Large dermoid cyst of the spermatic cord presenting as an incarcerated hernia: a rare presentation and literature review

Dermoid cyst of the spermatic cord is a very rare clinical entity with only a few cases reported in the literature so far. We herein describe an extremely rare case of a large dermoid cyst of the spermatic cord measuring 8.5 × 5 × 5 cm in a young patient who presented with clinical manifestations of an incarcerated inguinal hernia. After the cyst excision, a diffuse direct hernia became apparent and a Lichtenstein polypropylene mesh repair was performed. Direct hernia was likely the result of chronic pressure on the inguinal floor maintained by the large cyst. We conclude that although very rare, dermoid cyst of the spermatic cord should be considered as a part of the differential diagnosis in patients presenting with an irreducible inguinal mass of a long course.     

Inguinal dermoid cyst presenting as an incarcerated inguinal hernia.

A case of an inguinal dermoid cyst presenting as an incarcerated inguinal hernia in a 18-year-old boy is reported. A differential diagnosis of masses in the inguinal region is discussed and includes not only hernias but also gynecologic and vascular lesions. Dermoid cysts must be included in the differential diagnosis. Histologically, these cysts are characterized by an external lining composed of squamous epithelium with an underlying fibroconnective tissue containing hair follicles, sebaceous, eccrine, and apocrine glands. The presence of all the skin appendages in these cysts distinguishes them from epidermoid and sebaceous cysts. The lack of structures foreign to skin differentiates them from dermoids (benign cystic teratomas) in the ovarian, testicular, retroperitoneal, and sacrococcygeal region.     

Inflammatory malignant fibrous histiocytoma of the spermatic cord

A 74-year-old man with a right inguinal hernia since 15 years was admitted because of inguinal pain and enlarged ipsilateral testis. Surgical exploration revealed a hernia with an empty hernial sac and three tumoral masses in the spermatic cord. Tumoral masses, spermatic cord, and testis were removed. Histological examination of the tumoral masses revealed a malignant inflammatory fibrous histiocytoma. The tumor infiltrated the vas deferens, pampiniform plexus, and adjacent adipose tissue. Epididymis and testis were not infiltrated. Three years after treatment with radiotherapy no recurrence or metastases have been observed.     

A Dermoid Cyst of the Round Ligament Clinically Misdiagnosed as Incarcerated Inguinal Hernia

We present a case of a dermoid cyst located in the round ligament in a patient with a preliminary diagnosis of inguinal hernia. The dermoid cyst was diagnosed based on MRI findings and confirmed histopathologically. Dermoid cyst (mature teratoma) is a congenital cystic tumour formed by the well-developed (mature) tissues of at least two of the three germinal layers. It is mainly encountered in the gonads. Location within the round ligament is quite rare. Due to the anatomical localization of the round ligament, dermoid cysts within it or other inguinal canal masses are usually misdiagnosed as inguinal hernia. However, when an inguinal canal mass is encountered, despite the higher hernia frequency, a proper suspicion and investigation with regard to masses in this area could be extremely important in preventing intraoperative surprises.     

Congenital dermoid cyst of the anterior fontanelle in Turkish children--four case reports

Four cases of congenital inclusion dermoid cysts located over the anterior fontanelle occurred in male Turkish children aged 6 months to 5 years. These rare cysts presented as slow-growing soft masses over the anterior fontanelle. The cysts were totally removed without recurrence. Dermoid cysts can be easily cured because of the absence of intracranial extension.     

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.     

Inguinal hernia of seminal vesicle cyst

Seminal vesicle cysts are uncommon abnormalities in the pelvis. The case of a seminal vesicle cyst that extended through the inguinal canal is reported. A 35-year-old man presented with left inguinal swelling. He was diagnosed with a left inguinal hernia. However, the interpretative diagnosis was a spermatic cord tumor. The operation was changed to tumor resection. The tumor existed along with the vas deferens from part of the parietal peritoneum outside the inguinal tunnel to the deep pelvic space. The cylinder-shaped tumor was 3 cm in diameter and 20 cm long. Pathological examination revealed a seminal vesicle cyst that extended through the inguinal canal. To the best of our knowledge, this is the first case report of a seminal vesicle cyst inguinal hernia.     

Inguinal cord cysts

Inguinal cord cysts are found in less than 1% of inguinal hernia dissections. They are benign masses anatomically distinct from scrotal hydroceles that frequently mimic incarcerations or may have unusual tissue components; therefore it is recommended that they be removed when encountered to prevent future symptoms. Five cases of male inguinal cord cysts treated by the same surgeon are reviewed. Electronic Publication     

Spermatic cord hydatid cyst: an unusual localization

Lesions of the groin include hernia, hydrocele, spermatic cord cyst, undescended testes, lymphadenopathy, and abscess. Hydatid cysts are endemic in certain regions of the world. They are usually located in the liver, lung, spleen, brain, and kidney. Although many uncommon locations have been reported, hydatid disease has been reported 3 times in the spermatic cord. This is the first report of a child with hydatid disease in the spermatic cord. A 9-year-old boy with a spermatic cord cyst proven to be a hydatid cyst is reported.     

Μesothelial cyst of the spermatic cord as a cause of acquired cryptorchidism

Mesothelial cysts of the spermatic cord (MCSC) are a rare entity. A 2-year-old cryptorchid boy with an inguinal mass was found to have a MCSC which was confused with undescended testis. The testis was readily placed into the hemiscrotum after excision of the cyst. MCSC may present as undescended testis and may be an unusual cause of acquired cryptorchidism. It should be excised and the inguinal canal should be explored for the existence of an undescended testis.     

精索恶性纤维组织细胞瘤1例报告并文献复习

目的：探讨精索恶性纤维组织细胞瘤的临床特点、治疗及预后.方法回顾性分析1例精索恶性纤维组织细胞瘤的临床资料,结合相关文献分析讨论该病的病因、临床表现、诊治方法及预后.结果患者右腹股沟区肿物2年,泌尿系彩色多普勒超声检查发现右腹股沟区有一3．3 cm×1．7 cm 中低混合回声结构,CT 检查见右侧腹股沟区类圆形异常密度影,病变内部密度欠均匀,呈高低混杂密度,行精索肿物切除术,病理检查结果为精索恶性纤维组织细胞瘤.结论精索恶性纤维组织细胞瘤为罕见的高度恶性肿瘤,易误诊、误治;病史、B 超、CT 及 MRI 检查等是诊断精索恶性纤维组织细胞瘤的重要手段,确诊依靠组织病理学检查;治疗推荐广泛性或根治性切除术联合术后辅助放疗.     

A case of metastatic tumor of spermatic cord from ascending colon carcinoma

A 75-year-old man presented with a left inguinal mass two months after surgery for ascending colon cancer. Physical examination revealed a solid mass in the left inguinal area. High orchiectomy was performed under the diagnosis of spermatic cord tumor. Gross examination of the specimen revealed a 5.0 X 3.2 X 3.0 cm tumor in the spermatic cord. Pathological examination of the tumor was reported as poorly differentiated adenocarcinoma with features similar to those of previously resected colon cancer. He developed peritonitis carcinomatosa and died 6 months after left orchiectomy. To our knowledge, a metastatic tumor of the spermatic cord from colon or rectal cancer is rare. As previously reported, the prognosis of this case was also poor.     

A case of metastatic tumor of the spermatic cord from gastric carcinoma

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.     

Spontaneous thrombosis of pampiniform plexus

A case is reported of a spontaneous thrombosis of the left pampiniform plexus. On examination it may be confused for any number of conditions producing spermatic cord enlargements. Surgical intervention is believed to be indicated, not for this specific entity but to rule out some of these other conditions, such as an incarcerated inguinal hernia, torsion of the spermatic cord, or even malignancy.     

精索在腹股沟管内的固定及其意义

腹股沟管是腹股沟区的重要解剖结构，而精索则是腹股沟管的核心所在，在内、外环口均存在固定机制，此机制对精索的生理功能以及疝的发生、进展、手术治疗均有重要的意义；腹股沟管也并非一条普通的容纳精索通过的管道，而是存在精细解剖和生理功能的完整结构和组织系统。     

Dermoid cyst of the spermatic cord: a rare cause of benign inguinal lump

Dermoid cyst of the spermatic cord is an extremely rare pathology seen at the urological clinic. We present the case of a 26-year-old man who presented with a groin lump, thought to be a lipoma or a hydrocoele of the cord. The final histopathological analysis established the diagnosis of a dermoid cyst.     

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??Anatomy observation of the inguinal canal JIANG Zhi-peng, YANG Bin, LI Ying-ru,et al. Center of Hernia Therapy of South China, Department of Gastrointestinal Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
Corresponding author: CHEN Shuang, E-mail: chensh2@mail.sysu.edu.cn
Abstract Objective Analysis of the inguinal canal anatomical structures and their significance by intraoperative observation. Methods From June 2011 to May 2012,a total of 115 male patients(10 patients with bilateral hernias) whom were undergone open tension-free hernioplasty were involved in the observation. In open operation field, with high definition video equipment for recording and playback of the procedure, distribution of cremaster and nerves inside the inguinal canal and the relationship between spermatic cord and the inguinal canal rings were analyzed. Results The visible rates of the genital branch of genitofemoral nerve, ilioinguinal and iliohypogastric nerves were 90.4%, 98.4% and 38.4%, respectively. Cremaster muscle was “Ω” shape wrapping the spermatic cord. There were natural anatomic planes between spermatic cord and the inguinal ligament and inguinal falx. The spermatic cord was relatively fixed inside the inguinal canal by attachment of the inner and outer rings. Conclusion Ilioinguinal nerve is relatively constant in the inguinal canal, which theoretically could be safely cut off alike with the iliohypogastric nerve, as they are cutaneous branch in this position. The fixation of spermatic cord by the inguinal rings is a protective mechanism to prevent indirect hernia occurs. The anatomical planes between the spermatic cord and the inguinal canal can be used of division.     

Intraoperative Varicocele Anatomy: A Microscopic Study of the Inguinal Versus Subinguinal Approach

PurposeThe groin approach to varicocelectomy is performed by an inguinal (aponeurosis of external oblique opened) or subinguinal (external oblique aponeurosis intact) technique. We describe the number and relationship of internal and external spermatic arteries, veins and lymphatics within the subinguinal portion of the spermatic cord in infertile men undergoing microscopic varicocelectomy and compare these findings to the microanatomy observed with the inguinal approach.Materials and MethodsA total of 48 consecutive patients underwent 84 microsurgical subinguinal varicocelectomies during which the detailed intraoperative microanatomy of the spermatic cord and gubernacula was recorded. These observations were compared with a previously reported group of 83 consecutive patients that underwent 115 inguinal varicocelectomies. Subinguinal microscopic findings were also evaluated relative to clinical varicocele grade.ResultsThe spermatic cord in the subinguinal dissection was characterized by a smaller number of large (greater than 5 mm) internal spermatic veins and a greater number of small (less than 2 mm) internal spermatic veins than the cord in the inguinal dissection (mean 0.4 vs 1.9 large veins and mean 7.9 vs 4.7 small veins, respectively). The subinguinal dissection was also characterized by a significantly greater percentage of external spermatic veins greater than 2 mm than that observed during inguinal dissection (93% vs 74%, respectively, p <0.05). Multiple spermatic arteries were identified in 75% of subinguinal dissections and in only 31% of inguinal dissections (p <0.03). Internal spermatic arteries were surrounded by a dense complex of adherent veins in 95% of cases using the subinguinal approach, whereas this finding was true in only 30% of cases with the inguinal approach (p <0.001). The clinical grade of a varicocele was significantly associated with the number of internal spermatic veins greater than 2 mm found intraoperatively (p <0.001) but not with the maximum internal spermatic vein diameter.ConclusionsAlthough the subinguinal approach to microsurgical varicocelectomy obviates the need to open the aponeurosis of the external oblique, it is associated with a greater number of internal spermatic veins and arteries compared with the inguinal approach. The primary branch point for the testicular artery occurs most commonly during its course through the inguinal canal. Internal spermatic arteries at the subinguinal level are more than 3 times as likely to be surrounded by a dense network of adherent veins than when they are identified at the inguinal level. Taken together, these data suggest that microscopic dissection is more difficult with a subinguinal incision.     

Multiple Echinococcosis with an unusual location in the spermatic cord treated successfully by Albendazole: A case report

Hydatid cysts are endemic in certain regions of the world. It can affect any organ. However, the primary site to the spermatic cord is an unusual location. Hydatid disease has been reported 5 times in the spermatic cord. The purpose of this study was to report a new case of a child with hydatid disease in the spermatic cord. This cyst is the first case treated successfully by Albendazole without surgery.     

Duplicated vas deferens: A case report and comprehensive review of the literature

Duplication of vas deferens is a very rare anomaly which two vasa deferentia are found in the spermatic cord. It can be recognised during autopsy or cadaveric dissection and also several surgical procedures which require spermatic cord dissection including inguinal hernia repair, orchiopexy, vasectomy, varicocelectomy, vasectomy reversal and radical prostatectomy. Recognition of the duplicated vas deferens is important to avoid surgical complications such as an unsuccessful vasectomy or transection of the vas. It was reported in only three cadavers and 31 patients since 1959. In this study, we describe a new case of duplicated vas deferens found incidentally during routine inguinal hernia repair in a 66-year-old patient. We also review all previously reported cases in the literature to draw attention to this rare but important anomaly.