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A case of spermatic cord liposarcoma is reported. A 66-year-old male visited our hospital with the complaint of right scrotal swelling. Laboratory and radiological examinations were unremarkable. A right high orchiectomy with en bloc resection of pericordal tissue was performed. Histological examination revealed well-differentiated liposarcoma of spermatic cord. There are 19 cases of spermatic cord liposarcoma reported in Japan.
Malignant tumors of the spermatic cord are rare with primary neoplasms being mostly sarcomas. Adenocarcinomas of the spermatic cord are found extremely seldom and are predominantly metastases of extragonadal tumors. We present an asymptomatic 47-year-old patient who was referred to our clinic after a vasectomy had been performed and the histological examination had surprisingly shown adenocarcinoma of the left spermatic cord. Extensive laboratory analysis and diagnostic imaging did not demonstrate any testicular, spermatic cord, or extragonadal tumor. To exclude a mix-up of specimens, we performed DNA analysis. Microsatellite PCR clearly demonstrated the different origins of the tumor and the vasectomy specimen. Specimen mix-up or contamination may happen in any phase of surgical or pathological processing. In any case of clinical uncertainty concerning the identity of a tissue specimen, this possibility has to be taken into consideration. Microsatellite PCR can clearly identify the origin of tissue samples even on embedded material.
Unilateral spermatic cord torsion has been shown to cause damage to the contralateral testis in humans and animal models. In an attempt to explain conflicts among various laboratories concerning the extent of this contralateral effect and to determine the importance of the extent of torsion, prepubertal rats (35 to 40 days) were subjected to unilateral spermatic cord torsion of various degrees (zero to 1440 degrees). Sham surgeries were performed and served as controls (0 degrees of torsion). The animals were allowed to recover from the surgeries and to attain puberty before a period of fertility testing. Fertility, fecundity, organ weight and testicular histological data were obtained after the breeding period. Our data indicate that animals undergoing 360 degrees of torsion exhibited no changes in the parameters studied. However, if 720 degrees, 1080 degrees or 1440 degrees of torsion was induced, a significantly lower percentage of fertile males and pregnant females resulted for each of these experimental groups when compared to those values for the 0 degrees controls. These data indicate that the extent of contralateral testicular degeneration is dependent upon the degree of spermatic cord torsion to which the ipsilateral testis is subjected. The induction of unilateral spermatic cord torsion at 720 degrees or more causes a significant reduction of subsequent fertility while torsion of a lesser degree has little or no effect in the development of this phenomenon.
Leiomyosarcoma of the spermatic cord is extremely rare. We report a case associated with recurrent papillary bladder tumours and benign hyperplasia of the prostate. The use of adjuvant chemotherapy is described for the first time in the management of this condition.
Phaeochromocytoma of the spermatic cord is very rare. It can arise anywhere in the distribution of cells of neural crest origin, but 80-90% arise in the adrenal medulla and only 3% are extra-abdominal. A small tumour may be asymptomatic because insufficient catecholamines are secreted to cause haemodynamic disturbance.
Liposarcoma of the spermatic cord is a rare tumor. Most are of a low-grade malignancy, and treatment is wide local excision with radical orchiectomy. At present there is no clear indication for chemotherapy. Because recurrence, especially local recurrence, is a possibility, periodic followup is necessary. Local recurrences are treated with repeat wide local excision and radiotherapy.
Sarcomas of the spermatic cord are rare, with only approximately 200 such tumors reported in the literature. Of those cases only 3 fit the definition of malignant mesenchymoma: a mesenchymal tumor with 2 or more malignant elements other than fibrosarcoma. We report the fourth such case treated by local excision alone. The patient was free of disease 6 years after treatment.
Liposarcoma of the spermatic cord is rare. It usually presents as a painless slowly-growing scrotal mass of consistency like lipoma. Inguinal orchiectomy is an adequate surgical approach. Retroperitoneal lymphadenectomy is not indicated owing to the low malignancy potential of the sarcomas. Value of adjuvant radiotherapy/chemotherapy remains uncertain. Recurrences are frequent, owing to incomplete surgical removal of the tumor. We report on a 62 year old male who presented with a half a year history of a soft painless mass in the left scrotum extending from the groin up to the testis. Clinical examination suggested inguinal hernia. Radical orchiectomy was performed. Histological examination revealed a well-differentiated liposarcoma of sclerosing subtype. No evidence of recurrence or metastases has been noted during the 6-month and one year follow-up without any postoperative adjuvant therapy.
A case of fibroma of the spermatic cord is presented. A 26-year-old man was admitted with the complaint of a painless swelling in the left scrotum. On physical examination, the tumor seemed to be in the left spermatic cord. It was removed surgically on May 2, 1983. Microscopic examination of the specimen revealed that the tumor was composed of collagen fibers and fibroblasts. This histological finding was compatible with that of fibroma. Seven cases of fibroma of the spermatic cord so far reported in Japan, including this case, were reviewed.
Torsion of the spermatic cord is responsible for an ischemic necrosis of the testis in the absence of rapid resaturation of the perfusion. It is also responsible for contralateral parenchymal alterations resulting in subfertility. Torsion of the spermatic cord mostly occurs in newborns and adolescents. Its classical clinical pattern is that of an acute-onset ipsilateral scrotal pain. Its diagnosis is clinical and its suspicion must lead to an immediate surgical scrotal exploration. The surgical procedure may be preceded by an attempt of external detorsion, but never delayed by any para clinical exploration. If the diagnosis is confirmed at surgery, contra-lateral orchidopexy must be considered. Trophicity of the ischemic testicle and the fertility of the patient are uncertain. Improvement of the prognosis of patients with torsion of the spermatic cord needs an urgent surgical management of the patients. It also claims for the development of testicular parenchyma protective medical treatments. But the most important improvement should come from parental and teenagers educational information so that they urgently visit a practitioner in case of acute scrotal pain.
A recently experienced case of lipoma of the spermatic cord is reported. The patient was a 42-year-old man with the chief complaint of indolent swelling of the left scrotal contents which had been noticed about six months earlier. An elastic firm, nontender and fist-sized mass with negative transillumination was palpated in the left spermatic cord. The tumor was removed and histologically diagnosed as lipoma originating in the left spermatic cord. The removed specimen weighed 72 g and was 8 X 5 X 3 cm. Including the present case, 40 cases of lipoma of the spermatic cord in the Japanese literature are reviewed.
A case of metastatic tumor of right spermatic cord in a 54-year-old man is reported. He visited our department with the complaint of a painless mass in right inguinal lesion. The initial diagnosis was a right spermatic cord tumor, and then orchiectomy was performed. Since pathological findings showed a poorly differentiated adenocarcinoma, further examinations were done, postoperatively. An upper gastrointestinal series revealed the presence of gastric carcinoma. Thus, these results suggested that the spermatic cord tumor was a metastatic lesion from the gastric carcinoma. Forty eight cases of metastatic tumor of the spermatic cord have been reported in our country. In 26 of these cases, gastric carcinoma metastasized to the spermatic cord.
OBJECTIVES: To characterize the arterial microanatomy within the spermatic cord. METHODS: Between June 2002 and March 2003, 72 men underwent 120 microsurgical subinguinal varicocelectomies for the treatment of varicocele. A micro-ruler was used to measure the diameter of each artery in the spermatic cord at the external inguinal ring. RESULTS: A single testicular artery was identified in 83 (69%), two testicular arteries in 32 (27%), and three arteries in 4 (3%) of 120 cases. The testicular artery diameter ranged from 0.2 to 1.9 mm (mean 1.0). A single vasal artery was identified in 117 (98%) of 120 cases, with the vasal artery diameter ranging between 0.2 and 1.8 mm (mean 0.6). A single cremasteric artery was identified in 66 (55%), two arteries in 37 (31%), and three arteries in 5 (4%) of 120 cases. The cremasteric artery diameter ranged from 0.1 to 1.5 mm (mean 0.5). The diameter of the testicular artery was equal to or greater than the sum of the vasal and cremasteric artery diameters in 69 (57.5%) of 120 spermatic cords. CONCLUSIONS: The testicular artery was consistently the largest caliber arterial vessel, with a diameter equal to or greater than the sum of the vasal and cremasteric arteries in more than 50% of the spermatic cords. This suggests that although the vasal and cremasteric arteries combined contribute significantly to the testicular blood supply, the testicular artery provides most of the blood flow to the human testes. Preservation of the testicular arteries is recommended for optimal testicular blood flow.
BACKGROUND: Although the primary abnormality in testicular torsion is at the spermatic cord, imaging studies up to now have mostly been oriented to evaluation of the testicle itself, with emphasis on color Doppler ultrasonography (US). However, findings can be inaccurate when there is incomplete interruption of testicular flow. Indirect findings, such as morphological changes in the testis alone, are not reliable for the diagnosis since they become evident late in the disease. OBJECTIVE: To call to attention to the fact that sonographic visualization of the spermatic cord can be the key for diagnosis in those patients with acute scrotal pain as a result of testicular torsion, particularly when color Doppler US shows that intratesticular flow is present within the affected testis. PATIENTS AND METHODS: Six patients who presented clinically with acute scrotal pain and had spermatic cord torsion, proven at surgery. All patients were initially studied with color Doppler US, and intratesticular flow was detected in all of them. Patients who showed structural abnormalities on gray-scale US and/or absence of intratesticular vascular flow in the affected testis were not included. In addition to a conventional study, the spermatic cord was examined. RESULTS: The spermatic cord was shown to be rotated on the symptomatic side in all patients. Local morphological and vascular flow changes, distal and at the site of the torsion, were found and registered. CONCLUSIONS: The finding of a rotated spermatic cord could be a highly reliable and direct sign for the diagnosis of a testicular torsion, and this is especially important when vascular flow is present within the affected testis on color Doppler US examination. Examination of the spermatic cord should be added to evaluation of the testis in patients with suspected testicular torsion to enhance sensitivity of the examination.
Spermatic cord entrapment is an unusual complication of inguinal herniorrhaphy. The case of a 52-year-old man who presented with severe pain along the left spermatic cord and testicle, varicocele, and dyspareunia after a laparoscopic bilateral inguinal hernia repair performed elsewhere is reported. Medical treatment failed, and laparoscopic exploration showed the vas deferens and spermatic vessels entrapped by a mesh slit that was pulling the genital branch of the genitofemoral nerve. The vas deferens and spermatic vessels were released, neurotomy of the affected nerve branch was performed, and a new mesh was positioned in the residual space. The patient's pain disappeared completely after the surgery and the varicocele decreased progressively. The patient remains asymptomatic at 1-year follow-up. Laparoscopy might be the approach of choice to treat some of the complications of laparoscopic hernia repair, not only because it allows better observation of the anatomic structures, but also because the surgical therapy can be done with minimal tissue damage compared to the traditional approach.
To distinguish spermatic cord torsion from other intrascrotal pathology, scrotal ultrasound and radionuclide scanning have been highly recommended on the basis of both clinical and experimental studies. We review the data from six patients in whom ultrasound or nuclear medicine examination was misleading. We emphasize that history, physical examination, and urinalysis remain the cornerstones of the diagnosis of spermatic cord torsion. Scrotal ultrasound and nuclear medicine scans are useful adjuncts and are reassuring when in agreement with the clinical picture. However, they are not 100% sensitive or specific, and a negative study should not prevent emergency operative exploration of a clinically suspicious lesion.
Torsion of the spermatic cord in the neonate should no longer be considered a clinical rarity. Effectual diagnosis is totally dependent on prompt detection of an asymptomatic, irreducible scrotal swelling that fails to transilluminate. Immediate surgical exploration is indicated. Detorsion and careful inspection for signs of circulatory return should be undertaken in every case. Frankly necrotic testes should probably be removed, but conservation of testicular tissue is otherwise strongly recommended, even in the borderline cases. After detorsion testis must be firmly fixed in proper position. Prophylactic contralateral orchiopexy appears to be advisable, unless a congenital hydrocele intervenes. Most importantly, to avert the grim prognosis this condition bears, we must continually alert our colleagues responsible for neonatal care to the possibility of torsion of the spermatic cord in the immediate postpartum examination of every newborn male infant.
A rare case of lipoma of the spermatic cord is reported. A 53-year-old man was admitted with painless mass in the left scrotum during the preceding one year. Since an elastic soft, tenderless, smooth surface, fist-sized and low echoic solid pattern mass in the left scrotum was suspected of tumor of the spermatic cord, resection of the mass with left orchiectomy was performed. Histological finding showed lipoma of the spermatic cord. Including the present case, 61 cases of intrascrotal lipoma in the Japanese literature are reviewed.