Clinical Analysis of Treating 155 Cases of Hydrocele of Tunica Vaginalis in Infant with Mini-incision
0
Citation
0
Reference
20
Related Paper
Abstract:
Objective:To explore the method of treating hydrocele of tunica vaginalis in infant.Method:The clinical data of 155 cases (from Oct.2003 to Dec.2009) with hydrocele of tunica vaginalis were treated by mini-incision was analyzed retrospectively.Among them,145 male,all were unilateral;10 female cases,9 were unilateral,1 were bilateral.Result:155 cases were cured without complication and 1 case recurrence occurred.Conclusion:Mini-incision in treating the hydrocele of tunica vaginalis has following advantages:low cost,convenience with minimal invasion,low recurrence rate.Keywords:
Tunica vaginalis
Hydrocele
Tunica
Cite
Rhabdomyosarcoma (RMS) is a soft tissue malignancy originating from primitive mesenchymal cells that differentiate into skeletal muscle tissue. Histologically, RMS is divided into two categories: embryonal and alveolar. Paratesticular RMS (including RMS originating from the spermatic cord, epididymis, tunica vaginalis, appendices of the testis, and epididymis) is highly aggressive and exceedingly uncommon in adult patients (the median age at diagnosis being 8 years). Less than 10% of paratesticular RMS is of the alveolar subtype, which carries an even poorer prognosis. We report here the case of a 22-year-old male presenting with right scrotal pain and swelling, the scrotum having been rapidly enlarging over a period of 3 weeks. His condition had been treated elsewhere as epididymitis, without any response to antibiotic therapy. Physical examination detected a right hydrocele with mild tenderness. Ultrasonography displayed several confluent nodules arising from the right tunica vaginalis and anechoic fluid surrounding the right testis (Fig. 1A). Levels of serum beta-human chorionic gonadotropin and alpha-fetoprotein were normal. (A) Ultrasonography showing several confluent nodules (arrows) arising from the tunica and protruding into the cavity, with an anechoic fluid collection surrounding the testis (T). (B) Macroscopic examination showing a diffusely thickened tunica and several nodules (arrows) arising from the testicular surface of the tunica. (C) Microscopic examination demonstrating a small round cell tumor with an alveolar-like structure, 100×. (D) Immunohistochemical investigation revealing intense staining with cytoplasmic desmin, 400×. Because of the abnormal ultrasonographic findings and lack of response to antibiotics, tumor was considered, and a surgical exploration using a scrotal approach was undertaken, revealing clear fluid and nodular thickening of the tunica. A part of the tunica was resected for intraoperative frozen section examination, demonstrating a malignant tumor (with a high suspicion of sarcoma). Thus, a right radical inguinal orchiectomy was performed. Macroscopically, the tunica was diffusely thickened, with several nodules arising from the tunica (Fig. 1B). Microscopic examination revealed a small round cell tumor with an alveolar-like structure (Fig. 1C). Immunohistochemically, the tumor cells were positive for desmin (Fig. 1D) and bcl-2, and negative for SMA, EMA, CK5/6, PCK, CD34, CR, S-100, and ALK-1. Based on these findings, a pathologic diagnosis of primary alveolar RMS of the right tunica vaginalis was made. Adjuvant chemotherapy with a vincristine/dactinomycin/cyclophosphamide (VAC) regimen was provided postoperatively. The patient has since remained disease-free for 3 years. To the best of our knowledge, only four cases of primary sarcoma of the tunica vaginalis have been described in the English-language literature, with two being embryonal RMS [1], [2], one leiomyosarcoma [3], and one malignant mesothelioma [4]. Our patient is the first case of primary alveolar RMS of the tunica. Based on these five cases, we conclude that sarcoma of the tunica most commonly presents as a symptomatic or asymptomatic hydrocele. Although there are many causes of hydrocele, sarcoma of the tunica is most highly probable on account of the rapidly enlarging hydrocele without response to antibiotics, nodules arising from the tunica, and thickening or calcification of the tunica [1]-[4]. However, the definitive diagnosis depends on pathologic analysis. Due to the rarity of adult paratesticular RMS, its optimal management remains to be elucidated. However, the pediatric protocol may be followed, which includes a selective combination of surgical resection, radiotherapy (for residual disease), and chemotherapy [5]. Radical orchiectomy may act as the cornerstone for local control. Ipsilateral retroperitoneal lymph node dissection may be considered for Stages II, III, and IV disease, regardless of the preoperative radiologic findings, and adjuvant chemotherapy based on a VAC regimen is advantageous to survival in all stages. We treated our patient following the same protocol (radical orchiectomy plus adjuvant chemotherapy). This treatment strategy induced a stable response and, 3 years after initial diagnosis, no relapse.
Tunica vaginalis
Hydrocele
Tunica albuginea (penis)
Echogenicity
Spermatic cord
Cite
Citations (3)
81negatived by culture.Reference to the register shows that, among the last 574 cases admitted under certificate of diphtheria, repeated cultures proved negative in 172.Of the remaining 402, in which the diagnosis was confirmed by the bacteriological examination, 231 had exhibited in the swab- smear diphtheria bacilli with polar granules, a percentage of 57.
Tunica vaginalis
Hydrocele
Cite
Citations (0)
Hydrocele
Primary (astronomy)
Cite
Citations (23)
Tunica vaginalis
Tunica media
Tunica
Cite
Citations (4)
Hydrocele
Tunica vaginalis
Cite
Citations (11)
Testicular mesothelioma originating from tunica vaginalis is a very rare disease. A 70-year-old man complained of left testicular swelling and was operated with the clinical diagnosis of hydrocele. Intra-operative examination revealed diffuse thickening of tunica vaginalis, which was thought to be inflammatory and benign by the urologist. Nevertheless an incisional biopsy was performed and atypical mesothelial proliferation was reported in histopathology. Morphologic findings were insufficient for definitive diagnosis of malignancy. Patient was followed-up for ten months. Due to the persistance of paratesticular thickening and additional appearance of nodularities, left inguinal orchiectomy was performed. Microscopy revealed classical malignant mesothelioma originating from tunica vaginalis. Two years after the diagnosis, patient had metastases to the paraaortic lymph nodes. Malignant mesothelioma of the testis may represent with diagnostic difficulties both clinically and pathologically. In all cases where paratesticular tissues may deviate from normal, mesothelioma must enter into the differential diagnosis. J Med Cases. 2011;2(6):275-278 doi: https://doi.org/10.4021/jmc396w
Tunica vaginalis
Hydrocele
Histopathology
Cite
Citations (1)
Tunica vaginalis
Tunica
Cite
Citations (0)
Tunica vaginalis
Hydrocele
Tunica
Cite
Citations (0)
Beyond this stage, however, the disease will proceed if the same cause be brought again into operation.The bronchial tubes will become affected, and an affection closely analogous to bronchial phthisis will produce rapid debility, and, finally, epileptic fits, and under these depressing causes the patient dies, completely worn out.This man,
Tunica vaginalis
Hydrocele
Tunica
Cite
Citations (0)
Hydrocele
Tunica vaginalis
Cite
Citations (0)