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Radiology Case Reports Nov 2023Liposarcoma of the spermatic cord is a malignant neoformation so rare that less than 200 cases are reported in the world. It is a tumor that originates from adipose...
Liposarcoma of the spermatic cord is a malignant neoformation so rare that less than 200 cases are reported in the world. It is a tumor that originates from adipose tissue and when it is found in the spermatic cord it can deceptively simulate an inguinal hernia and not be easily identified. The present work describes the case of a 37-year-old man with liposarcoma of the spermatic cord who arrives at our institution with painless swelling of the left testicle. Physical examination revealed a painless swelling in the scrotal sac. The scrotal ultrasound examination revealed a mass, measuring 8 cm (cranio-caudal) × 5.4 cm (latero-lateral) × 8 cm (antero-posterior) and characterized later with a basal CT examination of the abdomen. The patient was subsequently surgically treated with excision of the tumor, plus hernial plastic with plug and mesh. Histological examination revealed a mature adipocyte neoplasm whose morphological and molecular characteristics (amplification of the MDM2 gene) are consistent with the diagnosis of . The patient is currently under cancer surveillance with no signs of loco-regional recurrence. Spermatic cord liposarcoma is an extremely rare malignancy. It's not easy to identify as it can simulate an inguinal hernia, hydrocele, lipoma, funicular cyst, or testicular tumor. Diagnosis is usually established postsurgery, however, relapses are common and the role of chemo-radiotherapy remains to be defined.
PubMed: 37680656
DOI: 10.1016/j.radcr.2023.08.031 -
ANZ Journal of Surgery May 2022
Topics: Cryptorchidism; Humans; Male; Spermatic Cord; Testis
PubMed: 34658122
DOI: 10.1111/ans.17281 -
Radiology Case Reports Dec 2022Spermatic cord abscess is a rare condition usually associated with other genitourinary infections. We present a case of a 49-year-old male with past medical history of...
Spermatic cord abscess is a rare condition usually associated with other genitourinary infections. We present a case of a 49-year-old male with past medical history of uncontrolled diabetes mellitus. He presented with right groin swelling and pain for a week. Ultrasound showed a tubular hyperemic structure extending into the scrotal sac. Computed tomography showed concurrent perinephric abscess and right spermatic cord abscess. The spermatic cord abscess was managed surgically by incision and drainage. To our knowledge, this is the first case report of a patient with spermatic cord abscess and concurrent perinephric abscess. We highlight the clinical importance of familiarity with such a rare condition and the role of imaging in establishing the correct diagnosis while excluding close differentials.
PubMed: 36204416
DOI: 10.1016/j.radcr.2022.09.026 -
Asian Journal of Andrology 2020We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General...
We retrospectively reviewed data for 286 patients with varicocele who underwent microsurgical subinguinal varicocelectomy from March 2015 to May 2017 in Shanghai General Hospital (Shanghai, China). In this surgical approach, the testis was delivered, and the gubernacular and external cremasteric veins were stripped. In addition, the spermatic cord was delivered downward with continuous double traction away from the external ring. The remaining procedure was similar to the conventional approach. We followed patients for at least 3 months and evaluated postoperative semen parameters, pain symptoms, and complications. We excluded data for 32 men due to inadequate follow-up (<3 months). Of the remaining 254 patients, 73 had oligoasthenospermia, 121 had nonobstructive azoospermia, and 60 had symptomatic varicoceles. Total progressive sperm counts increased in the oligoasthenospermic patients from a median preoperative value of 9.15 × 10 ml to 25.33 × 10 ml (n= 34), and 35.6% (26/73) initially oligoasthenospermic men contributed to unassisted pregnancies. Sperm returned to the ejaculate in 12.4% (15/121) azoospermia patients. In patients with scrotal pain (n = 60), 43 (71.7%) reported complete resolution of pain, 16 (26.7%) reported partial resolution, and 1 (1.7%) reported no change. No patients experienced varicocele recurrence. This double-traction strategy avoids opening the external oblique aponeurosis, and results in less damage and faster recovery. In addition, the stripping strategy eliminates potential damage to the testis caused by the varicose veins. Our results showed that microsurgical subinguinal varicocelectomy using spermatic cord double traction in conjunction with testicular delivery for vein stripping is a safe and effective approach for varicocele repair.
Topics: Adolescent; Adult; Humans; Male; Microsurgery; Middle Aged; Retrospective Studies; Spermatic Cord; Testis; Treatment Outcome; Urogenital Surgical Procedures; Varicocele; Veins; Young Adult
PubMed: 31793442
DOI: 10.4103/aja.aja_118_19 -
American Family Physician Jan 2022
Topics: Aneurysm; Genital Diseases, Male; Hernia, Inguinal; Humans; Male; Middle Aged; Physical Examination; Scrotum; Spermatic Cord Torsion; Testicular Hydrocele; Testis; Varicocele
PubMed: 35029938
DOI: No ID Found -
Basic and Clinical Andrology May 2022Sarcoidosis is a multi-system disease characterized by the formation of non-caseating granulomas in various organs. The lungs remain the most frequently affected organ,...
BACKGROUND
Sarcoidosis is a multi-system disease characterized by the formation of non-caseating granulomas in various organs. The lungs remain the most frequently affected organ, whereas lesions in the genitourinary system affect around 0.2% of patients. The primary site found in the spermatic cord is extremely rare.
CASE PRESENTATION
We present a patient's case where the spermatic cord involvement was the first manifestation of sarcoidosis. For several months, a number of tests had been performed, which showed, among others, non-caseating granulomas in pathomorphological material, bilateral hilar lymphadenopathy, and leukopenia with lymphopenia. Tumor markers were normal. Infection with urogenital pathogens (including Chlamydia Trachomatis, Neisseria gonorrhea, Mycoplasma hominis) was excluded. The patient did not report any general symptoms such as fever, excessive fatigue, weight loss. He denied swelling, shortness of breath. At the same time, a complete differential diagnosis was carried out, and the extent of the disease was assessed. Due to interdisciplinary management, the patient's quality of life and fertility is preserved. In the discussion, we present the diagnosis, treatment, and prognosis of such patients.
CONCLUSION
Sarcoidosis is a multi-system disease, which should not be omitted in the differential diagnosis. Selective excision of the lesion with intraoperative examination plays a significant role while establishing a diagnosis. However, in the primary site in the genitourinary system, the diagnosis is challenging.
PubMed: 35590251
DOI: 10.1186/s12610-022-00158-8 -
Urology Case Reports Nov 2020Epididymo-testicular infarction associated with ischemia of spermatic cord without torsion secondary to an orchiepididymitis is an extremely rare pathological entity, of...
Epididymo-testicular infarction associated with ischemia of spermatic cord without torsion secondary to an orchiepididymitis is an extremely rare pathological entity, of little known etiopathogenesis and idiopathic in the majority of cases. The authors report an original observation of a 23-year-old young patient with a history of untreated orchiepididymitis, which presented to the emergency department for testicular pain. The ultrasound has showed an ischemic testicle and the exploratory scrototomy objectified an epididymo-testicular necrosis associated with ischemia of spermatic cord without torsion. This case highlighted the interest of early diagnosis and effective treatment of orchiepididymitis to prevent this rare serious complication.
PubMed: 33102026
DOI: 10.1016/j.eucr.2020.101324 -
World Journal of Urology Dec 2023Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic...
PURPOSE
Cut-off time to avoid orchiectomy relies on small series of patients. The objective was to determine the cut-off time to avoid orchiectomy in torsion of the spermatic cord in a large cohort.
METHODS
We performed a retrospective multicenter study (TORSAFUF cohort) of patients with suspected spermatic cord torsion between 2005 and 2019. All patients aged > 12 years who were suspected of having a torsion of the spermatic cord in 14 University Hospitals in France were included (n = 2986). Patients for whom data on pain duration were not available (n = 923) or for whom the final diagnosis was not torsion of the spermatic cord (n = 807) were excluded. The primary outcome was orchiectomy. The secondary outcomes were testicular survival time and the prediction of orchiectomy with the duration of pain.
RESULTS
1266 patients were included with an orchiectomy rate of 12% (150 patients). The mean age was 21.5 years old in the salvage group and 23.7 years old in the orchiectomy group (p = 0.01), respectively. The median time from the onset of pain to surgery was 5.5 (IQR = 5) hours in the salvage group and 51.1 (IQR = 70) hours in the orchiectomy group (p < 0.0001). The risk of orchiectomy increased after a time cut-off of 6 h 30. A delay of 15 h 30 in pain duration was found to predict orchiectomy (sensitivity: 0.81; specificity: 0.87).
CONCLUSIONS
Pain duration can predict the probability of salvaging the testicles and performing orchiectomy. Rapid intervention should be recommended, regardless of the time elapsed from the onset of pain.
Topics: Adult; Humans; Male; Young Adult; Orchiectomy; Orchiopexy; Pain; Retrospective Studies; Spermatic Cord Torsion; Adolescent
PubMed: 37897515
DOI: 10.1007/s00345-023-04671-x -
Frontiers in Surgery 2020A spermatic cord lipoma is found in 20-70% of all inguinal hernia repairs. The clinical picture of an inguinal hernia with bulging and pain but without an actual...
A spermatic cord lipoma is found in 20-70% of all inguinal hernia repairs. The clinical picture of an inguinal hernia with bulging and pain but without an actual indirect hernia sac may become manifest in up to 8% of these cases. Missed spermatic cord lipoma can result in recurrence or pseudo-recurrence. This review presents the relevant literature on this topic. A systematic search of the available literature was performed in February 2020 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals and reference lists. Forty-two publications were identified as relevant for this topic. Spermatic cord lipoma seems to originate from preperitoneal fatty tissue within the internal spermatic fascia in topographical proximity to the arteries, veins, lymphatics, nerves, and deferent duct within the spermatic cord. Reliable diagnosis cannot be made clinically, but rather with ultrasound, CT, or MRI. In the absence of a real hernia sac, a spermatic cord lipoma is classified as a lateral inguinal hernia with a defect size <1.5 cm according to the European Hernia Society (EHS LI). Missed or inadequately treated spermatic cord lipoma results in recurrence or pseudo-recurrence. Since spermatic cord lipoma obtains its vascular supply from the preperitoneal space, it can be reduced or resected. Spermatic cord lipoma is a common finding in inguinal hernia repairs and must be properly diagnosed and treated with care respecting the anatomy of the spermatic cord.
PubMed: 32793626
DOI: 10.3389/fsurg.2020.00039