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BMJ Case Reports Jan 2021Proximal-type epithelioid sarcoma is an ultra-rare, high-grade soft tissue malignancy usually presenting as a deep-seated painless mass in the proximal extremities. Most...
Proximal-type epithelioid sarcoma is an ultra-rare, high-grade soft tissue malignancy usually presenting as a deep-seated painless mass in the proximal extremities. Most patients are diagnosed as young adults, between 20 and 40 years of age. Perineal and genital masses do occur but are extremely rare and represent a challenging tumour to diagnose and treat. Early radical excision is recommended due to its aggressive behaviour and poor prognosis. Median overall survival from initial diagnosis is 30 months. We present the case of a 22-year-old man with a left groin proximal-type epithelioid sarcoma who is sadly deceased 12 months after initial presentation despite early surgical excision, completion of both first-line and palliative chemotherapy, and palliative radiotherapy.
Topics: Genital Neoplasms, Male; Humans; Male; Sarcoma; Spermatic Cord; Young Adult
PubMed: 33414109
DOI: 10.1136/bcr-2019-232385 -
Frontiers in Surgery 2020Spermatic cord sarcomas represent a rare genitourinary malignancy with a challenging diagnostic and therapeutic pathway. Different histotypes have been described and...
Spermatic cord sarcomas represent a rare genitourinary malignancy with a challenging diagnostic and therapeutic pathway. Different histotypes have been described and prognostic factors remain poorly defined due to the paucity of data presented in literature. Retrospective chart review of 22 adult patients treated for spermatic cord sarcoma in a single institution in the last 20 years was performed. Clinicopathological characteristics of the tumors were collected with primary and subsequent treatment. Survival analysis was performed in order to identify prognostic factors of disease-specific survival. The median age at diagnosis was 68 years (58-78), the most common histotype was liposarcoma (14/22), and most patients (63.6%) were found to have positive surgical margins after surgery. The 5-year cancer specific survival was 91.3%. Grading ( = 0.480), histotype ( = 0.327), and type of intervention ( = 0.732) were not associated with survival. All patients dead of disease had positive surgical margins ( = 0.172). We report a good prognosis at 5 years. Wide radical resection remains the first and probably the most important step; thus, according also to literature, negative surgical margins should be aimed.
PubMed: 33282904
DOI: 10.3389/fsurg.2020.566408 -
Journal of Pediatric Surgery Aug 2021The bell-clapper deformity (BCD) predisposes to intravaginal torsion (IVT) and is classically bilateral. The precise pathological definition of what constitutes a BCD is... (Review)
Review
INTRODUCTION
The bell-clapper deformity (BCD) predisposes to intravaginal torsion (IVT) and is classically bilateral. The precise pathological definition of what constitutes a BCD is not clear. The current study aims to clarify the specific anatomic details of this anomaly.
METHODS
A systematic review was performed utilizing the PRISMA principles. Studies are presented chronologically based on their level of evidence. They are further divided into study types: autopsy and operative studies of acute torsion, intermittent torsion and studies of the contralateral testis in vanishing testis.
RESULTS
The bell-clapper deformity is best defined by complete investment of the testis, epididymis and a length of the spermatic cord by the tunica vaginalis. Based on autopsy studies the rate of BCD in scrotal testis varied from 4.9% to 16%; with bilaterality in 66%-100%. In cases of acute IVT bilaterality was noted in 54%-100%. The most disparate results were in cases of testicular regression syndrome where contralateral BCD was noted in 0%-87% of cases.
CONCLUSION
We suggest future studies employ the strict anatomical definition above. As there is evidence of age-dependent investment of the testes, it will be important to develop age-standardized measurements of intravaginal length of spermatic cord. This critical morphometric measurement will allow a better understanding of the risk of IVT.
LEVEL OF EVIDENCE
Systematic review of diagnostic studies: lowest level of evidence of included manuscripts Level IV (case-control studies with a poor reference standard).
Topics: Cryptorchidism; Gonadal Dysgenesis, 46,XY; Humans; Male; Spermatic Cord; Spermatic Cord Torsion
PubMed: 32762939
DOI: 10.1016/j.jpedsurg.2020.06.023 -
The Journal of Urology Apr 2018
Topics: Denervation; Groin; Humans; Male; Pelvic Pain; Robotic Surgical Procedures; Spermatic Cord
PubMed: 29289601
DOI: 10.1016/j.juro.2017.10.058 -
Virchows Archiv : An International... Nov 2022Pure seminomas represent the majority of testicular germ cell tumors and accurate diagnosis and staging require an accurate sampling of radical orchiectomy specimens....
Pure seminomas represent the majority of testicular germ cell tumors and accurate diagnosis and staging require an accurate sampling of radical orchiectomy specimens. The aim of our study is to find the most informative gross sampling method for orchiectomy specimens. We performed the extensive sampling of 88 radical orchiectomy specimens embedding in their entirety testicular hilum, rete testis, hilar soft tissue, and spermatic cord. We examined the impact of this procedure on tumor stage, prognostic parameters (lymphovascular invasion and infiltration of rete testis, epididymis, tunica vaginalis, and spermatic cord), and their relationship with recurrence. Eighty-eight seminomas from 88 radical orchiectomies were sampled. Seventy-seven cases (87.5%) presented as clinical stage I and 11 cases (12.5%) as clinical stage II. The follow-up period range was 18-54 months and 82 patients (93.2%) had a minimum of 2-year follow-up. Tumor size ranged from 0.4 to 16 cm (mean 3.6) requiring a mean of 7.1 sections for entire tumoral sampling. Epididymis required 2 to 8 sections (mean 3.3), and hilum and hilar soft tissues 2 to 9 sections (mean 3.4). Epididymal infiltration and lymphovascular invasion resulted significant at multivariate analysis generating a receiver operating characteristic (ROC) curve with area under curve of 0.778. All the other parameters (except for pagetoid rete testis infiltration) were significant to predict metastasis only at univariate analysis. Extensive sampling of radical orchiectomy specimens does not improve the accuracy of staging in pure seminomas. Lymphovascular invasion and epididymal infiltration are useful to predict metastasis.
Topics: Male; Humans; Seminoma; Orchiectomy; Spermatic Cord; Neoplasm Staging; Neoplasm Invasiveness; Testicular Neoplasms; Risk Factors
PubMed: 35776192
DOI: 10.1007/s00428-022-03370-z -
The Journal of Emergency Medicine Jul 2015
Topics: Abdominal Pain; Adult; Edema; Genital Diseases, Male; Groin; Humans; Inflammation; Male; Radiography; Spermatic Cord
PubMed: 25910826
DOI: 10.1016/j.jemermed.2015.02.001 -
Acta Clinica Croatica Mar 2021Liposarcoma of the spermatic cord is a malignant tumor so rare that there are less than 200 cases reported in the literature worldwide. Liposarcoma is a malignancy which...
Liposarcoma of the spermatic cord is a malignant tumor so rare that there are less than 200 cases reported in the literature worldwide. Liposarcoma is a malignancy which originates from fat tissue. Although only 3%-7% of all paratesticular sarcomas primarily arise from structures of the spermatic cord, clinical significance of these tumors must not be neglected because they are often preoperatively misdiagnosed. A 66-year-old male presented with a painless swelling on the left side of the scrotum. Local examination revealed a solid, smooth, limited mass of approximately 4x3 cm in the left side of the scrotum. Tumor markers were within the reference range. Ultrasound examination showed a solid, clearly limited non-homogeneous mass of 40x20 mm localized in the left spermatic cord. Magnetic resonance imaging showed an expansive mass measuring 60x85x60 mm in the left inguinoscrotal region without propagation into the abdominal cavity. Both testicles and epididymides appeared normal on magnetic resonance examination and no locoregional enlarged lymph nodes were seen. The patient was treated operatively with radical inguinal orchiectomy. In conclusion, liposarcomas of the spermatic cord are extremely rare neoplasms that clinically present as slow-growing, painless, palpable inguinal or scrotal masses. Radical orchiectomy with high ligation of the spermatic cord and wide excision of the surrounding soft tissues within the inguinal canal remains the gold standard treatment option. Recurrence of the disease is frequent even several years after primary therapy, therefore long-term follow-up is mandatory.
Topics: Aged; Genital Neoplasms, Male; Humans; Liposarcoma; Male; Neoplasm Recurrence, Local; Orchiectomy; Spermatic Cord
PubMed: 34588721
DOI: 10.20471/acc.2021.60.01.07 -
The Canadian Journal of Urology Dec 2016
Topics: Child; Delayed Diagnosis; Early Medical Intervention; Health Knowledge, Attitudes, Practice; Humans; Male; Spermatic Cord Torsion
PubMed: 27995860
DOI: No ID Found -
International Journal of Surgery Case... Apr 2021Liposarcoma of the spermatic cord is very rare, representing about 7% of para testicular sarcomas. It is considered to be one of the highest malignancy grades. We...
Liposarcoma of the spermatic cord is very rare, representing about 7% of para testicular sarcomas. It is considered to be one of the highest malignancy grades. We present a case of a liposarcoma of the spermatic cord in a 45-year-old male complaining of a progressive painless swelling in the right inguinoscrotal region. Ultrasonography and computed tomography findings were compatible with liposarcoma of the spermatic cord. We performed a right radical orchiectomy with a wide resection of the mass. Histological examination confirmed the diagnosis and showed a pleomorphic subtype. The mainstay of management of spermatic cord liposarcoma is wide excision with radical orchiectomy. The most important factors for prognosis are the histologic subtype and surgical margin status. Adjuvant radiotherapy should be considered in cases at high risk for local recurrence. Long-term surveillance is mandatory. Liposarcoma of the spermatic cord is an uncommon para testicular tumor which should be part of the differential diagnosis of inguinoscrotal mass. A radical inguinal orchiectomy with wide resection of the soft tissue mass and the spermatic cord are the key to longest local and systemic disease-free survival.
PubMed: 33740530
DOI: 10.1016/j.ijscr.2021.105725 -
The Urologic Clinics of North America Nov 2014Use of the operative microscope marked a new era for microsurgery in male infertility and andrology in the 1970s. More than a decade has passed since the initial... (Review)
Review
Use of the operative microscope marked a new era for microsurgery in male infertility and andrology in the 1970s. More than a decade has passed since the initial description of the first robotic-assisted microsurgical vasovasostomy. Large single-center series have recently been published on robotic-assisted microsurgery for vasectomy reversal, especially in the past few years. Multicenter studies are also beginning to be reported, and the potential for this new platform for microsurgery is starting to become more apparent. This article describes the basic technical details of robotic-assisted microsurgery in male infertility and andrology, and reviews the latest literature.
Topics: Humans; Infertility, Male; Male; Microsurgery; Robotic Surgical Procedures; Spermatic Cord; Testis; Varicocele; Vasovasostomy
PubMed: 25306167
DOI: 10.1016/j.ucl.2014.07.010