Liposarcoma of the spermatic cord in the left scrotum and inguinal region: a case report

We report a rare case of liposarcoma of the spermatic cord in the left scrotum and inguinal region. The patient was a 75 year old male, who visited our hospital with the complaint of painless left scrotal swelling and inguinal mass which had been noticed for 3 to 4 years. Ultrasonography and computed tomography (CT) showed a heterogenous mass in the left inguinal region and intrascrotum. We suspected a left testicular tumor and removed it by high inguinal orchiectomy. Histological examination revealed a well-differentiated liposarcoma of sclerosing type. Tumor local recurrence was not recognized at 8 months after operation. This is the 43rd case of liposarcoma of the spermatic cord in the Japanese literature.     

Liposarcoma of the spermatic cord associated with rectum cancer: a case report

We report a case of liposarcoma of the spermatic cord associated with rectum cancer. A 78-year-old man visited our hospital with a complaint of painless left inguinal mass. He also showed constipation and bloody bowel discharge, rectum cancer was diagnosed by further evaluation. Ultrasonography, computed tomography and magnetic resonance imaging revealed a 2 x 4 x 6 cm mass in the left spermatic cord. Left high orchiectomy for the left inguinal tumor and Hartmann's procedure for rectum cancer was performed. Histologically, the mass in the left spermatic cord was well differentiated liposarcoma and rectum cancer was poorly differentiated adenocarcinoma. He died from rectum cancer with no evidence of recurrence of liposarcoma of the left spermatic cord after follow up for 6 months.     

Elective laparoscopic surgery for sigmoid colon carcinoma incarcerated within an inguinal hernia: report of a case

Primary colon carcinoma within an inguinal hernia sac is very rare and most reported cases were found at emergency open surgery for an incarcerated hernia. We report a case of incarcerated sigmoid colon carcinoma diagnosed preoperatively and treated with elective laparoscopic surgery. A 67-year-old man with a 2-year history of swelling of the scrotum and a breast lump was referred to us for surgical treatment of an irreducible left inguinal hernia and a right breast tumor. Blood examination results showed severe anemia. Computed tomography scan and endoscopic biopsy confirmed sigmoid colon carcinoma incarcerated in the left inguinal hernia. Thus, we performed definitive laparoscopic sigmoidectomy and conventional hernia repair for preoperatively diagnosed sigmoid colon carcinoma within an inguinal hernia.     

Epiploic appendagitis masquerading as incarcerated left inguinal hernia

Epiploic appendagitis is a rare condition resulting from acute inflammation of an epiploic appendage. This condition occurs usually within the abdominal cavity and is frequently misdiagnosed; as an unexpected hernia content, it is a very rare entity. We herein report the case of a 38-year-old male patient with a known left inguinal hernia who presented acutely with a painful left inguinal mass. Emergent surgical exploration was mandatory to rule out a possible incarcerated bowel loop; it revealed a hernia sac containing a 3 cm thick, swollen, inflamed and incarcerated epiploic appendage of healthy sigmoid colon. The patient recovered after resection of the epiploic appendage and a tension-free hernioplasty.     

Retroperitoneal well-differentiated liposarcoma presenting as an incarcerated inguinal hernia

A 69-year-old man was admitted with a complaint of left irreducible inguinal mass. On surgical exploration no evidence of hernia was found and the inguinal floor was overwhelmed by a large lobulated mass, arising from the properitoneal fat, that involved the spermatic cord. The mass was partially removed, sparing the elements of cord. The transversalis fascia was repaired by direct suture and a polypropylene mesh was located above. The histopathological diagnosis was well differentiated-type liposarcoma with myxoid features. The liposarcoma is a malignant tumour of the adipose tissue that arises from the primitive mesenchymal cells. These neoplasms have been usually found in the soft tissues of limbs, trunk, mediastinum, retroperitoneum and occasionally in the spermatic cord. The clinical aspect is frequently a complaint of scrotal or inguinal painless mass, mimicking to an inguinal hernia and the diagnosis of tumor is performed mainly during surgery, as in our patient. In the case of a firm not reducible painless inguinal mass without signs and symptoms of bowel obstruction, an abdominal tumor with inguinal or scrotal extension should be suspected and preoperatively excluded. The US and CT scan may be helpful to plane a correct therapeutic strategy before intervention.     

Liposarcoma of the spermatic cord masquerading as an incarcerated inguinal hernia

We present a rare case of liposarcoma of the spermatic cord. There are only 61 reports in the literature. The presenting complaint is usually a painless bulge in the inguinal or scrotal region. Our patient presented with a new-onset inguinoscrotal swelling that was misdiagnosed preoperatively as an incarcerated indirect hernia. The treatment for a spermatic cord liposarcoma is radical orchiectomy with high ligation of the cord. Radiation therapy is recommended in addition to surgery in situations with evidence of tumor with propensity for more aggressive behavior (i.e., high-grade tumor, lymphatic invasion, inadequate margin, or recurrence). The current literature, diagnosis, and management of malignant tumors of the spermatic cord are reviewed.     

Two cases of liposarcoma of spermatic cord

Liposarcomas are most commonly found in the extremities, in the retroperitoneum and, less often, in the head and neck area. The spermatic cord is a rare site of origin, accounting for about 3-7% of all liposarcomas. We report two cases of liposarcoma of spermatic cord. Case 1. A 69-year-old male presented with complaints of a painless left inguinal mass. MRI showed a huge fatty mass in the left inguinal region. The mass was removed with left testis and spermatic cord. Histopathological examination revealed a well-differentiated and dedifferentiated liposarcoma. The surgical margin was positive, so re-resection was performed. Complete excision was achieved after re-resection. Case 2. A 63-year-old male with the difficulty urinating had a left scrotal mass. Left radical orchiectomy was performed. Histopathological examination revealed a well-differentiated liposarcoma. These are the 84th and 85th cases of liposarcoma of the spermatic cord reported in Japan.     

A case of myxoid liposarcoma in the right inguinal region: a case report

We report a case of myxoid liposarcoma developed in the right inguinal region. A 45-year-old man visited our hospital with a chief complaint of painless right inguinal mass. He was diagnosed with right direct inguinal hernia for the first time and received a hernia repair. However, the size of the inguinal mass increased gradually after the operation. Then, the tumor was re-evaluated by imaging study such as ultrasonography, computed tomography and magnetic resonance imaging. A fatty mass 4.0 cm in diameter was demonstrated and the tumor was diagnosed as a liposarcoma preoperatively. In addition to the right high orchiectomy, surrounding fatty tissue was also removed at the time of the operation. Histological examination revealed a myxoid liposarcoma and the existence of several daughter regions outside the pseudo-capsule. Right spermatic cord and testis were intact. Postoperatively, he received 54 Gy dose of radiation therapy to right inguinal region for the prevention of the local recurrence of the disease.     

Spermatic cord myxoid liposarcoma presenting as an incarcerated inguinal hernia: report of a case and review of literatures

Incarcerated inguinal hernia is a common surgical indication in the emergency room. Delayed diagnosis can result in ischemic bowel or bowel perforation. The reported incarcerated contents include bowel loop, mesentery, omentum and, rarely, malignant lesions, such as lymphoma, metastatic tumors etc. We report a new case of primary spermatic cord liposarcoma presenting as emergent incarcerated inguinal hernia and review the related literature.     

A case of liposarcoma of spermatic cord

An 84-year-old male was referred to our hospital with the chief complaint of a painless inguinal mass. An elastic hard mass was palpable in the right inguinal region next to the spermatic cord. Ultrasonography and computed tomography showed an inguinal homogeneous mass which was slightly enhanced. Since the operation appearance indicated the tumor was arising from the right spermatic cord, right radical orchiectomy was performed. Histopathological examination revealed a well-differentiated liposarcoma of the right spermatic cord. This is the 70th case of liposarcoma of the spermatic cord reported in Japan.     

Laparoscopic resection of metastatic pelvic liposarcoma

We report a pelvic liposarcoma originating from the left spermatic cord that recurred following inadequate excision. In our case, the tumor was resected without performing orchiectomy previously. The patient was managed by laparoscopic resection, before undergoing radical orchiectomy in the left inguinal region. To our knowledge, no case of laparoscopic resection for the recurrent liposarcoma has been described. In addition, the present case serves to demonstrate that radical orchiectomy with wide excision is needed for paratesticular tumor.     

Liposarcoma developing in the paratesticular region: Report of a case

A 74-tear-old man presented to our hospital with a 2-year history of a painless and slow-growing fixed mass in the left paratesticular region. There were no specific abnormalities in the laboratory data, and the tumor markers were within normal limits. Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US) revealed findings suggestive of either inguinal hernia or lipoma. However, intraoperatively, the tumor was observed to roll up the isolateral spermatic cord and testicular vessels, which led to the differential diagnosis of liposarcoma. The tumor was then widely resected along with the left testis, spermatic cord, and testicular vessels. Histopathologic study confirmed the diagnosis of well-differentiated liposarcoma, but no malignant cells were found in any of the surgical margins. A periodical follow-up has been performed by US every 3 months, and no evidence of recurrence or metastasis has been seen in the 6 months since his operation, without any postoperative adjuvant therapy.     

Primary omental liposarcoma presenting as an incarcerated inguinal hernia

Herein, we present a case of primary liposarcoma of the omentum found in an incarcerated inguinal hernia in a 52-year-old male patient. The patient was admitted to our hospital in June 2000 with sudden onset of left-sided abdominal and groin pain of 12 hours duration with a large, irreducible inguinal hernia. This was not associated with nausea or vomiting. An emergency operation was performed, and in the hernia sac the tumor, arising from the greater omentum, was found. After we opened the transversal fascia and peritoneum, the tumor was resected with a block of the greater omentum, and hernioplasty was performed using Shouldices method. The histopathological diagnosis of resected tumor showed myxoid type liposarcoma. In the English medical literature, omental liposarcoma has never before been reported as the content of a hernia sac.     

精索多形性脂肪肉瘤1例报告并文献复习

目的：分析并总结精索脂肪肉瘤患者的临床表现及其诊断及治疗方法。方法：回顾性分析我院收治的1例精索脂肪肉瘤患者的临床资料：左侧阴囊内有-9．0cm×9．4cm×6．7cm肿块,B超检查示左侧阴囊内存在一非均质实性包块;MRI显示左侧阴囊内有实质性肿瘤,未见肿大淋巴结。血清肿瘤标志物13-HCG、CEA、PSA和AFP检查均无异常。手术切除肿瘤的同时行左侧阴囊部分切除术。结果：术后病理检查提示为多形性混合型脂肪肉瘤。患者术后恢复顺利。结论：精索脂肪肉瘤是一种罕见的泌尿生殖系肿瘤,诊断主要依据病理检查结果确定;治疗以根治性睾丸切除术为主要方式,辅助放疗、化疗疗效不确切;预后与肿瘤组织病理类型密切相关,局部复发很常见,需长期随访。     

Spermatic cord liposarcomas incidentally found during hernia surgery: is histology of any lipoma mandatory? A review of the literature

Abstract

Purpose: Liposarcomas found incidentally during open or laparoscopic inguinal hernia surgery are extremely rare. It is unclear, whether any adipose tissue being removed during inguinal hernia surgery must be sent for histology due to the potential risk of liposarcoma of the spermatic cord. This study aims to evaluate the frequency of liposarcomas incidentally found in the inguinal canal during hernia surgery and tries to derive evidence-based recommendations regarding the optimal management of any fatty tissue found in the inguinal canal.

Methods: A literature review of the PubMed/Medline electronic databases between January 1980 and January 2019 was performed using the search terms ‘inguinal hernia’ and ‘liposarcoma’. There was only one study available on this topic. Therefore, an additional literature review was performed analyzing all reports on patients with incidentally detected liposarcomas of the spermatic cord in the inguinal canal during hernia surgery.

Results: There was only one retrospective study evaluating the frequency of inguinal liposarcoma found at hernia operations with a frequency of less than 0.1%. There were 18 cases of spermatic cord liposarcomas that were truly found incidentally during operation for an unsuspected symptomatic or incarcerated inguinal hernia. These included 16 case reports with a total of 18 patients and 19 liposarcomas. All patients were male with a median age of 62.5?years (range: 24–86?years) years. Median size of liposarcoma was 10.5?cm (range: 3–30?cm). In seven patients, the inguinal liposarcoma was an extension of a retroperitoneal sarcoma. Treatment consisted of radical orchidectomy during the primary operation in 12 patients. Three out of the seven patients with retroperitoneal extension of the tumor underwent a secondary operation with complete resection of the tumor.

Conclusions: Currently, there is no evidence-based recommendation available regarding the management of lipomas detected during open or laparoscopic inguinal hernia surgery. Due to the extremely low risk of the presence of a liposarcoma, routine histologic examination cannot be recommended unless the diameter exceeds 10?cm.     

Mesothelial cyst presenting as an irreducible inguinal mass

Inguinal hernias are common in the pediatric population. We describe a 10-year-old child who presented with signs and symptoms suggestive of an incarcerated inguinal hernia. Ultrasound examination demonstrated an aperistaltic multicystic inguinal mass of uncertain origin. The mass was resected, and the adjacent hernia was repaired. Histologic examination identified the mass as a mesothelial cyst. Mesothelial cysts are rare groin lesions in children that can masquerade as an incarcerated inguinal hernia in a child.     

A case of arteriovenous hemangioma of the undescended testis

An 8-month-old boy was admitted to our hospital with the complaint of left inguinal pain during his follow-up of left cryptorchism. Computed tomography showed a solid mass with a low density area in the left inguinal region. Tumor markers, including alpha-fetoprotein and human gonadotropin-beta, were normal. Exploration of the left testis by an inguinal approach revealed a reddish mass occupying more than half of the testicular parenchyma and we performed left orchiectomy. The tumor was histopathologically diagnosed as arteriovenous hemangioma.     

Nephron-sparing radical excision of a giant perirenal liposarcoma involving a solitary kidney

We describe our experience in a patient with a congenital solitary kidney encased by a perirenal liposarcoma managed by nephron-sparing excision. The best predictor of survival with liposarcoma is complete resection of the tumor. Generally a diffuse peri-renal liposarcoma arising within Gerota's fascia would necessitate a radical nephrectomy. Having a congenitally solitary kidney, this patient refused nephrectomy, therefore a kidney-sparing excision of his liposarcoma was attempted. To obtain negative margins and to provide a nephron-sparing excision, the capsule of the kidney was resected with the mass. Direct extension into the diaphragm necessitated an en bloc resection of 4 x 6 cm of the left hemidiaphragm. The defect was reconstructed with a Gortex patch graft. Pathology revealed a 32 x 22 x 8-cm liposarcoma with areas of sclerosing liposarcoma and poorly differentiated spindle cell sarcoma, focally Grade 3 of 3, with the remaining tumor being Grade 1. There was diaphragmatic invasion, but all surgical margins were negative. At 22 months CT follow-up, the patient has no radiographic evidence of disease. Excision of this mass with the renal capsule allowed our patient to be margin negative and maintain normal renal function. This is the only report in the literature describing nephron-sparing resection of a giant perirenal liposarcoma involving a solitary kidney.     

Neuroendocrine tumor of the appendix inside an incarcerated Amyand’s hernia

Amyand’s hernia is a rare type of hernia where the vermiform appendix is within an inguinal hernia sac. Tumors of the appendix are quite uncommon. The coincidence of an Amyand’s hernia with neuroendocrine tumor of the appendix, as in our case, is even more rarely reported.We report the case of an 81-year-old male who presented with an incarcerated right inguinal hernia. After resuscitation, the clinical diagnosis was confirmed by computed tomography. It showed an incarcerated right inguinal hernia which contained the distal ileum, cecum, thickened appendix, as well as a small amount of fluid. Subsequently, the patient was prepared for emergency surgery. During the operation, the hernia sac was found and opened. The appendix was swollen. Therefore, appendectomy was performed. The inguinal defect was repaired using the Modified Bassini Technique. The patient had an uneventful postoperative recovery and surprisingly the histopathology of the appendix revealed a 1.5 cm well-differentiated low grade neuroendocrine tumor (carcinoid) of the appendix tip.An incidental finding of neuroendocrine tumor of the appendix in a patient with s hernia is extremely rare. A high index of suspicion is the key to diagnose such a coincidence in order to safely and optimally treat such a condition.     

Inguinal hernia containing a kidney with a duplicated system: An exceptionally rare case

An inguinal hernia is a commonly encountered surgical case, with multiple unusual contents being reported. We present an exceptionally rare case of an inguinal hernia. Computed tomography imaging of the 62‐year‐old male patient showed a large left inguinal hernia extending into the left scrotum that contained a duplicated left kidney. There was an associated large left hydrocele and incidental non‐obstructive nephrolithiasis. Left nephropexy, left orchiectomy, and repair of the incarcerated left inguinal hernia with mesh placement via a preperitoneal (retroperitoneal) approach were performed. The patient was discharged to home on post‐operative day 5 and the post‐operative course was uneventful. We discuss a possible mechanism for this rare event.