RESUMO
INTRODUCCIÓN: Los tumores paratesticulares representan del 7%-10% de las masas intraescrotales. Los sarcomas abarcan el 90% de las lesiones malignas del cordón espermático y de éstas, aproximadamente, el 3%-7% son liposarcomas. CASO CLÍNICO: Presentamos el caso de un varón de 45 años, que consultó en urgencias por una masa inguinoescrotal derecha no reductible, diagnosticándose de hernia inguinal incarcerada. Se realizó cirugía urgente evidenciando una gran tumoración de aspecto lipomatoso, dependiente de cordón espermático. Se realizó orquiectomía y hernioplastía inguinal. La anatomía patológica, reveló un liposarcoma bien diferenciado de cordón espermático. Posteriormente, se realizó estudio de extensión, sin afectación a distancia y no precisó tratamiento adyuvante. Actualmente, tras dos años de seguimiento no ha presentado recidiva. DISCUSIÓN: Sólo alrededor de 200 casos han sido comunicados previamente en la literatura y sólo 61 de éstos se presentaron simulando una hernia inguinal incarcerada. Debido a la baja incidencia de esta patología es difícil de conocer la historia natural y llegar a conclusiones sobre los resultados del tratamiento, el cual hasta el momento sigue siendo la orquiectomía radical, con escisión amplia de los tejidos locales. El papel de la radio y quimioterapia aun es controvertido. CONCLUSIONES: Los sarcomas del cordón espermático son neoplasias raras con alta tasa de recurrencia local. Su manejo inicial es quirúrgico. Se requiere de un alto índice de sospecha clínica para el diagnóstico ya que las implicaciones oncológicas varían en función del tratamiento que, en ocasiones, es llevado a cabo por cirujanos generales al simular una hernia inguinal.
INTRODUCTION: Paratesticular tumors represent 7%-10% of intraescrotal masses. Sarcomas account for 90% of malignant lesions of the spermatic cord and of these approximately 3%-7% are liposarcomas. CLINICAL CASE: This is the case of a 45 year old male who consulted in the emergency department for a non-reducible right inguino-scrotal mass and was diagnosed with an incarcerated inguinal hernia. Emergency surgery was performed which revealed a large lipomatous tumor, originating from the spermatic cord. Orchiectomy and hernioplasty were performed. Histopathology revealed a well-differentiated liposarcoma of the spermatic cord. Later extension study was conducted, without distant affectation, and did not require adjuvant treatment. Today, after two years of monitoring has been no recurrence. DISCUSSION: Only about 200 cases have been previously reported in the literature and only 61 of these were presented mimicking an incarcerated inguinal hernia. Due to the low incidence of this disease it is difficult to know the natural history and draw conclusions on the results of treatment, which so far remains the radical orchiectomy with wide local excision of the tissue. The role of radiotherapy and chemotherapy is still controversial
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Testiculares/cirurgia , Lipossarcoma/cirurgia , Cordão Espermático , Cordão Espermático/patologia , Neoplasias Testiculares/diagnóstico , Orquiectomia/métodos , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Lipossarcoma/diagnósticoRESUMO
A castração é o procedimento cirúrgico mais realizado na prática da medicina equina, mesmo com os contínuos avanços ainda são comuns complicações no pós-operatório. A funiculite é um exemplo de complicação, embora infrequente é possível a ascensão do processo infeccioso do cordão espermático para o abdômen resultando em quadros de peritonite ou formação de abscessos. Descreve-se um caso de formação de abscesso abdominal após realização de orquiectomia a campo. O equino foi atendido com claudicação do membro pélvico direito e histórico de castração há oito meses. Ao exame físico, foi observado aumento de volume sobre o anel inguinal externo direito, á palpação transretal e avaliação ultrassonográfica foi notado a presença de massa firme de aproximadamente 15 centímetros de diâmetro sobre o anel inguinal interno direito. O animal foi medicado com antibiótico de amplo espectro, também foi instituída compressa com água morna e aplicação tópica de pomada rubefaciente. Após cinco dias de terapia, houve drenagem de conteúdo purulento espontâneo por fístula que foi ampliada manualmente para a realização de curativos diários com solução antisséptica. Após 30 dias do início da terapia houve completa regressão do aumento de volume abdominal e cicatrização da ferida. Dez meses após a alta, o animal não tinha qualquer sinal de claudicação ou aumento de volume na região inguinal e voltou às atividades físicas normais.(AU)
Castration is the most common surgery performed in the practice of equine medicine, even with continuous advances complications are still common after surgery. The funiculitis is an example of complication, although infrequent is possible the rise of the spermatic cord infection to the abdomen resulting in peritonitis or abscess formation. We report a case of abdominal abscess formation after orchiectomy undergoing in the field. The horse was referred with claudication of the right hindlimb and castration history of eight months ago. On physical examination an increased volume was observed on the right external inguinal ring, on transrectal palpation and ultrasonography were noted the presence of solid mass of approximately 15 cm diameter on the right internal inguinal ring. The animal was treated with broad-spectrum antibiotic, it was also established compress with warm water and topical rubefacient ointment. After five days of treatment, there was spontaneous drainage of purulent content from a fistula which was manually extended to perform daily dressings with antiseptic solution. After 30 days of onset of therapy there was complete regression of abdominal swelling and wound healing. Ten months after discharge the animal had no lameness signal or swelling in the inguinal region and back to normal physical activities.(AU)
Assuntos
Animais , Masculino , Cavalos/cirurgia , Orquiectomia/veterinária , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/terapia , Abscesso Abdominal/veterinária , Cordão Espermático/patologia , Infecções do Sistema Genital/complicações , Infecções do Sistema Genital/veterináriaRESUMO
Phosphatidylcholine is the main phospholipid present in cell membranes and in lipoproteins, and can interfere with various biological processes. This lipid also has antioxidant activity, and protects against damage caused by free radicals under conditions of ischemia/reperfusion. Therefore, the present study was designed to evaluate toxicogenetic damage caused by twisting of the spermatic cord in ischemia/reperfusion, and whether phosphatidylcholine plays a role in conditions of ischemia/reperfusion in preclinical trials. The results indicate that spermatic cord torsion does not cause genotoxic damage or mutagenesis. A dose of 300 mg/kg of phosphatidylcholine is toxic and is thus not recommended. However, a dose of 150 mg/kg does not promote toxicogenetic damage, and though it does not statistically prevent tissue damage occurring from lack of oxygenation and nutrition of testicular cells, it has a tendency to reduce this damage. Therefore, this research suggests that further studies should be conducted to clarify this tendency and to provide a better explanation of the possible therapeutic effects of phosphatidylcholine in cytoprotection of germ cells affected by ischemia/reperfusion.
Assuntos
Antioxidantes/farmacologia , Fosfatidilcolinas/farmacologia , Traumatismo por Reperfusão/tratamento farmacológico , Cordão Espermático/efeitos dos fármacos , Testículo/efeitos dos fármacos , Animais , Morte Celular/efeitos dos fármacos , Ensaio Cometa , Avaliação Pré-Clínica de Medicamentos , Histocitoquímica , Injeções Intraperitoneais , Leucócitos Mononucleares/efeitos dos fármacos , Leucócitos Mononucleares/metabolismo , Leucócitos Mononucleares/patologia , Masculino , Testes para Micronúcleos , Microtomia , Ratos , Ratos Wistar , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/patologia , Cordão Espermático/irrigação sanguínea , Cordão Espermático/metabolismo , Cordão Espermático/patologia , Testículo/irrigação sanguínea , Testículo/metabolismo , Testículo/patologia , Torção MecânicaRESUMO
BACKGROUND: A caecal appendix within an inguinal hernia, with or without appendicitis, is defined as Amyand's hernia. In 1% of inguinal hernias an appendix without inflammation can be found, however, the prevalence of appendicitis in a hernia sac is only 0.08-0.13%. CLINICAL CASE: Male of 43 years old, began two days before admission with pain in the right inguinal region. He was scheduled for surgery due to a complication of a right inguinal hernia. The surgical findings were Amyand's hernia, necrotic spermatic cord, and perforated appendix. Surgical repair was performed with a favourable outcome, and he was discharged on the fourth postoperative day. DISCUSSION: Most of Amyand's hernia exhibit characteristics of incarcerated or strangulated inguinal hernia. Even acute appendicitis or perforated appendix within the hernia sac does not reflect specific symptoms or signs, therefore, a preoperative clinical diagnosis of Amyand's hernia is difficult to achieve. In our case, the patient had perforated appendicitis, developing necrosis of the spermatic cord. Orchiectomy, appendectomy, and inguinal hernia repair was performed without placing mesh. Due to the controversy on the use of mesh in contaminated abdominal wall defects, it was not indicated here, due to the high risk of wound infection and appendicular fistula. CONCLUSION: An extremely rare condition is presented, with a surgical choice that led to a favourable outcome.
Assuntos
Apendicectomia/métodos , Apendicite/complicações , Hérnia Inguinal/complicações , Herniorrafia/métodos , Orquiectomia/métodos , Adulto , Apendicite/cirurgia , Contraindicações , Drenagem , Hérnia Inguinal/cirurgia , Humanos , Isquemia/etiologia , Masculino , Necrose , Cordão Espermático/irrigação sanguínea , Cordão Espermático/patologia , Cordão Espermático/cirurgia , Telas Cirúrgicas , Infecção da Ferida Cirúrgica/prevenção & controle , Técnicas de SuturaRESUMO
PURPOSE: To determine whether tension in the spermatic cord of rats causes lesions in the testis, epididymis or vas deferens. METHODS: Forty Wistar rats were randomly allocated into four groups. A traction force of 1.6 Newton (N) in group I and 1 N in group II was applied to the right spermatic cord. Group III was the sham, and group IV served as the control. RESULTS: Testicular lesions occurred on the right side in 66.7% of the rats and on the left side in 46.1% of the rats. The testes showed a decreased number of Sertoli cells, necrosis and a decreased number of germ cells in the seminiferous tubules. Anatomopathological changes in the vas deferens were not identified. There was no decrease in the thickness of the muscle wall of the vas deferens. In the right epididymis, 71.8% of the animals showed a reduction and 5% showed an absence of intraluminal sperm. In the left epididymis, 37.5% of the rats showed a reduction. The volume and the final testicular weight of the right side in group IV was different from those in the other groups. CONCLUSIONS: Anatomopathological lesions were found in the testis and epididymis.
Assuntos
Cordão Espermático/patologia , Tração/efeitos adversos , Animais , Epididimo/lesões , Epididimo/patologia , Masculino , Modelos Animais , Necrose/etiologia , Tamanho do Órgão , Ratos Wistar , Túbulos Seminíferos/patologia , Cordão Espermático/lesões , Testículo/lesões , Testículo/patologia , Ducto Deferente/patologiaRESUMO
PURPOSE: To determine whether tension in the spermatic cord of rats causes lesions in the testis, epididymis or vas deferens. METHODS: Forty Wistar rats were randomly allocated into four groups. A traction force of 1.6 Newton (N) in group I and 1 N in group II was applied to the right spermatic cord. Group III was the sham, and group IV served as the control. RESULTS: Testicular lesions occurred on the right side in 66.7% of the rats and on the left side in 46.1% of the rats. The testes showed a decreased number of Sertoli cells, necrosis and a decreased number of germ cells in the seminiferous tubules. Anatomopathological changes in the vas deferens were not identified. There was no decrease in the thickness of the muscle wall of the vas deferens. In the right epididymis, 71.8% of the animals showed a reduction and 5% showed an absence of intraluminal sperm. In the left epididymis, 37.5% of the rats showed a reduction. The volume and the final testicular weight of the right side in group IV was different from those in the other groups. CONCLUSIONS: Anatomopathological lesions were found in the testis and epididymis. .
Assuntos
Animais , Masculino , Cordão Espermático/patologia , Tração/efeitos adversos , Epididimo/lesões , Epididimo/patologia , Modelos Animais , Necrose/etiologia , Tamanho do Órgão , Ratos Wistar , Túbulos Seminíferos/patologia , Cordão Espermático/lesões , Testículo/lesões , Testículo/patologia , Ducto Deferente/patologiaRESUMO
Metastatic tumour of spermatic cords, epididymis and seminiferous duct from gastric carcinoma has been recently reported but rarely seen. A case of metastatic tumour from gastric carcinoma in a 50-year old man is herein reported. The initial diagnosis was thickening of both spermatic cords. Needle biopsy of the spermatic cord, testicle and epididymis was performed. Pathological findings showed a gastric signet ring cell carcinoma. Thus, double radical orchiectomy was performed and metastatic signet ring cell carcinoma of the spermatic cord and testis was diagnosed through histological examination and immunohistochemistry. Physicians should be aware that gastric carcinoma is one of the possibilities for metastasis to the seminal duct.
El tumor metastásico de los cordones espermáticos, el epidídimo y el conducto seminífero a partir de un carcinoma gástrico ha sido reportado recientemente, pero pocas veces visto. En este trabajo se reporta el caso de un tumor metastásico a partir de un carcinoma gástrico en un hombre de 50 año de edad. El diagnóstico inicial fue el engrosamiento de los dos cordones espermáticos. Se realizó una biopsia con aguja del cordón espermático, testículos y epidídimo. Los resultados patológicos mostraron un carcinoma de células en anillo de sello. Por consiguiente, se realizó una orquiectomía radical doble, y el carcinoma metastásico en anillo de sello del cordón espermático y el testículo, fue diagnosticado mediante examen histológico e inmunohistoquímico. Los médicos deben tener presente que el carcinoma gástrico es una de las posibilidades de metástasis en los conductos seminales.
Assuntos
Humanos , Pessoa de Meia-Idade , Cordão Espermático/patologia , Neoplasias Gástricas/patologia , Carcinoma/patologia , Neoplasias dos Genitais Masculinos/secundário , Biópsia por Agulha , Orquiectomia , Neoplasias dos Genitais Masculinos/cirurgia , Neoplasias dos Genitais Masculinos/diagnósticoRESUMO
OBJECTIVE: The presence of tumor cells in the spermatic cord was evaluated in patients undergoing inguinal testis study in order to assure if the placement of a clamp in it was necessary to avoid tumor dissemination. MATERIAL AND METHODS: Inguinal testis studies were performed over a two year period in 38 patients diagnosed of testicular mass. The presence of tumor cells in blood vessels or lymph nodes of the cord was evaluated in all of the patients. RESULTS: Testicular tumors were found in 28 patients (20 seminoma, 5 mixed tumor and 3 embryonal) with an average age of 42 (range 21-82) years. There were T1N0M0 21; T1N1M0 3; T2N0M0 2 and T2N1M0 2 cases, respectively. Independently of the stage and tumor lineage, tumor cells in the cord vessels were not observed in any of the cases through the pathology study. CONCLUSION: In our causistics, it seems that the surgical act consisting in the placement of a clamp early in the cord lacks a scientific foundation. However, this study does not make it possible to state that not performing this maneuver during the surgical procedure is oncologically safe. Thus, a precedent is established to perform studies with a larger number of patients that will make it possible to corroborate this observation. This would result in less traumatic and safer surgical techniques that would allow conserving the testis and its functionality.
Assuntos
Cordão Espermático/patologia , Neoplasias Testiculares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia/métodos , Humanos , Canal Inguinal , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Inoculação de Neoplasia , Estudos Prospectivos , Instrumentos Cirúrgicos , Adulto JovemRESUMO
Os pseudotumores fibrosos são lesões incomuns que ocorrem geralmente em resposta a cirurgia, trauma, infecção ou inflamação. Relatamos um caso de paciente com 25 anos de idade que apresentou massa escrotal indolor. Realizou-se orquiectomia radical. O diagnóstico anatomopatológico foi de pseudotumor fibroso do cordão espermático.
Fibrous pseudotumors are uncommon lesions that mostly occur in response to surgery, trauma, infection or inflammation. We report the case of 25 year-old patient, who presented painless scrotal mass. A total orchidectomy was performed. The anatomopathological diagnosis was fibrous pseudotumor of the spermatic cord.