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SAGE Open Medical Case Reports 2024Testicular epidermoid cysts, accounting for 1%-2% of all testicular masses, present a diagnostic challenge often identified post-orchiectomy. Conservative surgery is...
Testicular epidermoid cysts, accounting for 1%-2% of all testicular masses, present a diagnostic challenge often identified post-orchiectomy. Conservative surgery is recommended, emphasizing the need for accurate preoperative diagnosis. A 28-year-old patient with acute left scrotal pain, initially suggestive of testicular torsion, underwent intraoperative exploration revealing extra-vaginal torsion with an incidentally discovered 2-cm intra-testicular mass. Due to suspected malignancy, a total orchiectomy was performed. Pathological analysis confirmed an epidermoid cyst with normal postoperative tumor markers. The patient had a good postoperative outcome and underwent testicular prosthesis placement 3 months after the surgery. Epidermoid cysts, often identified incidentally during urgent scenarios, underscore the importance of accurate preoperative diagnosis. Conservative surgery remains the preferred approach, emphasizing the consideration of benign factors to prevent unnecessary orchiectomies.
PubMed: 38595943
DOI: 10.1177/2050313X241245286 -
Urology Case Reports May 2024Primary rhabdomyosarcoma of the testis is an exceptionally rare and highly malignant sarcoma. To date, there are only 23 reported cases in the literature. We report a...
Primary rhabdomyosarcoma of the testis is an exceptionally rare and highly malignant sarcoma. To date, there are only 23 reported cases in the literature. We report a 17-year-old male patient presented with massive scrotal swelling that had been progressively enlarging over seven-months. Scrotal ultrasound and contrast-enhanced CT revealed a 10 × 10cm left testicular heterogeneously enhancing mass that extends into the spermatic cord. A left inguinal orchiectomy was performed, and histopathological examinations showed findings consistent with Rhabdomyosarcoma, Embryonic-type. Primary embryonal testicular rhabdomyosarcoma has poor prognosis, particularly for adolescents, and tumour size greater than 10cm. Early diagnosis and radical orchiectomy improve the prognosis.
PubMed: 38571549
DOI: 10.1016/j.eucr.2024.102723 -
Urology Jun 2024Extravaginal torsion (EVT) is a rare type of testicular torsion that usually occurs in neonates. The primary type of testicular torsion that occurs in adolescents is...
Extravaginal torsion (EVT) is a rare type of testicular torsion that usually occurs in neonates. The primary type of testicular torsion that occurs in adolescents is intravaginal torsion. In this case report, we describe the first case of EVT reported in a 16-year-old male with a contralateral bell clapper deformity and subsequent surgical management using a tunica vaginalis flap and bilateral orchiopexy. In discussion of this case, we examine possible anatomical causes of EVT and suggestions for appropriate surgical management.
Topics: Humans; Male; Spermatic Cord Torsion; Adolescent; Orchiopexy
PubMed: 38555070
DOI: 10.1016/j.urology.2024.03.027 -
Reproductive Sciences (Thousand Oaks,... Jul 2024The present study investigates the changes in M1/M2 macrophage polarization resulting from unilateral testicular torsion in the bilateral testis. The study sample...
The present study investigates the changes in M1/M2 macrophage polarization resulting from unilateral testicular torsion in the bilateral testis. The study sample included 63 male Sprague-Dawley rats, which were randomly divided into nine groups (n = 7): Control, Sham (4 h (4 h), 24 h, 7 days (7d), 14d), and Torsion/Detorsion (T/D) (4 h, 24 h, 7d, 14d). Histopathological evaluations revealed no changes in the Sham groups, while T/D was noted to cause edema, vascular occlusion, disruption of seminiferous tubule epithelial organization, germ cell abnormalities and structural anomalies in the experimental rats, the severity and extent of which increased from 4 h to 14d after T/D. The Cosentino scores used to determine the degree of histological damage were consistent with the histopathological findings in all groups, while the Johnsen scores, as a marker of spermatogenesis, were lower in the T/D groups. Seminiferous tubule diameters and germinal epithelial thickness decreased significantly in parallel with increased tubule damage in the ipsilateral testicles. Testicular torsion significantly affected sperm motility, with significant reductions observed in the T/D 7d and T/D 14d groups. A hormone profile analysis revealed decreased testosterone levels in both the Sham and T/D groups when compared to the Controls. CD68 and CD163 immunoreactivities, as M1 and M2 macrophage surface markers, were determined in the testicular tissue using the avidin-biotin-peroxidase complex method. T/D interventions caused M1/M2 macrophage polarization changes and increased M1 macrophages, particularly in contralateral testicular tissue. The increase in M1 macrophages in contralateral testicular tissue following T/D in the present study suggests that cell processes, including macrophages, may play an important role in contralateral testicular injury.
Topics: Animals; Male; Spermatic Cord Torsion; Macrophages; Rats, Sprague-Dawley; Testis; Rats; Antigens, CD; Sperm Motility; Antigens, Differentiation, Myelomonocytic; Spermatogenesis; Cell Polarity; Receptors, Cell Surface; CD68 Molecule
PubMed: 38532231
DOI: 10.1007/s43032-024-01519-6 -
Journal of Equine Science Mar 2024Equine testicular arteritis commonly occurs as a consequence of the migration of nematode larvae or equine arteritis virus (EAV) infection. However, testicular arteritis...
Equine testicular arteritis commonly occurs as a consequence of the migration of nematode larvae or equine arteritis virus (EAV) infection. However, testicular arteritis without evidence of these infections has been reported, and the underlying pathogenesis remains unclear. We encountered testicular arteritis without evidence of nematode or EAV infection in a 3-year-old male heavy draft horse with scrotal enlargement. Grossly, the volume of the pampiniform plexus was markedly increased due to edema. Histologically, non-suppurative and necrotizing testicular arteritis, characterized by lymphocyte infiltration and fibrinoid necrosis of the arterial walls, was diffusely observed in the spermatic cord, pampiniform plexus (most severe), testis, and epididymis. We were unable to identify the cause of arteritis, such as a viral infection or autoimmune abnormality.
PubMed: 38524753
DOI: 10.1294/jes.35.15 -
International Journal of Surgery Case... Apr 2024Inguinal hernia is common, but the groin area can host various pathologies. Distinguishing clinically between hernias and rare conditions like torsion of funiculocele...
INTRODUCTION
Inguinal hernia is common, but the groin area can host various pathologies. Distinguishing clinically between hernias and rare conditions like torsion of funiculocele poses challenges due to similar presentations.
CASE PRESENTATION
A 50-year-old man, with a 10-year-history of a groin mass, presented with a painful groin mass, initially diagnosed as a strangulated hernia. In surgery, a torsion of a cyst was identified, and it was attached to the spermatic cord. A detorsion of the cyst and an excision were successfully performed. The patient recovered well with no recurrence.
DISCUSSION
The most common causes of acute groin pain are injury, incarcerated hernia, kidney stone and bone fracture. Additionally, funiculocele can cause groin pain or discomfort. Funiculocele, a rare congenital anomaly, typically affects pediatric patients. A torsion of funiculocele is easily confused with an incarcerated hernia. Ultrasonography plays a crucial role in confirmation. Although unusual, a torsion of a cyst can occur, necessitating surgical excision.
CONCLUSION
Funiculocele in adults, mimicking hernias, is rare but requires timely surgical intervention to prevent complications. Awareness of this anomaly is vital for accurate diagnosis and appropriate management.
PubMed: 38522305
DOI: 10.1016/j.ijscr.2024.109547 -
European Journal of Surgical Oncology :... Jun 2024Spermatic cord sarcomas are exceedingly rare, often misdiagnosed and subsequently improperly treated at local hospitals. This retrospective study looked at the...
OBJECTIVES
Spermatic cord sarcomas are exceedingly rare, often misdiagnosed and subsequently improperly treated at local hospitals. This retrospective study looked at the oncological outcomes of spermatic cord sarcoma cases managed with curative intent resection at a tertiary referral sarcoma centre. We specifically studied how initial inadequate resections impact the oncologic outcomes compared to primary tumour resections at the reference centre.
METHODS
One hundred eighteen consecutive patients affected by primary, localized spermatic cord sarcoma surgically managed at our reference centre from January 2001 through January 2021 were included. Primary endpoints were local relapse free (LRFS), distant metastasis free (DMFS) and overall survival (OS). These outcomes were evaluated with multi-nomial logistic regression and Cox proportional hazards regression models for a co-relation to known patient, tumour and treatment-related prognostic factors, including a prior inadequate resection and time from diagnosis to a complete oncologic resection as independent variables. Secondarily, we compared the above variables and treatment intervals among the subgroups of primary versus re-resection surgery.
RESULTS
Over a median follow-up of 54 months (IQR 25-105), 12 patients (10.2%) developed local recurrence (LR) and 14 (11.6%) had distant metastasis (DM). 5-year local relapse (LRFS) and distant metastasis-free survival (DMFS) were 89.3% and 86.5%, respectively. Higher tumour grade and size were associated with a worse DMFS (p=<0.05). Likewise, marginal (R1) resection correlated with an inferior LRFS (p=< 0.05). Eighty-four patients (71.2%) had their initial diagnosis established on an inadequate surgical excision performed in a local hospital, followed by a re-excision at our centre (Re-resection group). During the same period, 34 (28.8%) were managed primarily with biopsy and treatment at our reference centre (Primary-resection group). The two groups had statistically significant differences in tumour size, histopathology, surgery duration, rate of postoperative complication and R0 resection (p < 0.005). Additionally, the difference in time intervals to achieve the treatment targets was statistically insignificant and did not correlate to the risk of recurrence as an independent variable. Residual disease was present in 51.2 % (n = 43) of the re-excision specimens. However, following a complete R0 resection, this did not correlate with a higher risk of recurrence (p = 0.481).
CONCLUSION
Prompt referral to a tertiary centre, where multidisciplinary evaluation and sound oncologic resections are the standard of treatment, can align the OS and DFS of patients receiving incomplete surgery elsewhere to those treated primarily in referral centres. The primary determinant of prognosis remains surgical margin, tumour size and grade.
Topics: Humans; Male; Retrospective Studies; Middle Aged; Sarcoma; Referral and Consultation; Neoplasm Recurrence, Local; Spermatic Cord; Genital Neoplasms, Male; Adult; Time-to-Treatment; Survival Rate; Aged
PubMed: 38520783
DOI: 10.1016/j.ejso.2024.108269 -
Journal of Pediatric Urology Jun 2024
Comparative Study
Topics: Humans; Male; Orchiopexy; Laparoscopy; Cryptorchidism; Testis; Spermatic Cord; Traction; Multicenter Studies as Topic
PubMed: 38519284
DOI: 10.1016/j.jpurol.2024.02.029 -
Abdominal Radiology (New York) Jun 2024To evaluate quantitative and qualitative spermatic cord CT abnormalities and presence of unilateral or bilateral symptomatic scrotal pathology (SSP) at ultrasound.
PURPOSE
To evaluate quantitative and qualitative spermatic cord CT abnormalities and presence of unilateral or bilateral symptomatic scrotal pathology (SSP) at ultrasound.
METHODS
This retrospective study included 122 male patients (mean age 47.8 years) undergoing scrotal ultrasound within 24 h of contrast-enhanced CT (n = 85), non-contrast CT (NECT, n = 32) or CT-Urogram (n = 5). CECT quantitative analysis assessed differential cord enhancement using maximum Hounsfield unit measurements. Three fellowship trained body radiologists independently assessed qualitative cord abnormalities for both CECT and NECT. Qualitative and quantitative findings were compared with the presence of SSP. Reader performance, interobserver agreement and reader confidence were assessed for NECT and CECT. Quantitative cutoff points were identified which maximized accuracy, specificity, negative predictive value, and other measures.
RESULTS
SSP was present in 36/122 patients (29.5%). Positive cases were unilateral in 30 (83.3%) and bilateral in 6 (16.6%). At quantitative assessment, 25% differential cord enhancement had the highest diagnostic accuracy (88.9%), with 90.5% positive predictive value, 88.4% negative predictive value, 96.8% specificity, and 70.4% sensitivity. At qualitative evaluation, CECT reader performance was excellent (aggregate AUC = 0.86; P < .001); NECT was poorly discriminatory, although remained significant (aggregate AUC = 0.67; P = .002). Readers had significantly higher confidence levels with CECT (P < .001). Qualitative inter-observer agreement was high for both CECT and NECT (ICC = 0.981 and 0.963, respectively).
CONCLUSION
Simple quantitative assessment of differential cord enhancement is highly accurate and specific for SSP at CECT. Qualitative abnormalities at CECT and NECT are also both predictors of SSP, however, CECT significantly out-performs non-contrast exams.
Topics: Humans; Male; Middle Aged; Retrospective Studies; Scrotum; Spermatic Cord; Tomography, X-Ray Computed; Contrast Media; Aged; Adult; Sensitivity and Specificity; Predictive Value of Tests; Ultrasonography; Aged, 80 and over; Genital Diseases, Male; Adolescent
PubMed: 38517545
DOI: 10.1007/s00261-024-04251-6 -
Indian Journal of Surgical Oncology Mar 2024Testicular tumors include germ cell tumors, sex cord stromal tumors, and ovarian type epithelial tumors. Testicular mucinous tumors belong to ovarian type epithelial...
Testicular tumors include germ cell tumors, sex cord stromal tumors, and ovarian type epithelial tumors. Testicular mucinous tumors belong to ovarian type epithelial tumors and are extremely rare with only 31 cases reported in literature so far. Among those, mucinous adenocarcinoma constitutes only 9 cases. There are no standard treatment guidelines owing to their rarity. We report a case of primary testicular mucinous adenocarcinoma managed by orchidectomy, chemotherapy, and retroperitoneal lymph node dissection. A 44-year-old gentleman presented with right testicular tumor with infiltration and ulceration of scrotal skin. Tumor markers were within normal limits. Patient underwent orchidectomy with excision of involved scrotal skin. HPE suggested mucinous adenocarcinoma of testis. Patient was then administered chemotherapy but had progression of disease and hence taken up for retroperitoneal, bilateral pelvic, and bilateral inguinal lymph node dissection with revision of spermatic cord. Patient recovered uneventfully and is on regular follow-up 6 months now since surgery. There are no standard guidelines for the management of mucinous adenocarcinoma of testis. It is essential to rule out mucinous carcinoma of gastrointestinal tract metastasizing to testis before labeling as primary mucinous adenocarcinoma of testis. Surgery remains the mainstay of treatment in metastasis confined to retroperitoneal and inguinal lymph nodes. Further studies are needed to identify optimal chemotherapy regimen for metastatic and adjuvant scenarios.
PubMed: 38511018
DOI: 10.1007/s13193-023-01832-7