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Modern Pathology : An Official Journal... Feb 2022The 8th Edition of the American Joint Committee on Cancer (AJCC) Staging Manual designates discontinuous involvement of spermatic cord soft tissue by testicular germ...
The 8th Edition of the American Joint Committee on Cancer (AJCC) Staging Manual designates discontinuous involvement of spermatic cord soft tissue by testicular germ cell tumors as a metastatic deposit. We conducted a retrospective international multi-institutional study to validate the current recommendations. Thirty-three (72%) nonseminomatous and 13 (28%) seminomatous testicular germ cell tumors were collected from 15 institutions in America, Europe, and Asia. Testicular tumor size ranged from 1.3 to 18.0 cm (mean: 6.1). Cases were classified as discontinuous involvement of spermatic cord soft tissue (n = 26), continuous cord involvement (n = 17), or cord lymphovascular invasion (n = 3). The mean follow-up was 39 months. Clinical stage for discontinuous involvement of spermatic cord soft-tissue patients was I (local disease) in 2/24 (8%), II (regional disease) in 6/24 (25%), and III (distant disease) in 16/24 (67%) cases; 16 (67%) patients presented with distant metastasis. Clinical stage for continuous cord involvement patients was I in 9/17 (53%), II in 4/17 (23%), and III in 4/17 (23%); 4 (23%) patients presented with distant metastasis. Disease progression was seen in 4 patients with discontinuous involvement of spermatic cord soft tissue and 5 with continuous cord-involvement (p = 0.699). When comparing discontinuous and continuous cord involvement, a significant difference was found in cord margin status (p = 0.044), spermatic cord tumor size (p = 0.016), lymph-node involvement (p = 0.037), distant metastasis (p = 0.010), individual clinical stage (p = 0.003), and nonadvanced vs. advanced disease (p = 0.003) at presentation. In multivariate analysis, after adjusting for age, histology, testicular tumor size, percent of embryonal carcinoma, lymphovascular invasion, and cord margin status, discontinuous involvement of spermatic cord soft tissue was significantly associated (p = 0.011) with advanced clinical stage at presentation. Our findings support the designation of metastatic disease for discontinuous involvement of spermatic cord soft tissue, as introduced by the 8th edition of the AJCC staging.
Topics: Humans; Male; Neoplasm Staging; Neoplasms, Germ Cell and Embryonal; Retrospective Studies; Spermatic Cord; Testicular Neoplasms
PubMed: 34504308
DOI: 10.1038/s41379-021-00912-9 -
Annals of Saudi Medicine 2020Inflammatory myofibroblastic tumor (IMT) is a neoplasm of intermediate biological potential. Few cases of spermatic cord IMT have been reported in the literature.... (Review)
Review
Inflammatory myofibroblastic tumor (IMT) is a neoplasm of intermediate biological potential. Few cases of spermatic cord IMT have been reported in the literature. Inflammatory myofibroblastic tumor is a consequence of the proliferation of fibroblasts and inflammatory cells. Despite its benign nature, the tumor often clinically mimics intrascrotal malignancy and usually remains undiagnosed preoperatively. The diagnosis of spermatic IMT is difficult preoperatively due to the non-specific findings. Therefore, if testicular tumors cannot be precisely excluded, radical orchiectomy should be performed for the diagnosis and treatment. However, it mainly occurs in children and young adults; spermatic IMT may also be seen among elderly men. Here, we report two cases of inflammatory myofibroblastic tumor involving the spermatic cord. SIMILAR CASES PUBLISHED: There are seven cases entitled "inflammatory myofibroblastic tumor of spermatic cord" in the literature. In our study we present two cases that had a spermatic cord IMT. Furthermore, one of these cases was 82 years of age and is the oldest patient presented in the literature.
Topics: Aged, 80 and over; Genital Neoplasms, Male; Humans; Male; Middle Aged; Neoplasms, Muscle Tissue; Spermatic Cord
PubMed: 32027518
DOI: 10.5144/0256-4947.2020.66 -
International Journal of Surgery Case... May 2024Encysted spermatic cord hydrocele is a rare anomaly characterized by obstruction of processus vaginalis closure. Clinically, it presents as a swelling in the inguinal...
INTRODUCTION AND IMPORTANCE
Encysted spermatic cord hydrocele is a rare anomaly characterized by obstruction of processus vaginalis closure. Clinically, it presents as a swelling in the inguinal region extending to the upper scrotum and does not communicate with the peritoneal cavity. It is often mistaken for indirect inguinal hernias, inguinal lymphadenopathy, undescended testis, and primary tumors of the cord in infants and children, making the diagnosis challenging.
CASE PRESENTATION
We report the cases of five male patients aged nine months to 12 years who presented with painless swelling on the right side of the scrotal region. Physical examination revealed firm masses in the right inguinal region with positive transillumination, negative cough impulse tests, and irreducibility. Inguinal and scrotal ultrasonography showed an anechoic cystic lesion with thin walls, without any signs suggestive of a hernia. Patients were diagnosed with encysted spermatic cord hydrocele and advised to undergo cyst excision. The postoperative periods were uneventful, and expected recovery was observed at one-week and one-month follow-ups.
CLINICAL DISCUSSION
Encysted spermatic cord hydroceles are rare causes of painless inguinal swelling. The medical history and clinical findings can be used to establish a diagnosis, which can be confirmed using ultrasonography. Management depends on differentiating between spermatic cord hydrocele and scrotal hydrocele and involves considering the type. Treatment options range from conservative measures to surgery, particularly for non-communicating hydroceles that persist beyond 12-18 months or enlarge in size.
CONCLUSION
Encysted hydrocele of the cord is rare and is often mistaken for indirect inguinal hernias in infants and children. This similarity makes the diagnosis challenging and necessitates vigilance from clinicians. Surgical intervention results in optimal outcomes, especially in cases where the hydrocele persists beyond 12-18 months or with size progression.
PubMed: 38626639
DOI: 10.1016/j.ijscr.2024.109619 -
Cancer Management and Research 2021The metastasis of gastric cancer to the testis or spermatic cord is very rare; however, simultaneous testicular and spermatic cord metastases are even rarer. Here, we...
The metastasis of gastric cancer to the testis or spermatic cord is very rare; however, simultaneous testicular and spermatic cord metastases are even rarer. Here, we report an unusual case of a 54-year-old male patient who had undergone radical gastrectomy for gastric adenocarcinoma more than two years before. He complained of palpable painful masses in the right scrotum and inguinal area occurring for more than half a year. Enhanced computed tomography (CT) separately showed an enhanced soft tissue mass in the right testicular and spermatic cord areas. Therefore, a right radical orchiectomy was conducted. The pathology was consistent with the metastases of gastric adenocarcinoma.
PubMed: 33654434
DOI: 10.2147/CMAR.S286909 -
Archivos Espanoles de Urologia Jul 2018We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and... (Review)
Review
OBJECTIVE
We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and therapeutic characteristics.
METHODS
Retrospective review of the medical records of two patients diagnosed of liposarcoma of the spermatic cord.
RESULTS
Case 1: 65 year old male, presented a left large scrotal mass of 20 × 14 × 11 cm. He underwent radical orchiectomy. Pathology reported a well differentiated spermatic cord liposarcoma. After one year of follow-up the patient was asymptomatic and there was no evidence of local recurrence. Case 2: A 90 year old man, with past medical history of right orchiectomy for well-differentiated cord liposarcoma 11 years before, and excision of recurrence 7 years ago. On follow up he presented a new 20 × 14 × 11 cm inguinal tumor recurrence. We performed excision of the mass, which was reported by pathology as well differentiated spermatic cord liposarcoma. Ten months after surgery the patient was asymptomatic without recurrence.
CONCLUSIONS
Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. It is therefore difficult to establish the guidelines for treatment, prognosis and differential diagnosis. As in liposarcomas in other sites, the histological type and grade of the lesion are useful for the prognosis. Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. It has not been demonstrated the efficacy of adjuvant treatments such as chemotherapy or radiotherapy, except in specific situations. The natural history of disease is slow and it has low mortality, but high recurrence rate, so a long-term monitoring is necessary.
Topics: Aged; Aged, 80 and over; Genital Neoplasms, Male; Humans; Liposarcoma; Male; Retrospective Studies; Spermatic Cord
PubMed: 29991664
DOI: No ID Found -
Acta Medica Portuguesa 1999Painful scrotum is a clinical entity that includes a variety of diseases, such as torsion of the spermatic cord, infectious conditions, injuries and oncology. This...
Painful scrotum is a clinical entity that includes a variety of diseases, such as torsion of the spermatic cord, infectious conditions, injuries and oncology. This condition is more common in infants or youths. It is extremely important to recognize this condition and treat it promptly if the testicle is to be saved.
Topics: Acute Disease; Communicable Diseases; Diagnosis, Differential; Genital Diseases, Male; Humans; Male; Scrotum; Spermatic Cord Torsion
PubMed: 10423872
DOI: No ID Found -
International Journal of Clinical and... 2020Extra-adrenal paraganglioma is rare, and occurs in the retroperitoneum, and head and neck. The incidence rate of paraganglioma in urogenital system is very low,...
Extra-adrenal paraganglioma is rare, and occurs in the retroperitoneum, and head and neck. The incidence rate of paraganglioma in urogenital system is very low, especially in the spermatic cord. A case of paraganglioma of spermatic cord is reported and relevant literature is reviewed. A spermatic cord mass was found in the right scrotum in a middle-aged man 2 years ago, without hormone symptoms. Understanding of clinical and intraoperative frozen pathology was inadequate. Ultrasound images showed that there was abundant blood supply around the right spermatic cord with clear boundaries. The conventional pathology of the tumor presented a typical histologic morphology of paraganglioma. Immunohistochemistry showed that chief tumor cells were CGA (+), syn (+), CD56 (+), SDHB (+), and sertoli cells were S-100 (strong+). There are few reported cases at present, and the etiology and pathogenesis are not clear yet. The rapid frozen pathologic diagnosis during operation is very challenging, and it is easily diagnosed by routine histology combined with immunohistochemistry. Gene detection is recommended if necessary. Early diagnosis is helpful to the choice of operation mode and the prevention and control of intraoperative risk.
PubMed: 32782705
DOI: No ID Found -
Current management of liposarcoma of the spermatic cord: A case report and review of the literature.Molecular and Clinical Oncology Mar 2017Liposarcomas of the spermatic cord, a rare cause of an inguinal mass, may closely mimic inguinal hernias on clinical examination. However, these tumors require a...
Liposarcomas of the spermatic cord, a rare cause of an inguinal mass, may closely mimic inguinal hernias on clinical examination. However, these tumors require a different surgical approach and treatment plan; therefore, intraoperative diagnosis might complicate patient management. We report the case of a 63-year-old man who presented with a mobile mass in the inguinal canal consistent with an inguinal hernia. The patient was subsequently diagnosed with a liposarcoma of the spermatic cord and successfully treated with extensive local resection, including radical orchiectomy and en bloc resection of the mass and associated cord structures. No adjuvant therapy was deemed necessary, and the patient remained asymptomatic and disease-free 10 years after surgery. The details of this case are presented, along with a review and discussion of the currently available data regarding the diagnosis and management of this challenging condition.
PubMed: 28451429
DOI: 10.3892/mco.2017.1157 -
The Archives of Bone and Joint Surgery Oct 2015Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes...
BACKGROUND
Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw.
METHODS
Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the distance of implants and the midline from the spermatic cord.
RESULTS
The average distance between the midline and spermatic cords was 34.2 mm. The average distance between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant.
DISCUSSION
Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde superior pubic ramus medullary screws.
PubMed: 26550592
DOI: No ID Found -
International Journal of Surgery... Dec 2015To assess the feasibility and the safety of conservative surgery to treat spermatic cord leiomyosarcoma.
OBJECTIVES
To assess the feasibility and the safety of conservative surgery to treat spermatic cord leiomyosarcoma.
METHODS
Patients undergoing inguinoscrotal exploration in 10 different Urological Centers with diagnosis of leiomyosarcoma were enrolled. Preoperative evaluation included physical examination, Scrotal US, Abdominal CT and Scrotal MRI in selected cases. Patients underwent organ sparing surgery or orchiectomy in case of intraoperative FSE was positive for a local infiltration. Data collected were: age, presence of infiltration, length of the lesion, number of lesions, definitive histological outcome, pre and postoperative testosterone level. Follow up was performed with abdomen CT scan and scrotal US.
RESULTS
From January 2007 to December 2013, 23 patients (mean age: 64.7 yrs) were diagnosed with spermatic cord leiomyosarcoma. Each patients underwent scrotal US. 10 patients underwent radical orchiectomy and 13 patients underwent conservative surgery. Mean follow up was 36.5 months. 5 patients (21.7%) developed a recurrent disease, 18 patients (78.3%) had a negative follow up (mean time: 40.8 months). Statistical analysis reveals that there is a significant correlation between number of lesions, length of the lesions and recurrent disease.
CONCLUSIONS
Spermatic cord leiomyosarcoma is a rare disease. Conservative surgical treatment of spermatic cord leiomyosarcoma is a feasible therapeutic option for small, single and not infiltrating lesion.
Topics: Aged; Feasibility Studies; Humans; Leiomyosarcoma; Magnetic Resonance Imaging; Male; Middle Aged; Orchiectomy; Patient Safety; Spermatic Cord; Testicular Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 26578108
DOI: 10.1016/j.ijsu.2015.11.012