Dedifferentiated liposarcoma of the spermatic cord

A man in his 60s presented to an outside hospital with persistent groin pain and a scrotal mass which was thought to be a recurrent hernia. Three months after initial presentation, the patient was found to have dedifferentiated liposarcoma (LPS) of the spermatic cord. LPS of the spermatic cord is a rare entity; however, clinicians should have LPS on the differential diagnosis especially in men with recurrent scrotal pain and mass. If unrecognised, LPS is associated with a high degree of morbidity and mortality. LPS can be subdivided into well-differentiated LPS, dedifferentiated LPS, myxoid LPS and pleomorphic LPS. In patients with advanced or metastatic LPS, chemotherapy consisting of Adriamycin, ifosfamide and mesna is used despite LPS being relatively chemoresistant. Therapies inhibiting mouse double minute 2 homologue, an oncoprotein that is a negative regulator of the tumour suppressor p53, appear to be promising in preclinical trials.

Liposarcoma of spermatic cord mimicking an inguinal hernia A case report and review of the literature

AIM

Liposarcoma of the spermatic cord (LSC) is a tumour often mistaken for common inguinal swelling as hernia and the aim of this work is to present our case with a review of the Literature to define the management of this rare condition.

MATERIAL OF STUDY

A systematic review has been realised, considering English language articles published on Pubmed, between 1956 and 2022, using as key words "Liposarcoma of the spermatic cord".

RESULTS

160 studies described 420 cases of LSC and in 40 cases the patient had undergone surgery with an initial diagnosis of inguinal hernia.

DISCUSSION

LSC is a very rare entity of genitourinary malignancies, occurring more often in the spermatic cord and diagnosis can be difficult. Our case and Literature data confirm the role of imaging in not conventional inguinal swelling, to avoid diagnostic mistakes and to define preoperatively the correct surgical management.

CONCLUSIONS

Imaging is mandatory in case of diagnostic doubt. The recommended treatment is a radical high orchiectomy with clear margins. A long follow-up period is necessary to detect a local recurrence which may occur even several years after the primary therapy.

KEY WORDS

Inguinal swelling, Liposarcoma, Spermatic cord.

Prognostic factors and outcomes of adult spermatic cord sarcoma. A study from the French Sarcoma Group

PURPOSE

To evaluate the outcomes of adult patients with spermatic cord sarcoma (SCS).

METHODS

All consecutive patients with SCS managed by the French Sarcoma Group from 1980 to 2017 were analysed retrospectively. Multivariate analysis (MVA) was used to identify independent correlates of overall survival (OS), metastasis-free survival (MFS), and local relapse-free survival (LRFS).

RESULTS

A total of 224 patients were recorded. The median age was 65.1 years. Forty-one (20.1%) SCSs were discovered unexpectedly during inguinal hernia surgery. The most common subtypes were liposarcoma (LPS) (73%) and leiomyosarcoma (LMS) (12.5%). The initial treatment was surgery for 218 (97.3%) patients. Forty-two patients (18.8%) received radiotherapy, 17 patients (7.6%) received chemotherapy. The median follow-up was 5.1 years. The median OS was 13.9 years. In MVA, OS decreased significantly with histology (HR, well-differentiated LPS versus others = 0.096; p = 0.0224), high grade (HR, 3 versus 1-2 = 2.7; p = 0.0111), previous cancer and metastasis at diagnosis (HR = 6.8; p = 0.0006). The five-year MFS was 85.9% [95% CI: 79.3-90.6]. In MVA, significant factors associated with MFS were LMS subtype (HR = 4.517; p < 10-4) and grade 3 (HR = 3.664; p < 10-3). The five-year LRFS survival rate was 67.9% [95% CI: 59.6-74.9]. In MVA, significant factors associated with local relapse were margins and wide reresection (WRR) after incomplete resection. OS was not significantly different between patients with initial R0/R1 resection and R2 patients who underwent WRR.

CONCLUSIONS

Unplanned surgery affected 20.1% of SCSs. A nonreducible painless inguinal lump should suggest a sarcoma. WRR with R0 resection achieved similar OS to patients with correct surgery upfront.

A case of spermatic cord B-cell lymphoma relapsing to the brain in a dog

A 13-year-old, intact male mixed-breed dog was referred to our clinic for lethargy and asthenia following an episode of gastroenteritis. As an incidental finding during abdominal ultrasound, a mass on the right spermatic cord was seen. Cytology of the mass revealed a monomorphic population of large, round cells with a lymphoid appearance. A bilateral orchiectomy was conducted, and histopathology revealed the presence of a B-cell lymphoma in the right spermatic cord. Based on clinical staging, which showed no involvement of other sites, no additional treatment was administered. Recheck evaluations were scheduled for every 3 mo thereafter. Five months after surgery, the dog developed left central vestibular syndrome with a paradoxical right-sided head tilt. An MRI of the brain showed multifocal lesions and, due to a rapidly worsening clinical condition, the dog was humanely euthanized. The histopathology of the brain lesions was consistent with B-cell lymphoma. Key clinical message: This is the first report of a primary spermatic cord lymphoma relapsing to the brain in a dog. Although rare, spermatic cord tumors should be included among the differential diagnoses for masses arising from the spermatic cord. If lymphoma is diagnosed, location to other sites, especially to the central nervous system, should be considered.

Rare paratesticular localization of dedifferentiated liposarcoma: Case report and review of the literature

RATIONALE

Dedifferentiated liposarcoma is defined as a malignant tumor that changes its shape from a well-differentiated liposarcoma to a non-liposarcomatous form. Most paratesticular liposarcomas manifest as an inguinal, painless, slow-growing mass. The standard treatment is extensive surgical excision, radiotherapy being proposed for cases with positive margins, those with recurrence, or in cases of the existence of unfavorable prognostic factors.

PATIENT CONCERNS

We present the case of a young patient diagnosed initially with left hydrocele, which after 2 years proved to mask a differentiated liposarcoma of the spermatic cord. The initial clinical manifestations were represented by the increase in volume of the left groin-scrotal region and pain at this level.

DIAGNOSIS

Microscopic examination in hematoxylin-eosin staining highlighted the presence of lipoblasts and fibroblasts in association with areas of hemorrhage and tumor necrosis. The performed immunohistochemical tests confirmed the diagnosis of dedifferentiated liposarcoma. To support and confirm the presence of the mouse double minute 2 homolog gene mutation, chromogenic in situ hybridization analysis was performed.

INTERVENTIONS

The initial treatment was the surgical one. After 2 weeks, the patient received zolendronic acid for hypercalcemia which was caused by the osseous metastasis.

OUTCOMES

The patient died secondary to acute renal failure caused by hypercalcemia despite the treatment received.

LESSONS

This case underlines the importance of both the correct management of oncological patients, as well as immunohistochemical and genetic tests in the identification of prognostic factors, with the ultimate goal of administering an appropriate oncological treatment.

Cremaster muscle thickening: the anatomic difference in men with testicular retraction due to hyperactive cremaster muscle reflex

The objective was to assess whether men suffering from testicular retraction secondary to hyperactive cremaster muscle reflex have an anatomic difference in the thickness of the cremaster muscle in comparison to men who do not have retraction. From March 2021 to December 2021, 21 men underwent microsurgical subinguinal cremaster muscle release (MSCMR) on 33 spermatic cord units, as 12 of them had bilateral surgery, at Surgicare of South Austin Ambulatory Surgery Center in Austin, TX, USA. During that same time frame, 36 men underwent subinguinal microsurgical varicocele repair on 41 spermatic cord units, as 5 were bilateral for infertility. The thickness of cremaster muscles was measured by the operating surgeon in men undergoing MSCMR and varicocele repair. Comparison was made between the cremaster muscle thickness in men with testicular retraction due to a hyperactive cremaster muscle reflex undergoing MSCMR and the cremaster muscle thickness in men undergoing varicocele repair for infertility with no history of testicular retraction, which served as an anatomic control. The mean cremaster muscle thickness in men who underwent MSCMR was significantly greater than those undergoing varicocele repair for infertility, with a mean cremaster muscle thickness of 3.9 (standard deviation [s.d.]: 1.2) mm vs 1.0 (s.d.: 0.4) mm, respectively. Men with testicular retraction secondary to a hyperactive cremaster muscle reflex demonstrate thicker cremaster muscles than controls, those undergoing varicocele repair. An anatomic difference may be a beginning to understanding the pathology in men who struggle with testicular retraction.

CT imaging of an unusual malignant inguinal mass: metastatic parafunicular dedifferentiated liposarcoma

A man in his 50s was redirected by his general practitioner to our University Hospital for a radiological evaluation after the complaint of a left inguinal swelling. The preliminary ultrasound and CT scan showed a left parafunicolar mass located between the root of the penis and the spermatic cord. The lesion was biopsied shortly after and histologically diagnosed as a dedifferentiated liposarcoma. The patient underwent a cycle of neoadjuvant radiotherapy, which proved to be ineffective. He was then subjected to an organ sparing surgical removal of the mass, followed by a second organ sparing removal of some residual disease. The last CT scan showed absence of the inguinal disease; however, lung and hepatic metastasis were detected, which are scheduled to be treated with a course of chemotherapy and radiofrequency.

Hydrocele with Paratesticular Liposarcoma

Paratesticular liposarcoma (PLS) is a rare type of genitourinary malignancy in the spermatic cord presenting as scrotal swelling. In this case study, we report an 82-year male who presented with prolonged left scrotal swelling and pain that did not respond to analgesic treatment for one week. His ultrasound confirmed increased fluid content in the left scrotal compartment in the form of septated hydrocele, and hydrocelectomy was planned. During the operation, infected fluid was drained. The testicle and surrounding tissues were infected; hence, left orchiectomy was performed. The pathological examination revealed a dedifferentiated liposarcoma. To our knowledge, this is the first report of liposarcoma of the spermatic cord with hydrocele in the literature. Key Words: Liposarcoma, Spermatic cord, Scrotal swelling, Hydrocele.

Zero-ischemia testis-sparing surgery for probably benign pediatric testicular tumors

Permanent ischemia-induced testicular damage may occur as early as 30 min in prepupertal rats. With the goal of potentially enhancing testicular function and fertility preservation, we performed testis-sparing surgery (TSS) without ischemia for testicular lesions in select children with negative markers and high likelihood of benignity on ultrasonography. Preliminary experience suggests that off-clamp TSS should be more liberally encouraged, especially in infants and prepubertal children, given their particularly vulnerable spermatic cord elements.

Sonographic appearance of a large lipoma of the spermatic cord presenting clinically as an inguinoscrotal hernia

Lipoma of the spermatic cord or the round ligament is called inguinal canal lipoma. It may present as an inguinal herniating mass of fat tissue, with or without an accompanying herniating sac. There are few reports about large lipomas of the spermatic cord. We describe a case of a large spermatic cord pure lipoma, initially suspected to be an inguinal hernia upon physical examination. We diagnosed the lipoma with ultrasound and magnetic resonance imaging. The patient subsequently underwent left orchiectomy.

Spermatic vein aneurysm: a report of a unique case and review of the literature

A spermatic vessel aneurysm is a rare entity, described only a few times in the literature. In most cases, it is caused by trauma or inflammation and appears as a painful mass in the scrotum or the inguinal area. We present a case of a 22-year-old man who came to our Surgical Department with a painful, palpable mass in the right inguinal area. A spermatic vein aneurysm was diagnosed with the use of ultrasonography and it was surgically excised. The findings were confirmed by pathological examination. The patient is well, four months after surgery. A spermatic vessel aneurysm, though rare, should always be included in the differential diagnosis of a scrotal or inguinal mass. The lesion can be cured by surgical resection.

Testicular torsion in a newborn: a case report

Discovery of an apparent scrotal mass is a non common entity in neonates. Testicular torsion is rare in newborn infants and is an urologic emergency that requires emergency surgical management. We present a rare case of testicular torsion in a neonate.

CIC fusion-positive sarcoma of the spermatic cord

In addition to germ cell tumors and tumors of the sex cord stroma, the WHO classification of testis and paratesticular tumors also contains malignant soft tissue tumors. Among them, liposarcomas of the spermatic cord are the most common entities. Other mesenchymal tumors with smooth muscle, skeletal muscle, fibroblastic/myofibroblastic, or nerve sheath differentiation are rare. Ewing sarcoma is composed of uniform small round cells and typically characterized by translocations of the EWSR1 gene. In rare cases, Ewing sarcoma-like tumors lack an EWSR1 gene fusion. Some of these tumors harbor a specific CIC translocation. However, Ewing-like sarcoma has up to now never been described in the testis or spermatic cord. The present case describes the first EWSR1-negative, undifferentiated round cell sarcoma with CIC translocation of the spermatic cord. Potential differential diagnoses are discussed.

Metastasis of the epididymis and spermatic cord from pancreatic adenocarcinoma: A rare entity. Description of a case and revision of literature

INTRODUCTION

Metastatic epididymal and spermatic cord adenocarcinoma from epithelial tumors are a rare condition. The most frequent primary cancers are prostate, lung, kidney, gastrointestinal tumors and breast. In literature, there are very low number of cases reporting metastasis from pancreatic cancer to epididymis and spermatic cord.

CASE DESCRIPTION

We report a case of 70-years old man with history of left orchiectomy for undescended testicle, who presented to our department with a palpable nodule in the right scrotum. Scrotal ultrasound revealed an inhomogeneous hypoechoic nodule of epididymis and/or spermatic cord. Neoplastic markers showed high levels of CEA (carcinoembryonic antigen) and bHCG (beta Human Chorionic Gonadotropin). The patient underwent right surgical scrotal exploration with orchifunicolectomy. Pathologic examination revealed pathologic tissue showing rare glandular structures. Immunohistochemistry profile was compatible with malign epithelial neoplasm with glandular differentiation. Total body CT-scan revealed pathologic tissue in pancreas between head and body and a suspect pathologic lesion in liver and 18-FDG PET-scan confirmed the pancreatic neoplastic mass and a suspect secondary hepatic lesion. Biopsy of pancreatic pathologic area was positive for ductal pancreatic adenocarcinoma. The patient was sent to oncologic evaluation and started chemotherapy.

CONCLUSIONS

Malignancies of epididymis and spermatic cord are rare entities and, in literature, very low number of cases of metastasis from pancreatic carcinoma to epididymis and spermatic cord are described. Early differential diagnosis is fundamental mostly in those patients with age range unusual for testis cancers.

Deep Vein Thrombosis: A Rare Cause of Acute Testicular Pain. Case Report: Literature Review

INTRODUCTION

Thrombosis is defined as the formation of a clot in a blood vessel that obstructs the flow of blood to the peripheral tissues. The incidence of thromboembolic disease ranges from 0.7 to 1.2% within urology.

CASE REPORT

A 40-year-old warehouse worker male presented to the emergency department with worsening of a month's lasting scrotal pain. Physical examination showed the presence of an enlarged and painful left testicle with no other findings. Right testicle, penis and abdominal examination showed no abnormalities whatsoever. Bilateral varicocele with a partial thrombosis of the left one associated with left inguinal hernia was diagnosed by performing an urgent testicular ultrasound test. Conservative treatment was first given. However, since pain was not relieved, surgery was indicated with left varicocelectomy and a left inguinal hernia repair procedure leading to complete symptoms control and normal testicular flow in the control Doppler ultrasound study 2 months after the surgery.

CONCLUSION

Spontaneous thrombosis of the pampiniform plexus is a rare entity where the management remains controversial. The clinical case we report here shows that surgery may be considered an effective option.

[ULTRASTRUCTURAL CHARACTERISTICS OF RATS TESTICLES UNDER SPERMATIC CORD STENOSIS AND AFTER BLOOD FLOW RESTORATION BY DIFFERENT METHODS]

Hemodynamic disorders in the testicles cause chronic organ hypoxia with damage of its stroma and seminiferous tubules, which plays a leading role in the pathogenesis of the testicular form of male infertility development. The aim of the work was to establish the features of ultrastructural reorganization of the testicles tissue and its vascular bed under circulatory hypoxia conditions and after restoration of blood flow in the organ. The study was conducted on 84 white adult male rats. The control group consisted of 12 intact animals. The experimental group was divided into 3 series: with stenosis of the spermatic cord (48 animals), with stenosis of the spermatic cord and its recanalization on the 3rd day without correction (12 animals) and with stenosis of the spermatic cord and its recanalization with correction on the 3rd day (12 animals). Under conditions of dosage spermatic cord stenosis (when the ligature is applied) in the remote monitoring period, with electron microscopic study, were detected destructive changes of spermatid and spermatozoa, which were combined with significant focal intracellular and extracellular edema. In part of the cells heads were deformed, the acrosomes were sophisticated and fragmented. At one-stage decompression of the spermatic cord (removal of the stenosing ligature on the third day), the above-described changes in accordance were deepened. At 14th day of the observation, collagen fibers and an electron-transparent amorphous component were found in the perivascular space. When the proposed method of dosed decompression of the spermatic cord (successive removal of three stenosing ligatures of different diameters) has been applied changes in the testicles parenchyma and its intraorganic vessels were less severe. Functional activity of the testicle after correction of reperfusion changes, was not significantly affected, what was proved by the presence in seminiferous tubules lumen of spermatozoa mature forms.

Angiomyofibroblastoma of the spermatic cord: a case report

Angiomyofibroblastoma (AMF) is a rare benign mesenchymal tumor with tendency to arise in the lower genital tract of middleaged women, predominately in the vulva. A few cases of AMF in males have been reported involving the scrotum, perineum or spermatic cord. We report a new case of AMF arising in the right inguinal region of a 27-year-old man. The tumor was well-circumscribed, myxoid and measured 30 mm in maximum dimension. On microscopic examination, the tumor was composed of spindle cells without atypia and with less than one mitosis figure per 10 high-power fields. Multinucleated cells and mast cells were observed. The stroma was myxoid and edematous with abundant capillary-sized blood vessels. Immunohistochemical staining showed a strong immunoreactivity for desmin and smooth muscle actin. The tumor cells were negative for estrogen receptors and focally positive for progesterone receptors with a low proliferative index of Ki67 (< 5%). This unusual neoplasm should be distinguished from aggressive angiomyxoma and other myxoid malignant tumors.

Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men

PURPOSE

A continuous spermatic venous reflux (SVR) at colour Doppler ultrasound (CDU) is an evidence for varicocele, a frequent correlate for male subfertility. We explored whether SVR after left varicocele repair is predictive for changes in semen quality in subfertile men.

METHODS

Blood hormones (FSH, LH, and total testosterone) and scrotal CDU were obtained in subfertile patients with left grade II or grade III varicocele on physical evaluation and a poor sperm quality. Semen analysis and CDU were re-evaluated 6 months after a retrograde internal spermatic vein scleroembolisation.

RESULTS

The retrospective study included 100 men with a baseline SVR >3 cm/s; 60 men showed a disappearance (group 1) and 40 men (group 2) showed a reduced SVR after varicocele repair. Total motile sperm count (TMC) was markedly increased after treatment (p < 0.0001; F = 35.79) and the increase was more relevant in group 1 compared to group 2 (p = 0.04; F = 4.20). TMC and left SVR values after varicocele repair were negatively correlated (R = -0.218; p = 0.035). Multivariate analysis showed that adjusted SVR after repair negatively predicted TMC change (TMC after repair minus baseline TMC) (ß = -2.56; p = 0.022). Disappearance of a continuous left SVR at CDU after varicocele repair was associated to a better improvement of semen parameters in subfertile men.

CONCLUSION

Recording of a continuous left spermatic vein reflux is an objective method to assess a successful varicocele repair aimed to improve sperm parameters in subfertile men.

Inguinal canal spermatic cord leiomyoma presenting as an incarcerated inguinal hernia

Leiomyoma is a benign neoplasm originating from smooth muscle cells and is most commonly seen in the uterus, followed by the small bowel and oesophagus. We report a rare case of a 41-year-old male patient with a spermatic cord leiomyoma that presented as an inguinal canal mass mimicking an irreducible inguinal hernia without scrotal involvement. This report highlights the rare presentation and workup of an inguinal mass, importance of intraoperative decision making based on operative findings and the significance of postoperative pathology findings.

Liposarcoma of the Spermatic Cord –A Rare Pathological Entity

Liposarcoma of the spermatic cord is a very rare neoplasm with fewer than 200 cases recorded in world literature. This report describes a case of liposarcoma of the spermatic cord which developed after radical prostatectomy and salvage radiotherapy for prostate cancer treatment. Four years following surgical treatment of the primary neoplasm and one year following radiotherapy, the 67 –year –old patient was referred to the urology clinic for the emergence of a mass in the right hemiscrotum region. Ultrasonography revealed a homogenous isodense mass measuring 4.5 cm in diameter, while positron emission tomography (PET) with 2-deoxy-2(18F) fluoro-D-glucose (FDG) indicated the presence of viable tumors cells. Radical orchiectomy was performed to remove the neoplasm which appeared to be dedifferentiated liposarcoma of the spermatic cord. Lymph nodes were not affected, but the surgical margins were found positive and the patient was referred to further oncologic treatment.

Spermatic cord dedifferentiated liposarcoma presenting as a recurrent inguinal hernia

Paratesticular sarcomas are a rare entity and provide a unique clinical challenge due to their slow growing, often painless natural course. Adding to this challenge is the complex anatomy of the scrotum that allows these masses to mimic other conditions, including inguinal hernia, cysts, or fluid collections. We report such a case and our approach to an 83-year-old male with dedifferentiated liposarcoma of the spermatic cord with a history of inguinal hernia. In doing so, we highlight the need for thorough evaluation of scrotal masses and the management of these rare, though well-described, tumors.

Diagnosis challenge of atypical spindle cells neoplasm of the spermatic cord

OBJECTIVE

To report an unusual case of softtissue neoplasm and to review the literature on this type of tumour.

METHODS

We report an accidentally found tumour closely related to the spermatic cord that was diagnosed in a 70 year-old man when he was being operated on for an inguinal hernia repair.

RESULTS

After thorough analysis by experienced pathologists it was not possible to determine the nature of the tumour that was removed at surgery.

CONCLUSIONS

Soft tissues neoplasms of the spermatic cord may occur in an unusual way and they may be a real challenge to diagnose.

[THE VARICOCELE ENIGMA: "BACKGROUND NOISE" OR COMMON MALE INFERTILITY ETIOLOGY?]

Infertility derived from mate etiology is a health problem which has increased over the last decades. Varicocele is a common cause for mate infertility with incidence of 35% and 75% among males with primary and secondary infertility, respectively, compared to 10%-15% among the general population. VaricoceLe is defined as dilated and entangled pampiniform plexus and internal spermatic veins located in the spermatic cord. The effect of varicocele on male infertility was controversial due to lack of published data uniformity and high standard studies. During recent years several published researches supplied reliable evidence regarding the influence of varicocele on mate infertility, treatment options and appropriate indications. Adequate patient selection significantly improves the chances for spontaneous pregnancy. Treatment varies between surgical veins ligation by various means and embolization by the endovascular approlch of the dilated veins. The current article summarizes updated treatment indications, advantages and drawbacks of the optional approaches and describes the considerations for choosing the optimal treatment for the infertile couple due to varicocele.

Paratesticular liposarcoma of the spermatic cord: a case report and review of the literature

Spermatic cord liposarcoma is a rare medical condition and liposarcomas are most commonly found in the retroperitoneum, in the extremities and less often in the head and the neck area. The spermatic cord is a rare site of origin, accounting for about 3-7% of all liposarcomas. We report a case of liposarcoma of spermatic cord. A 62-year-old male patient presented with a painless right inguinal mass. MRI (magnetic resonance imaging) showed a fatty mass in the right inguinoscrotal region, and was interpreted as an inguinal hernia containing omentum protruding into scrotum. The mass was removed with right testis and spermatic cord. The surgical margins were negative. Histopathological examination and immunohistochemistry revealed a well-differentiated liposarcoma. In this article, we discuss the clinical behavior of the spermatic cord liposarcoma and currently recommended treatment of the spermatic cord liposarcoma by reviewing the literature. In conclusion, spermatic cord liposarcoma are rare neoplasm that present as firm, slow-growing palpable paratesticular masses and the surgical treatment should include a wide resection around the inguinal canal, with removal of the spermatic cord and the surrounding soft tissue deep to the internal inguinal ring.

Parasitised large intestinal diverticulum of the spermatic cord

We present a 70-year-old male patient with an unusual incidental finding at an elective repair of an indirect left inguinal hernia (LIH). A black nodule resembling a melanoma metastasis in a lymph node was discovered attached to the spermatic cord. There was no contiguity with the large bowel on the same side. Histological examination showed an isolated, detached colonic diverticulum containing a faecolith. We postulate derivation from an incarcerated colonic diverticulum that became 'parasitised' onto the spermatic cord.

[Metastatic tumor of the spermatic cord from gastric cancer: a case report]

A 66-year-old man presented with a painless swelling of left scrotal contents. We performed left inguinal orchiectomy and left inguinal lymphnode dissection. Histopathological examination revealed spermatic cord metastases from gastric carcinoma. We collected 44 cases of metastatic tumor of the spermatic cord from gastric cancer in the Japanese literature.

Leiomyosarcoma of the spermatic cord with scalp metastasis: case report and literature review

Herein we present 82-year-old man with leiomyosarcoma arising from the spermatic cord with scalp metastasis, five years after primary surgical treatment. Complete surgical excision is required in such cases, as well as precise evaluation of further therapy. Paratesticular leiomyosarcoma is a rare entity, malignant mesenchimal tumor of smooth muscle differentiation. Although leiomyosarcomas of different localizations have well-known metastatic potential, cutaneous metastases are extremely rare with only 16 cases described in the literature. To our knowledge there are no reported cases of the paratesticular leiomyosarcoma metastatic to the skin. This article reviews the literature regarding paratesticular leiomyosarcoma presentation, diagnosis and treatment.

[Comparative characteristic of methods for operative treatment of patients suffering varicocele]

Efficacy and security of treatment of varicocele constitute a complex issues in urology, necessitating the additional investigations conduction. The results of surgical treatment of 280 patients, suffering left-sided varicocele and operated using three different methods--retroperitoneal varicocelectomy, laparoscopic varicocelectomy and subinguinal microsurgical varicocelectomy (SMV)--were analyzed. The advantages and faults of these methods were estimated, basing on the recurrence rate, complications by hidrocele occurrence and changes in the patients quality of life. SMV was determined as most effective and secure method of varicocele correction. The data obtained may be useful for choice of tactics for the disease treatment.

Primary spermatic cord tumors: disease characteristics, prognostic factors, and treatment outcomes

INTRODUCTION

Experience with management of spermatic cord tumors (SCTs) is uncommon. We utilized a large population-based cancer registry to characterize the demographic, pathological, treatment characteristics, and outcomes of SCTs.

MATERIAL AND METHODS

The Surveillance, Epidemiology, and End Results database (1973-2007) was queried.

RESULTS

From the database, 362 patients were identified with SCT. The annual incidence of SCT was 0.3 cases per million and did not change over time. The most common histologic types were liposarcoma (46%), leiomyosarcoma (20%), histiocytoma (13%), and rhabdomyosarcoma (9%). The median age of diagnosis for rhabdomyosarcomas was (26.3 y), whereas for other SCTs, it was (64.7 y) (P<0.001). On multivariate analysis, a worse outcome was observed with undifferentiated tumor grade, distant disease, positive lymph nodes, and leiomyosarcoma or histiocytoma cell histology.

CONCLUSION

We describe the largest cohort of SCT studied to date. Liposarcoma was most common, while leiomyosarcoma and histiocytoma histologic subtypes were observed to be the most aggressive. Multivariate analysis revealed that tumor grade, stage, histologic type, and lymph node involvement were independently predictive of prognosis.

Diffuse large B cell lymphoma of the spermatic cord: a case report and literature review

Primary lymphoma of the spermatic cord is rare. We report a case of primary lymphoma of the spermatic cord and review the literature. A 77-year-old man presented with a 5 month history of an enlarging right inguino-scrotal mass. On physical exam, the mass involved the spermatic cord. Computerized tomography and magnetic resonance imaging revealed a 10 cm x 4 cm inguinoscrotal mass related to the spermatic cord. A right inguinal orchidectomy with wide local excision was performed. Pathological and immunohistochemical evaluation identified the tumor as a diffuse large B cell lymphoma of the spermatic cord. Postoperatively, patient began a chemoradiotherapy regimen consistent with metastatic lymphoma.

Pseudo-tumor of the scrotum, a rare clinical presentation of dirofilariasis: a report of two autochtonous cases due to Dirofilaria repens

In Europe, human dirofilariasis refers to a group of autochtonous parasitic infections caused by tissue nematodes of the genus Dirofilaria, responsible for two distinct clinical presentations: Dirofilaria immitis usually presenting as pulmonary lesions and Dirofilaria repens as subcutaneous nodules. Rare in humans, genital involvement manifests itself as pseudotumor nodules affecting the scrotum, epididymis, or spermatic cord. We report on two cases of Dirofilaria repens infections, involving the spermatic cord and epididymis.

[Is it necessary to place a surgical clamp early in the spermatic cord during testicular examination via inguinal approach?]

OBJECTIVE

The presence of tumor cells in the spermatic cord was evaluated in patients undergoing inguinal testis study in order to assure if the placement of a clamp in it was necessary to avoid tumor dissemination.

MATERIAL AND METHODS

Inguinal testis studies were performed over a two year period in 38 patients diagnosed of testicular mass. The presence of tumor cells in blood vessels or lymph nodes of the cord was evaluated in all of the patients.

RESULTS

Testicular tumors were found in 28 patients (20 seminoma, 5 mixed tumor and 3 embryonal) with an average age of 42 (range 21-82) years. There were T1N0M0 21; T1N1M0 3; T2N0M0 2 and T2N1M0 2 cases, respectively. Independently of the stage and tumor lineage, tumor cells in the cord vessels were not observed in any of the cases through the pathology study.

CONCLUSION

In our causistics, it seems that the surgical act consisting in the placement of a clamp early in the cord lacks a scientific foundation. However, this study does not make it possible to state that not performing this maneuver during the surgical procedure is oncologically safe. Thus, a precedent is established to perform studies with a larger number of patients that will make it possible to corroborate this observation. This would result in less traumatic and safer surgical techniques that would allow conserving the testis and its functionality.

[A case of malignant peritoneal mesothelioma presenting with bilateral swelling of spermatic cord]

A 67-year-old man had pain and swelling in the bilateral inguinal region. His past medical history included non-alcoholic steatohepatitis and liver cirrhosis. A clinical examination revealed a solid mass that was palpable along with the bilateral spermatic cord from the external inguinal ring to the root of the scrotum. Other than a hydrocele in the right testis, the epididymis and testes were intact. Abdominal computed tomography showed ascites and a solid tumor of the bilateral spermatic cord. Magnetic resonance imaging findings did not suggest malignancy, while antibiotics showed no effects. The patient wanted relief from the inguinal pain and a bilateral high orchiectomy was performed, during which time the spermatic cord was found firmly adhered to the surrounding tissue, and could not be completely resected. A histopathological examination showed epithelial mesothelioma. For additional examination of the ascites, the patient underwent paracentesis, which revealed an extremely high level of hyaluronic acid. Our working diagnosis was peritoneal malignant mesothelioma that had infiltrated the bilateral spermatic cord. We began systemic chemotherapy treatment with pemetrexed and cisplatin, but, the patient died 3 months after the operation.

Paratesticular fibrous hamartoma in an infant

Fibrous hamartoma of infancy is a rare benign tumour with local infiltration. The lesion is usually found in the upper torso and rarely occurs in the genital region. Diagnosis before surgery is rare, and complete excision is essential to prevent recurrence. We present a case in which fibrous hamartoma of infancy involving the spermatic cord was found. A pre-operative clinical diagnosis could not be made. On inguinal exploration, the tumour could not be dissected away from the testicular vessels, which necessitated an orchidectomy for complete removal. The case is presented due to its rarity and successful management.

Spermatic cord dermoid cyst as paratesticular mass. Case report and bibliographic review

OBJECTIVE

Presentation of a new case of dermoid cyst of the spermatic cord and to perform a review of the literature.

METHODS

We describe the case of a 48 year-old male who consulted because of reappearance of a mass in the left high scrotal area and inguinal zone. He was operated for left inguinal hernia two years before.

RESULTS

Since physical examination and ultrasound were inconclusive, we performed a surgical exploration with complete excision of the mass. Intraoperartive pathologic analysis confirmed the benign nature of the mass so we did not proceed to radical orquiectomy.

CONCLUSIONS

Among paratesticular tumors, benign in the majority of cases, dermoid cyst is a rare pathology of the spermatic cord that the clinician always has to take into account before making a decision when we treat the spermatic cord masses.

Paratesticular liposarcoma of the spermatic cord: a case report and a review of the literature

BACKGROUND

Paratesticular liposarcomas are uncommon and in view of this most practitioners would be unfamiliar with the diagnosis and management.

OBJECTIVE

To report a case of paratesticular liposarcoma, a rare tumour and to review the literature on paratesticular liposarcoma.

METHODS AND RESULTS

A 77-years old man with paratesticular liposarcoma originating from the left spermatic cord is reported. This patient noticed the lump eight years prior to its excision. The tumour was originally thought to be benign lipoma and was left alone and its management was based upon the principle of watchful waiting. The tumour was excised as an additional procedure when the patient underwent trans urethral resection of prostate following lower urinary tract symptoms and retention of urine and at this stage the 'lipomatous' lump was noticed to have grown bigger over recent months. The patient underwent a successful surgical excision (a radical excision of the testis and surrounding mass) and has remained under surveillance by the Regional Oncologists. Literature review revealed that 109 cases of para-testicular liposarcoma had previously been reported and radical excision with a wide resection margin is the recommended surgical approach to its management.

CONCLUSION

Radical surgical excision with wide resection margins is the most appropriate approach to the management of para-testicular liposarcoma and the patients should be referred to the Oncologist.

[Liposarcoma of the spermatic cord: a case report]

OBJECTIVE

The aim of the article is to summarize experience in the pathology, diagnosis and treatment of spermatic cord liposarcoma (SCL).

METHODS

The clinical data of a patient with liposarcoma of the spermatic cord was reviewed in combination with related literature.

RESULTS

A 24-year-old male presented with a 1-year history of a mass in the right hemiscrotum. The tumor was resected and right inguinal orchidectomy was performed. The tumor had not recurred after 6 months follow-up.

CONCLUSION

Spermatic cord liposarcoma (SCL) is a rare medical condition and it is therefore difficult to establish guidelines for treatment, diagnosis and prognosis. Radical orchidectomy with wide local excision of the mass is the recommended therapy, while adjuvant radiotherapy may be considered in intermediate or high-grade tumors and recurrent liposarcomas. The role of chemotherapy is not well-defined.

[Spermatic cord liposarcoma: a case report and review of the literature]

OBJECTIVE

To explore the clinical features and treatment of spermatic cord liposarcoma (SCL).

METHODS

We retrospectively analyzed the clinical data of a case of SCL, reviewed the related literature and investigated the diagnosis and treatment of the disease.

RESULTS

The patient underwent tumor resection and left inguinal orchidectomy. Postoperative pathology confirmed the case to be s SCL. Neither recurrence nor metastasis was found during the five-month follow-up.

CONCLUSION

SCL is a rare medical condition with no specific imaging and laboratory features. Radical orchidectomy with wide local excision of the mass is recommended for its treatment, and adjuvant radiotherapy can be considered in intermediately or highly differentiated tumors and recurrent liposarcomas, while the role of chemotherapy is not well-defined.

Paratesticular leiomyosarcoma: case report and review

Paratesticular leiomyosarcoma is a rare entity. Greater than 95% of tumors arising within the scrotal sac are testicular in origin. Of the paratesticular tumors, rhabdomyosarcoma accounts for nearly half of malignant masses. Paratesticular leiomyosarcoma is infrequently encountered, resulting in a relative paucity of literature regarding this tumor type. Here we present a case report of a leiomyosarcoma arising from the spermatic cord in a 71-year-old man and review the literature regarding paratesticular leiomyosarcoma presentation, diagnosis and treatment.

Management of spermatic cord liposarcoma in renal transplant recipients: case report

Herein, we report the case of a 52-year-old man with a spermatic cord liposarcoma that developed 4 years after renal transplantation. The patient was admitted with a diagnosis of inguinal hernia. During surgical exploration, a solid mass was found arising from the spermatic cord. Histologic analysis demonstrated a well-differentiated sclerosing liposarcoma.

[Effects of inguinal hernioplasty mesh implant on reproductive function]

In vivo experiment involved 95 white breedless male rats of pubertal age. The animals were divided in three groups: 1st group had unilateral hernioplasty with mesh implant; 2nd group had bilateral mesh implantation and 3rd group had animals with hernioplasty with lavsan thread. The results were assessed with the use of morphological method, the state of reproductive organs - with the use of biological method and compared with the control (intact) group. Stable progressive increase of thickness of epithelium and spermatic duct wall during the whole observation time was registered after hernioplasty with mesh implantation. In the group after hernioplasty with lavsan thread the above mentioned changes returned to normal values by the end of the first month after the operation. Disorders of the reproductive system in animals after bilateral mesh implantation turned out to be essential and resulted in sterility within the whole time of the observation. Mildly decreased or average fertility was observed among animals after unilateral mesh implantation and hernioplasty. Notably, that after hernioplasty with lavsan thread, fertility was sufficient. The study demonstrated the negative influence of mesh implant on spermatic duct structure, which may cause infertility.

Malignant fibrous histiocytoma: a case report and literature review

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in late adult life. It occurs most frequently in the extremities (70%), followed by the retroperitoneum (16%). The occurrence of MFH in the spermatic cord is extremely rare (approximately 50 cases in the literature). We are reporting one case of MFH of the spermatic cord that presented as a hard painful inguinal mass. The patient was treated by a right radical orchiectomy followed by postoperative radiotherapy. The patient remained alive, with no local recurrence after 30 months of follow-up.

A novel role for SED1 (MFG-E8) in maintaining the integrity of the epididymal epithelium

The epididymis is a highly convoluted tubule that connects the testis with the vas deferens, and in which mammalian sperm acquire the ability to fertilize eggs. The most proximal portion of the epididymis, or initial segment, secretes numerous factors that are critical for sperm maturation and storage. One such factor is SED1 (also known as MFG-E8) a bi-motif protein composed of two N-terminal EGF domains, the second of which contains an RGD motif, and two C-terminal discoidin domains (also known as F5/8 type C domains). Previous studies have reported that SED1 is secreted into the epididymal lumen, where it coats sperm and later facilitates sperm-egg binding. Herein, we report that SED1-null males also harbor unexpected epididymal pathologies, including detached epithelia and spermatic granulomas. We therefore examined whether SED1 has a tissue-intrinsic role in the epididymis, in addition to its role in sperm-egg adhesion. Improved fixation protocols revealed that SED1 is found in the basolateral domains of epididymal epithelial cells in vivo, and similarly, SED1 is secreted both apically and basally from polarized epididymal cells in vitro. The basolateral distribution of SED1 suggests that it may play a novel role in epididymal cell adhesion. Consistent with this, in vitro assays showed that SED1 supports epididymal cell adhesion via RGD binding to alphaV integrin receptors on epididymal epithelial cells. Finally, epididymal cells from SED1-null males showed reduced adhesion in vitro, a phenotype that can be rescued with exogenous SED1. These results suggest that SED1 facilitates epididymal cell adhesion, and that its loss leads to breakdown of the epididymal epithelium and consequent development of spermatic granulomas.