
- Vimentin/analysis
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Affiliation(s)
- Bryan Tzy-Young Lin
- Department of Surgical Pathology, Tarzana Regional Medical Center, 18321 Clark Street, Tarzana, California 91356, USA
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15
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Sekine Y, Ohki K, Okamoto K, Nomura M, Tomita H, Ohtake N, Suzuki K, Kurokawa K, Mashimo M, Saruki K, Morita T, Nakazato H, Yokoo H, Yamanaka H. Malignant fibrous histiocytoma of the right spermatic cord: a case report. Int J Urol 2001; 8:581-4. [PMID: 11737490 DOI: 10.1046/j.1442-2042.2001.00375.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The patient was a 47-year-old male, who visited Hidaka Hospital with a chief complaint of swelling in the right inguinal region and the scrotum. With a diagnosis of a right spermatic cord tumor, right high orchiectomy was performed. Since an inflammatory type of malignant fibrous histiocytoma (MFH) was diagnosed from histopathological findings, chemotherapy and radiation therapy were performed as postoperative treatment. Malignant fibrous histiocytoma with the primary focus of the spermatic cords is a rare disease. To our knowledge, this is the 20th case of MFH of the spermatic cord in Japan (the 42nd in the world) and it is the second case of inflammatory type of MFH in Japan.
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Affiliation(s)
- Y Sekine
- Department of Urology, Gunma University, School of Medicine, Maebashi, Japan.
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Uchida K, Oda T, Adachi H, Wakabayashi J, Hisasue S, Takagi Y. Malignant fibrous histiocytoma of the spermatic cord: a case report. Int J Urol 1999; 6:630-2. [PMID: 10609548 DOI: 10.1046/j.1442-2042.1999.00120.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We present a case of malignant fibrous histiocytoma of the spermatic cord. An 86-year-old man was admitted to the hospital with a right painless scrotal mass. Under the diagnosis of a testicular tumor, right radical orchiectomy was performed. Grossly, the tumor firmly adhered to the spermatic cord. The right testis and epididymis were normal. The histologic diagnosis was malignant fibrous histiocytoma. There was local recurrence 2 months after surgery. The recurrent tumor was resected with the surrounding soft tissue, but the patient died 5 months after the initial operation.
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Affiliation(s)
- K Uchida
- Department of Urology, Hakodate Goryoukaku Hospital, Japan
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Merimsky O, Terrier P, Bonvalot S, Le Pechoux C, Delord JP, Le Cesne A. Spermatic cord sarcoma in adults. Acta Oncol 1999; 38:635-8. [PMID: 10427954 DOI: 10.1080/028418699431249] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The cases of 16 adult patients with spermatic cord sarcoma were retrospectively reviewed. Patient ages had a bimodal distribution (median 57.5 years). Presentation was scrotal mass, inguinal mass or both, with an average diameter of 6.7 cm. Radical orchiectomy was performed in 9 patients, and simple tumorectomy in 7. Lymph node dissection was performed in 6 patients, including retroperitoneal dissection in 4 patients. Various types of soft tissue sarcomas were found. Embryonal rhabdomyosarcomas were evident only in young patients. Lymph node metastases were found in 2 out of 6 cases. Testicular atrophy was observed in 3 young patients, germline destruction by the tumor in 2, and partial spermatogenesis in 2 patients. The median time to first relapse in 13 patients was 5.5 months. Surgery was the primary treatment and the best salvage modality. The role of chemotherapy and radiation therapy as true adjuvant or post-salvage-surgery adjunctive treatments remains unclear.
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Affiliation(s)
- O Merimsky
- Department of Medicine, Institut Gustav Roussy, Villejuif, France.
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Staiman VR, O'Toole KM, Rubin MA, Lowe FC. Giant malignant fibrous histiocytoma of the testis/spermatic cord: psychologic and possible etiologic complications of unethical Nazi medical experimentation. Urology 1996; 48:939-43. [PMID: 8973684 DOI: 10.1016/s0090-4295(96)00319-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This case of malignant fibrous histiocytoma of the testis/spermatic cord was found in a Holocaust survivor who was injected with an unknown substance in the left testicle while in Auschwitz concentration camp in 1943. Because malignant fibrous histiocytoma is a neoplasm rarely found in this location, with only 26 previously reported cases, a review of this entity was performed. A review of Nazi medical practices in the literature and through the Holocaust Museum research department was undertaken in an attempt to ascertain identification of the unknown substance injected into this patient; however, exact identification of the Auschwitz experiment or experimenter could not be determined. A left radical orchiectomy was performed, and subsequent histolopathologic review revealed a well-encapsulated 27 x 22 x 17-cm malignant fibrous histiocytoma. The left testis was not clearly identified due to necrosis of the tumor. This is the largest malignant fibrous histiocytoma of the spermatic cord/testis recorded in the literature to date. Based on the unusual location and size, the intratesticular injection probably contributed to the tumor development and certainly caused the patient's delay in seeking medical treatment.
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Affiliation(s)
- V R Staiman
- Department of Urology, Columbia-Presbyterian Medical Center, New York, New York, USA
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