Synchronous bilateral malignant mesothelioma of tunica vaginalis testis: early diagnosis

We report a case of bilateral synchronous malignant mesothelioma of the testis. A 21-year-old man presented with an acute scrotum after 3 months of recurrent pain on the right side. Ultrasonography demonstrated an irregular thickening of the tunica vaginalis testis, scrotolyths, and an increased blood flow to the right epididymis testis. Bilateral exploration revealed torsion of the hydatid and a bilateral malignant mesothelioma of the tunica vaginalis. One year later, elective bilateral exploration showed one minute area on the parietal tunica vaginalis of malignant mesothelioma. After 2 years of follow-up, the patient had no signs of distant disease.     

An experimental study of methods to produce intrascrotal testicular fixation

Methods to produce fixation between the tunica albuginea (visceral tunica vaginalis) and surrounding structures were used in Sprague-Dawley rats as an experimental model of orchiopexy to prevent testicular torsion. Eversion of the parietal tunica vaginalis without suture, or with absorbable or nonabsorbable suture produced excellent scarification, as did the use of talc. Absorbable and nonabsorbable suture, when placed between the parietal tunica vaginalis and tunica albuginea (visceral tunica vaginalis), produced only minor degrees of inflammation. Tetracycline instillation similarly failed to produce a significant inflammatory response.     

Hemorrhagic cyst of the cavum tunica vaginalis testis: a case report

The patient, an eight-year-old boy, visited our clinic with the chief complaint of right painful scrotal swelling persisting for two days. A scrotal puncture yielded 9 ml of bloody fluid. Afterwards a small cystic mass was detected near the epididymal head on palpation and by ultrasonography. Laboratory test results including bleeding tendency were normal. A pedunculated red cystic mass originating from the parietal lamina of the tunica vaginalis testis was found on emergency operation. Histological examinations revealed hemorrhagic cyst of the tunica vaginalis testis with no malignancy.     

睾丸扭转误诊113例分析

目的 :提高睾丸扭转 (精索扭转 )诊治水平。　方法 :回顾分析 1994～ 2 0 0 4年总计 113例睾丸扭转误诊的临床资料。　结果 :首诊误诊率 84 .3%。误诊为急性附睾、睾丸炎 81例 (71.7% ) ;鞘膜积液 10例 (8.8% ) ;急性肠炎 7例 (6 .2 % ) ;泌尿系结石 5例 (4.4 % ) ;腹股沟疝 5例 (4.4 % ) ;睾丸肿瘤 3例 (2 .7% ) ;附睾结核 2例 (1.8% )。发病至误诊时间 2h～ 2个月 ,平均 6 .3d。手法复位成功 3例 ;92例行手术探查 ,睾丸、附睾切除 6 4例 ,睾丸萎缩 2 6例 ,总计睾丸毁损率 79.6 %。　结论 :提高首诊医生对睾丸扭转的诊治水平是减少误诊的关键 ,诊断流程采用病史、体征、彩超 3者结合 ,治疗的最佳方法是积极开展阴囊急诊的手术探查。     

A cyst arising from tunica vaginalis testis : report of a case

A 38-year-old man presented with left intrascrotal painless mass. Ultrasound and magnetic resonance imaging (MRI) examinations demonstrated a cystic lesion at the upper side of left testis without enhancement. This mass gradually enlarged in size, and left high orchiectomy was planned. Because intraoperative finding showed a cyst arising from tunica vaginalis testis, excision of the cyst was performed. Histopathological examination showed a cyst with a fibrous wall lined with cuboidal endothelial cells without malignancy. To our knowledge, this is the 15th reported case of a benign cystic lesion in tunica vaginalis testis in Japan. The age distribution of patients showed two peaks ; one from 5 to 8 years old and the other from 30 to 69 years old. Most of the pediatric patients showed acute scrotal swelling with pain. On the other hand, most adult patients demonstrated painless scrotal swelling with slow growth. Operative investigation should be performed in cases with suspicion of malignancy.     

Recurrent torsion after previous testicular fixation

Background : Occasionally patients present with acute testicular pain having undergone a previous testicular fixation for torsion. The aim of this article is to review the literature and determine whether recurrent torsion of the testis is possible and whether the technique used at initial fixation is relevant. Methods : A literature search was performed using MEDLINE, Pre‐MEDLINE, EMBASE and CIANHL databases using the terms ‘spermatic cord torsion’ and ‘testicular torsion’ in combination with ‘treatment failure’, ‘re‐operation’ or ‘recurrence’. Results : Twenty cases of recurrent testicular torsion after fixation are described. Fifteen of the 17 that specified the type of suture used at initial fixation had used absorbable suture. Animal models suggest that to produce dense adhesions at testicular fixation, the tunica vaginalis must be everted behind the testis with or without fixation, before the testis is returned to the scrotum. Without this eversion, the adhesions around the testis are fine and only located at the site of fixation suture. The use of non‐absorbable suture led to abscess formation in 30% of testes in animal models. Conclusions : The higher incidence of recurrent torsion after fixation using absorbable rather than non‐absorbable sutures in the literature may be caused by a greater number of fixations being carried out using absorbable suture. Use of non‐absorbable suture is limited by the high rate of abscess formation. The most important factor for adhesion formation would appear to be the eversion of the tunica vaginalis and it is recommended that this is carried out at all testicular fixations.     

Malignant mesothelioma of testicular tunica vaginalis

We report here a case with malignant mesothelioma of testicular tunica vaginalis. An 81-year-old Japanese man with left hydrocele was referred for operation. When hydrocelectomy was performed, a thick wall of tunica vaginalis without malignancy was observed. Seven months after hydrocelectomy, a hard irregular mass was noticed in the left scrotum, therefore inguinal orchiectomy was performed. Pathologically, the mass showed severe atypia and mitosis. The diagnosis of malignant mesothelioma was made. He refused any adjuvant treatment and died 1 year later from multiple metastases to the paraaortic lymph nodes and lumbar supine.     

睾丸钟摆畸形与睾丸扭转22例报告

目的 提高对睾丸钟摆畸形（bell-clapper deformity，BCD）的认识，探讨鞘膜内睾丸扭转的解剖和发病特点。方法 回顾性分析22例间歇性睾丸疼痛病例，年龄7～23岁，平均17岁。左侧18例、右侧4例。其中睾丸扭转坏死16例、睾丸大小正常4例、左侧睾丸萎缩2例。结果 22例解剖上均有钟摆畸形即睾丸缺乏正常鞘膜的包裹，睾丸引带缺如，缺乏与壁层鞘膜的粘连，鞘膜腔大，鞘膜在精索上的止点较高，精索活动度较大。16例睾丸坏死或萎缩者行病侧睾丸切除，对侧睾丸固定；6例间歇性睾丸疼痛患者作双侧睾丸探查及固定。22例随访6个月～10年，平均4年9个月，均无睾丸疼痛症状。结论 应高度重视间歇性睾丸疼痛患者，提高间歇期或扭转早期的诊断率，在睾丸未发生扭转坏死之前及时行双侧睾丸探查及固定术，减少睾丸坏死率。     

Leiomyoma of the scrotum: a case report]

A case of intrascrotal leiomyoma is reported. A 62-year-old male was admitted to our hospital with the chief complaint of a painless intrascrotal mass, which had been gradually increasing in size during the past 25 years. Physical examination revealed impervious to light and elastic firm mass of 5 cm in diameter in the left scrotum. Although the serum level of some tumor markers such as alpha fetoprotein and human chorionic gonadotropin-beta were normal, since the border on the left testis was unclear on the ultrasonogram of the scrotum, a testicular tumor was suspected, and radical orchiectomy was performed. The tumor was 6 x 4 x 4 cm, 55 g, and well-defined with testis, epididymis and tunica dartos. It was histopathologically diagnosed as leiomyoma arising from the tunica vaginalis. The post operative course has been uneventful for 9 months after the surgery, and no recurrence has been recognized. An intrascrotal tumor is relatively rare, and is generally defined as one arising between tunica dartos and tunica vaginalis testis, which is independent of testis, epididymis, and funiculus spermaticus. This is the 25th case of intrascrotal leiomyoma reported in the literature in Japan.     

Torsion of the hernia sac within a hydrocele of the scrotum in a child

Torsion of the hernia sac is a rare disease that presents as acute scrotum in children. Including the present case, only six cases have been reported in the English literature. We report a 10-year-old boy who presented with pain and swelling of his right scrotum. Ultrasonography revealed a hypoechoic region adjacent to the normal right testis. The inflammatory changes of the right scrotum deteriorated. The patient underwent surgery and a necrotic cyst was recognized within a hydrocele of the scrotum. The cyst was not connected with the testis or epididymis and was twisted at an angle of 270 degrees. The cause of the necrotic cyst observed was anatomical and pathological torsion of the hernia sac.     

Malignant mesothelioma of the male genital tract: report of two cases

Two patients with urogenital mesothelioma are presented. The first patient had a malignant epithelial mesothelioma involving the scrotum and the peritoneal cavity. This patient was treated by extensive surgery and intraperitoneal perioperative chemotherapy; he is well and alive 62 months after diagnosis. The second patient had an aggressive malignant epithelioid mesothelioma of the tunica vaginalis testis; he died 24 months after diagnosis, with locoregional and metastatic recurrent disease, in spite of surgical and systemic chemotherapy treatment. Calretinin immunostains were positive in the first case and negative in the second. Eighty-eight previously published cases of malignant mesothelioma of the tunica vaginalis testis were found in a review of the literature to date. Mesothelioma of the tunica vaginalis testis usually presents as a scrotal mass, thus requiring urologist skills for first line treatment. A multidisciplinary approach is advised when dealing with the malignant form, considering its aggressive natural history.     

Paratesticular rhabdomyosarcoma in an adult

Embryonal rhabdomyosarcoma is a common tumor of children, rarely appearing in the scrotum from tunica vaginalis or paratesticular tissues. In adults it is rare and carries a particularly bad prognosis. A case of paratesticular rhabdomyosarcoma occurring in a seventy-three-year-old man who survived a total of five and one-half years from the time of his original operation, is presented.     

A case of chronic huge hematocele

A case of chronic hematocele with calcification of the tunica vaginalis is reported. A 65-year-old male was referred to our clinic because of painless swelling of left scrotal contents. Examination revealed a heavy hard mass, 18 cm in diameter, in left scrotum, which started to enlarge 5 years earlier. He had a history of having been kicked by a cow about 10 years previously. The scrotum did not transmit light. Ultrasonography demonstrated hematocele with calcified shell. As it was impossible to exclude a testicular tumor completely, we performed high orchiectomy. Upon opening the mass an old hematocele was formed, which contained old brownish black clotted blood and a normal testis. The thick shell of the mass was found to be a calcified tunica vaginalis. Only 2 cases of chronic hematocele have been reported in the Japanese literature.     

Case of mesothelioma of the tunica vaginalis testis with characteristic findings on ultrasonography and magnetic resonance imaging.

A case of mesothelioma of the right tunica vaginalis testis in a 32-year-old man is reported. Trans-scrotal ultrasonography revealed hydrocele and multiple nodular masses measuring 1.0-4.5 cm in size attached to the parietal vaginal layer. Magnetic resonance imaging demonstrated more clearly nodular masses with irregular surfaces lined on the hydrocele cavity. Histologic diagnosis of the tumor when orchiectomized was mesothelioma. The patient has been free of disease for approximately 3 years since the treatment.     

Torsion of the paradidymis

A second case of torsion of the paradidymis is reported. The embryologic aspects and incidence of appendages within the tunica vaginalis are discussed. This case is compared with the only other report of this clinical entity.     

A case of intrascrotal pseudocyst

A 37-year-old male visited our hospital with the chief complaint of a mass about the size of a hens egg in the right scrotum. Before hospitalization, he had noticed the abnormal intrascrotal mass. The mass gradually enlarged with pain, so he was admitted on May 23, 1982. Under the diagnosis of intrascrotal tumor, the mass was removed. It was a cyst with enriched geratinoid contents enclosed with thick granulation tissue and adhered to the tunica vaginalis externally. Pathological findings revealed it to be an intrascrotal pseudocyst. Discussion is made in relation to the histological genesis of this lesion.     

Multicystic malignant mesothelioma of the tunica vaginalis with an unusually indolent clinical course

We report an extremely rare case of a multicystic malignant mesothelioma in the tunica vaginalis with an unusually indolent clinical course. A 48-year-old man presented with a one-month history of painless swelling of right scrotal contents. Ultrasonography and computed tomography (CT) revealed a multicystic mass in the right scrotal sac with evidence of neither distant nor lymph node metastases. The testicular tumor markers were within the normal limits. Inguinal orchiectomy was performed under the suspicion of a malignant tumor. The cystic tumor consisted of fibrocellular, microcystic and adenomatoid elements microscopically was diagnosed biphasic malignant mesothelioma of tunica vaginalis but no invasion into the testis, epididymis and also scrotum. The patient has been disease-free for 72 months and is being followed on an outpatient basis with no further adjuvant therapy.     

睾丸鞘膜瓣在尿道修复中的应用

目的探讨睾丸鞘膜瓣覆盖技术在尿道畸形和尿道瘘修复中的效果。方法2002年起对38例尿道下裂手术和术后尿道瘘,采用睾丸鞘膜下组织蒂鞘膜瓣覆盖修复。结果术后随访半年至1年,除1例尿道上裂术后瘘修复后再次发生尿道瘘外,其余均获成功,未再出现尿道瘘或尿道狭窄,阴茎外观满意,勃起正常。结论采用该方法可有效防止尿瘘再发生,提高手术成功率且易于获取,对睾丸无不良影响。     

An exceptional complication following appendectomy: Acute inguinal and scrotal suppuration

Inguinal and scrotal suppuration following appendectomy is a rare event, occurring mostly when a patent processus vaginalis is present. Herein we report a small series of children operated for appendicitis and presented with acute inguinal and scrotal symptoms postoperatively. Although acute scrotum is commonly attributed to torsion of testis or its appendage, epididymo-orchitis and incarcerated hernia, following appendicitis scrotal and/or inguinal abscess should be considered.     

Torsion of the contralateral testis 5 years after orchiopexy

We report a case of spermatic cord torsion in the contralateral testicle 5 years after surgical fixation. Since diagnosis of such a lesion is difficult a high degree of suspicion is necessary. If torsion is suspected exploration is mandatory. We strongly recommend the use of a nonabsorbable reaction-producing suture (for example silk) when an orchiopexy is performed, with the point of fixation being between the visceral tunica vaginalis and the dartos muscle.