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Abstract Background Primary malignant neoplasms of the spermatic cord are extremely rare, with most reported cases being sarcomas or metastatic carcinomas. However, primary adenocarcinoma of the spermatic cord has not been previously reported. Case presentation A 34-year-old male with a solid mass in the right spermatic cord, was eventually diagnosed with primary adenocarcinoma. Histological examination revealed a moderately-to-poorly differentiated adenocarcinoma exhibiting glandular, cribriform, or nested growth patterns, characterized by medium to large-sized cells and focal extracellular mucus. Immunohistochemical analysis demonstrated positive staining for CK (AE1/AE3), CK8/18, CK19, MOC31 (EP-CAM), and Ber-EP4, while negative staining was observed for CK7, D2-40, WT-1, MC, PAX-8, NKX3.1, PSA, CEA, TTF-1, and NapsinA. Furthermore, a complete loss of INI-1 expression and consistent BRG1 expression were noted in all tumor cells. Next-generation sequencing revealed SMARCB1 deletion, low tumor mutation burden (TMB-L), and microsatellite stability (MSS). Conclusion We reported the first case of primary adenocarcinoma of the spermatic cord with SMARCB1 (INI-1) deficiency. This case contributes to the expanding understanding of rare neoplasms and underscores the importance of further research into therapeutic strategies targeting SMARCB1-deficient tumors.

Abstract Background Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB). Methods Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively. Results Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB. Conclusions PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB. Trial registration This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021).

Abstract Background Liposarcoma is considered the most common among spermatic cord sarcomas. It usually presents as a progressively enlarging inguinoscrotal mass. The resemblance between the spermatic cord liposarcoma and the inguinal hernia allows the swelling to be tolerated for a long duration giving time for hematogenous dissemination. In this article, we share the experience of a unique case of metastatic liposarcoma of the spermatic cord that showed a stationary course of the lower abdominal satellite lesions on follow-up following palliative resection. Case presentation We present a case of a 53-year-old male with progressively enlarging painless scrotal swelling over 1-year duration. A heterogeneous lesion of the right hemiscrotum and spermatic cord with non-specific radiological features was described by imaging. Two lower abdominal skip lesions were also discovered synchronously in addition to the primary one and were designated inoperable as they were adherent to the nearby bowel loops. The patient underwent cytoreductive surgery of the primary tumour which was proven to be an undifferentiated liposarcoma with free safety margins based on histopathology. Finally, the patient was referred for adjuvant chemotherapy and sequential follow-up. Conclusions Despite being a rare tumour, the radiologist should always consider the liposarcoma of the spermatic cord in the differential diagnosis of inguinoscrotal lesions even in the absence of typical imaging features. The diagnosis and management of spermatic cord liposarcoma remain a challenge with no clear accepted guidelines.

Background: Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB). Methods: Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively. Results: Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB. Conclusions: PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB. Trial registration: This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021). [ABSTRACT FROM AUTHOR]

Background: Primary malignant neoplasms of the spermatic cord are extremely rare, with most reported cases being sarcomas or metastatic carcinomas. However, primary adenocarcinoma of the spermatic cord has not been previously reported. Case presentation: A 34-year-old male with a solid mass in the right spermatic cord, was eventually diagnosed with primary adenocarcinoma. Histological examination revealed a moderately-to-poorly differentiated adenocarcinoma exhibiting glandular, cribriform, or nested growth patterns, characterized by medium to large-sized cells and focal extracellular mucus. Immunohistochemical analysis demonstrated positive staining for CK (AE1/AE3), CK8/18, CK19, MOC31 (EP-CAM), and Ber-EP4, while negative staining was observed for CK7, D2-40, WT-1, MC, PAX-8, NKX3.1, PSA, CEA, TTF-1, and NapsinA. Furthermore, a complete loss of INI-1 expression and consistent BRG1 expression were noted in all tumor cells. Next-generation sequencing revealed SMARCB1 deletion, low tumor mutation burden (TMB-L), and microsatellite stability (MSS). Conclusion: We reported the first case of primary adenocarcinoma of the spermatic cord with SMARCB1 (INI-1) deficiency. This case contributes to the expanding understanding of rare neoplasms and underscores the importance of further research into therapeutic strategies targeting SMARCB1-deficient tumors. [ABSTRACT FROM AUTHOR]

Scrotal masses, whether cystic or solid lesions, are routinely evaluated using ultrasonography. Magnetic resonance imaging (MRI) may be used for further investigation in cases with atypical findings, difficult diagnoses, large masses, and/or unclear relationships with the surrounding tissues. Scrotal solid masses are divided into intra- and extra-testicular masses. A staggering 90% of the intratesticular masses are malignant, whereas 75% of extratesticular masses are benign. Extratesticular masses are less common than intratesticular masses; however, some extratesticular masses present characteristic MRI findings. Familiarity with these specific MRI features of extratesticular masses is beneficial to radiologists, as appropriate diagnoses can help avoid unnecessary invasive treatments such as orchiectomy. In this review, we describe fibrous pseudotumors, polyorchidism, adenomatoid tumors, and scrotal leiomyoma as benign paratesticular masses, focusing on their characteristic imaging features on MRI. Although these tumors are extremely rare, their MRI findings are distinctive, and accurate diagnoses can prevent unnecessary orchiectomy. In addition, to demonstrate the pitfalls of diagnosing extratesticular masses, we present a case of seminoma misidentified as extratesticular masses due to large extensions outside the testis. Spermatic cord sarcoma, including rhabdomyosarcoma, leiomyosarcoma, and liposarcoma, and metastasis to the spermatic cord are described as malignant extratesticular masses. This review focused on extratesticular masses and elaborates the imaging findings that can aid in the accurate diagnosis using MRI. [ABSTRACT FROM AUTHOR]

ABSTRACT Liposarcoma of the spermatic cord (LSC) is extremely rare;

Testicular torsion, as one of the medical emergencies, needs prompt diagnostic and treatment measures. This cross-sectional study aimed to assess the clinical and paraclinical findings and the treatment measures performed in the community of hospitalized patients who underwent surgery in Shahid Beheshti Hospital of Babol from 2012 to 2021 with the initial diagnosis of testicular torsion. The research sample was selected via the convenience sampling method. The necessary information was collected from patients' medical records in the form of a checklist. Thereafter, the data were analyzed in SPSS software (version 22) using descriptive and graphical indicators, as well as Chi-square and Fisher's exact tests at a significance level of 0.05. The findings demonstrated that 197 patients with a mean age of 18.91 years were included in the study. The majority of them (n=121; 61.42%) had torsion on the right side. More than 98% of patients experienced pain, while most of them did not have fever (n=160; 81.22%) and vomiting (n=153; 77.66%). In 148 (75.13%) patients, the final diagnosis was testicular torsion, and in 101 (68.24%) patients, the testicle was preserved. Moreover, the result of the surgery had a significant relationship with the degree of rotation and the duration of the onset of symptoms until hospitalization and from hospitalization to surgery (P>0.001, 0.001 and 0.026, respectively). It can be concluded that an understanding of clinical characteristics of testicular torsion cases and as a result, informing the treatment staff involved in the treatment process, reduce the duration of delay in surgery and leads to more appropriate clinical treatment and improved results in testicular torsion patients.

Testicular torsion, as one of the medical emergencies, needs prompt diagnostic and treatment measures. This cross-sectional study aimed to assess the clinical and paraclinical findings and the treatment measures performed in the community of hospitalized patients who underwent surgery in Shahid Beheshti Hospital of Babol from 2012 to 2021 with the initial diagnosis of testicular torsion. The research sample was selected via the convenience sampling method. The necessary information was collected from patients' medical records in the form of a checklist. Thereafter, the data were analyzed in SPSS software (version 22) using descriptive and graphical indicators, as well as Chi-square and Fisher's exact tests at a significance level of 0.05. The findings demonstrated that 197 patients with a mean age of 18.91 years were included in the study. The majority of them (n=121; 61.42%) had torsion on the right side. More than 98% of patients experienced pain, while most of them did not have fever (n=160; 81.22%) and vomiting (n=153; 77.66%). In 148 (75.13%) patients, the final diagnosis was testicular torsion, and in 101 (68.24%) patients, the testicle was preserved. Moreover, the result of the surgery had a significant relationship with the degree of rotation and the duration of the onset of symptoms until hospitalization and from hospitalization to surgery (P>0.001, 0.001 and 0.026, respectively). It can be concluded that an understanding of clinical characteristics of testicular torsion cases and as a result, informing the treatment staff involved in the treatment process, reduce the duration of delay in surgery and leads to more appropriate clinical treatment and improved results in testicular torsion patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate quantitative and qualitative spermatic cord CT abnormalities and presence of unilateral or bilateral symptomatic scrotal pathology (SSP) at ultrasound. Methods: This retrospective study included 122 male patients (mean age 47.8 years) undergoing scrotal ultrasound within 24 h of contrast-enhanced CT (n = 85), non-contrast CT (NECT, n = 32) or CT-Urogram (n = 5). CECT quantitative analysis assessed differential cord enhancement using maximum Hounsfield unit measurements. Three fellowship trained body radiologists independently assessed qualitative cord abnormalities for both CECT and NECT. Qualitative and quantitative findings were compared with the presence of SSP. Reader performance, interobserver agreement and reader confidence were assessed for NECT and CECT. Quantitative cutoff points were identified which maximized accuracy, specificity, negative predictive value, and other measures. Results: SSP was present in 36/122 patients (29.5%). Positive cases were unilateral in 30 (83.3%) and bilateral in 6 (16.6%). At quantitative assessment, 25% differential cord enhancement had the highest diagnostic accuracy (88.9%), with 90.5% positive predictive value, 88.4% negative predictive value, 96.8% specificity, and 70.4% sensitivity. At qualitative evaluation, CECT reader performance was excellent (aggregate AUC = 0.86; P <.001); NECT was poorly discriminatory, although remained significant (aggregate AUC = 0.67; P =.002). Readers had significantly higher confidence levels with CECT (P <.001). Qualitative inter-observer agreement was high for both CECT and NECT (ICC = 0.981 and 0.963, respectively). Conclusion: Simple quantitative assessment of differential cord enhancement is highly accurate and specific for SSP at CECT. Qualitative abnormalities at CECT and NECT are also both predictors of SSP, however, CECT significantly out-performs non-contrast exams. [ABSTRACT FROM AUTHOR]

Para-testicular liposarcoma develops from the fatty tissue surrounding the spermatic cord and covers the testicle and epididymis. It is an extremely rare pathological entity. We report the case of a 58-year-old african man who presented with a tumor mass developed from the right spermatic cord. Right orchidectomy with wide excision of the tumor was challenging due to the significant size of the mass. The histological examination of the surgical specimen favored a paratesticular liposarcoma.

Liposarcoma of the spermatic cord is a malignant neoformation so rare that less than 200 cases are reported in the world. It is a tumor that originates from adipose tissue and when it is found in the spermatic cord it can deceptively simulate an inguinal hernia and not be easily identified. The present work describes the case of a 37-year-old man with liposarcoma of the spermatic cord who arrives at our institution with painless swelling of the left testicle. Physical examination revealed a painless swelling in the scrotal sac. The scrotal ultrasound examination revealed a mass, measuring 8 cm (cranio-caudal) × 5.4 cm (latero-lateral) × 8 cm (antero-posterior) and characterized later with a basal CT examination of the abdomen. The patient was subsequently surgically treated with excision of the tumor, plus hernial plastic with plug and mesh. Histological examination revealed a mature adipocyte neoplasm whose morphological and molecular characteristics (amplification of the MDM2 gene) are consistent with the diagnosis of dediferrentiated liposarcoma variety CO-MINGLED, G2 (sec. FNCLCC). The patient is currently under cancer surveillance with no signs of loco-regional recurrence. Spermatic cord liposarcoma is an extremely rare malignancy. It's not easy to identify as it can simulate an inguinal hernia, hydrocele, lipoma, funicular cyst, or testicular tumor. Diagnosis is usually established postsurgery, however, relapses are common and the role of chemo-radiotherapy remains to be defined.

Insidious, usually painless, and rare inguinoscrotal masses arising from paratesticular elements (spermatic cord, epididymis, tunica or the stroma) are known as paratesticular tumors. The overall incidence is less than 5%, and the total number of giant (>10cm) paratesticular liposarcomas is less than 300 cases recorded since 2020. We report a similar clinical dilemma of a giant scrotal mass managed via a wide local resection and close surveillance in a 61 year old male. However, owing to its rarity, there is no fixed treatment protocol; hence, a supplementary review of similar cases is discussed here.

Scrotal lipoma is benign and still, one of the rarest cancers, with very few cases previously reported in the world. The exact pathogenesis of lipomas remains unknown. Scrotal lipomas can be classified into three categories based on their origins: scrotal lipoma, spermatic cord and tunica vaginalis tumor, and primary scrotal lipoma. The disease may be misdiagnosed or diagnosed inaccurately. We present a case of a 46-year-old male with a giant bilateral scrotal lipoma presenting as scrotal swelling and discomfort, which was first diagnosed as an inguinal hernia. Computed tomography, ultrasound, and fine needle aspiration were performed and aroused a suspicion of lipoma. An operation was performed, and the tumor was completely excised and histologically confirmed as a lipoma. To our knowledge, this is the largest scrotal tumor reported in Vietnam, which led to not only diagnostic but also treatment challenges. Therefore, it is significant to report similar cases that can help clinicians diagnose and handle such tumors in a timely manner. [ABSTRACT FROM AUTHOR]

Background: The Lichtenstein method revolutionized the treatment of inguinal hernias. Since then, many methods of herni)oplasty have been proposed, of which the so-called isolation methods are gaining more and more relevance, which implies complete spermatic cord isolation from the mesh, in order to avoid the inclusion of the spermatic cord in the inflammatory process, which can cause a violation of the ejaculation function and spermatogenesis itself, as the Lichtenstein method is ac)companied by such a serious Complications such as: development of fibrous changes in the spermatic cord, deejaculation, obstructive azoospermia, oligospermia. These complications have been proven by experimental and clinical studies, due to the close contact of the rope with the mesh and are conditions that contribute to infertility in men. Aim: Study of subsequent changes in the vas deferens during modeled inguinal hernioplasty in the experiment, in the groups that underwent hernioplasty by Lichtenstein's method and complete spermatic cord isolation by Gvenetadze's method. Material and methods: 16 male rabbits aged 12 months ± 3 months, weighing 3.5 ± 0.5 kg were included in the study. Of these, 8 (50%) underwent hernioplasty by Lichtenstein's method, and 8 (50%) - with spermatic cord isolation from a mesh by Gvenetadze's method. Rabbits were divided into two groups. The first group: 8 rabbits, which underwent Lichtenstein's hernia surgery. The second group: 8 rabbits, which underwent hernioplasty with complete spermatic cord isolation by Gvenetadze's method. Vasography was performed in both groups 6 months after the operation, the patency of the ductus deferens and the degree of obstruction were studied. Results: Our experimental study showed that changes in the vas deferens after the operation occurred only in the first group (P<0.05), no changes were observed in the second group. During the Lichtenstein method, <25% narrowing of the vas def)erens was observed in 12.5%, 25-75% narrowing was observed in 50%, and >75% narrowing was observed in 37.5%. During the Gvenetadze method, no changes were observed in the vas deferens. Conclusions: the experimental method showed the narrowing and interruption of the vas deferens during the Lichtenstein method, which is the reason for the development of obstructive azoospermia and oligospermia and contributes to the devel)opment of infertility in men. The mentioned experimental study reliably confirms the negative aspects of Lichtenstein's method, which should be taken into account, especially in men of reproductive age. The isolation method claims that these changes do not develop in the vas deferens, tension-free isolation hernioplasty is simple, prevents male infertility and does not affect spermatogenesis. [ABSTRACT FROM AUTHOR]

Extraosseous osteosarcoma (EOO) is a rare mesenchymal malignancy representing 4% of all osteosarcomas and 1% of soft tissue sarcomas. The testes, its supporting structures, that is, paratestes, and the spermatic cord are among the rarest sites for EOO, with only 11 published English language reports to date. We report our experience with a 73-year-old male presenting with left hemiscrotal swelling, noted to have extensive amorphous intratumoral calcification on imaging. He underwent left high inguinal orchidectomy with en bloc hemiscrotectomy, with a final pathologic diagnosis of primary paratesticular osteosarcoma. Our literature review corroborates this distinctive, hitherto overlooked imaging feature.

Introduction/Purpose: Percutaneous core‐needle biopsy of the testicle has been shown to be a safe and effective method of obtaining tissue for histological analysis and can be considered in specific clinical scenarios. While the use of spermatic cord block has been shown to be effective in pain relief in the emergent setting and as an anaesthetic option for inguinal surgery, its use in percutaneous core‐needle biopsy has not been well described. Through this case series, we present our experience and technique of ultrasound‐guided percutaneous core‐needle biopsy using spermatic cord block in the setting of indeterminant testicular masses. Methods: Our departmental biopsy database was reviewed to identify patients who underwent percutaneous core‐needle biopsy of the testicle from March 2010 to July 2022 and who also received spermatic cord block during the procedure. Results: Three patients were identified who met the search criteria. All three patients presented for the evaluation of indeterminant testicular mass and had a known non‐testicular primary cancer diagnosis at the time of biopsy. All three biopsies were performed using a combination of spermatic cord block, moderate sedation, and local anaesthetic. Biopsies were obtained using an 18‐gauge spring‐loaded device with 4‐5 core samples obtained during each procedure. All biopsies were well tolerated without significant pain or post‐procedure complications. Discussion: Ultrasound‐guided percutaneous core‐needle testicular biopsy using spermatic cord block is a safe and effective option in sampling indeterminate testicular masses while maintaining patient comfort. Conclusion: The inclusion of a spermatic cord block in combination with local anaesthetic and moderate sedation has become standard practice in our institution, as we believe this maximises patient comfort and safety resulting in a better patient experience. [ABSTRACT FROM AUTHOR]

Background: Antibioma is a loculated collection in the spermatic cord, which is generally a transparent sterile fluid located above the testis in the inguinal region. It is an acquired congenital anomaly that is commonly observed in infants and children. Infected spermatic cord hydrocele has been reported on previously, but to the best of our knowledge, antibioma of spermatic cord hydrocele in adults has not yet been reported. In specific cases of long-standing abscesses, cartridge-based nucleic acid amplification test (CBNAAT) is used as the final diagnostic tool and can determine whether they are of tubercular pathology. Case: Here we are presenting a case of a 72-year-old male patient reporting to the surgery Outpatient Department, with complaints of swelling in the left inguinal region since birth, along with intermittent pain in the swelling for one year. It was diagnosed as antibioma and was confirmed to be of tubercular origin by CBNAAT following surgical exploration. The patient was started on anti-tubercular management as per the National Tuberculosis Elimination Programme protocol. Conclusions: Long standing abscesses are mostly tuberculous. We must look into whether they need urgent attention or can be managed conservatively as a routine procedure.

Extraosseous osteosarcoma (EOO) is a rare mesenchymal malignancy representing 4% of all osteosarcomas and 1% of soft tissue sarcomas. The testes, its supporting structures, that is, paratestes, and the spermatic cord are among the rarest sites for EOO, with only 11 published English language reports to date. We report our experience with a 73-year-old male presenting with left hemiscrotal swelling, noted to have extensive amorphous intratumoral calcification on imaging. He underwent left high inguinal orchidectomy with en bloc hemiscrotectomy, with a final pathologic diagnosis of primary paratesticular osteosarcoma. Our literature review corroborates this distinctive, hitherto overlooked imaging feature. [ABSTRACT FROM AUTHOR]

A 24-year-old healthy male with left sided groin pain and swelling extending into the left hemiscrotum. Computed tomography reported an encysted spermatic cord hydrocoele. Open exploration revealed a cystic structure arising from the spermatic cord. Histopathological analysis demonstrated sebaceous glands within the wall of the cyst, pathognomonic for a dermoid cyst. A literature review demonstrates just 12 cases of inguinal dermoid cysts to date. Our case demonstrates the importance of radiological imaging in cases of groin lumps to facilitate surgical planning as well as the importance of sending surgical specimens for histopathological analysis to aid in the event of recurrence.

In this article, we discuss benign and malignant spermatic cord tumors. We attempted to compile this rare group of diseases by reviewing the international literature. Tumors of the spermatic cord are found very rarely. However, it is important to be aware of their occurrence, as they can cause a protrusion in the inguinal area. They are usually misdiagnosed as an inguinal hernia. The most common tumors in this area are benign -- usually they are lipomas. In 20-70% of cases, adipose tumors accompany an inguinal hernia. Therefore, they should be kept in mind whenever a patient presents with symptoms of herniation in the inguinal region. Tumors of the spermatic cord may also involve the scrotum and manifest themselves as testicular hydrocele. Such a tumor is, for example, aggressive angiomyxoma. It is a locally malignant tumor that tends to infiltrate and compress the surrounding tissues but does not tend to give metastasis, therefore according to the WHO classification it is a benign tumor. However, malignant tumors such as rhabdomyosarcoma, which is the most common malignant neoplasm of testicular appendages, can also be located in the spermatic cord. The second most common soft tissue sarcoma is leiomyosarcoma, with poor initial prognosis, or metastases of malignant tumors from other organs, e.g. renal adenocarcinoma. As the prognosis for malignant tumors of the spermatic cord is generally dependent on the stage at the time of diagnosis, oncological vigilance and early diagnosis allow for faster detection of these tumors, which may improve the prognosis of patients with tumors in this location. [ABSTRACT FROM AUTHOR]

Résumé Contexte La sarcoïdose est une maladie multisystémique caractérisée par la formation de granulomes non caséeux dans divers organes. Les poumons restent l’organe le plus fréquemment touché, alors que les lésions du système génito-urinaire affectent environ 0,2% des patients. La découverte d’un site principal dans le cordon spermatique est extrêmement rare. Présentation du cas Nous présentons le cas d’un patient où l’atteinte du cordon spermatique a été la première manifestation d’une sarcoïdose. Pendant plusieurs mois, un certain nombre de tests ont été effectués, qui montraient, entre autres, des granulomes non caséeux dans le matériel pathomorphologique, une lymphadénopathie hilaire bilatérale, et une leucopénie avec lymphopénie. Les marqueurs tumoraux étaient normaux. Une infection par des agents pathogènes urogénitaux (y compris Chlamydia Trachomatis, Neisseria gonorrhea, Mycoplasma hominis) a été exclue. Le patient n’a signalé aucun symptôme général tel que fièvre, fatigue excessive, ou perte de poids. Il a nié toute œdème ou essoufflement. Dans le même temps, un diagnostic différentiel complet a été effectué et l’étendue de la maladie a été évaluée. Grâce à la prise en charge interdisciplinaire, la qualité de vie et la fertilité du patient ont été préservées. Dans la discussion, nous présentons le diagnostic, le traitement et le pronostic de ces patients. Conclusion La sarcoïdose est une maladie multisystémique, qui ne doit pas être omise dans le diagnostic différentiel. L’excision sélective de la lésion, avec examen peropératoire, joue un rôle important lors de l’établissement d’un diagnostic. Cependant, en cas de localisation du site primaire dans le système génito-urinaire, le diagnostic est difficile.

Leiomyosarcoma of the spermatic cord is a rare entity. It can arise from any mesenchymal cell of its structure. It occurs mainly in elderly patients. It presents as a firm and painless intrascrotal mass. We present a case of a 30-year-old man with a 3-year history of a painless left-sided scrotal mass. Ultra-sound examination showed a scrotal mass. Further work-up revealed no distant metastasis before surgery. A left radical 1-block orchidectomy with epididymis and spermatic cord was performed. The final histopathologic examination showed a pattern of leiomyosarcoma of the spermatic cord. Considering the result of the histopathological examination, the Onco-logical Council did not recommend any additional surgery, but only watchful waiting. Almost 4 years of follow-up have passed without additional treatment. Primary scrotal leiomyosarcoma is an exceptional entity with only 100 cases reported in the literature. Due to its rarity, additional studies are needed to better define the optimal therapeutic management. A literature review and treatment strategy are discussed. [ABSTRACT FROM AUTHOR]

Objective: To describe a rare pathology, spermatic cord liposarcoma (SCL), and to discuss the diagnosis and treatment. Introduction: Malignant lesions of the spermatic cord are rare, with approximately 100 cases reported in the world literature. Preoperative diagnosis is rare. The spermatic cord is the most involved urological site, being the origin of 30% of all genitourinary sarcomas. The diagnosis is often difficult and unexpected. The recommended treatment is surgery with wide local excision and adjuvant radiotherapy is proposed in cases with positive margins, when there is local recurrence or with poor prognostic factors. Case report: A 67 old man, who was admitted in Unidad Médica de Alta Especialidad Manuel Ávila Camacho, in Puebla, Mexico, with a right parascrotal tumor. Underwent a left radical orchiectomy, finding a tumor in the left spermatic cord. Histopathological examination showed a dedifferentiated liposarcoma. During the follow-up of the patient, it progressed to the inguinal region. Conclusions: Liposarcomas of the spermatic cord are a rare entity. Diagnosis is difficult or often confused with hernias, hydrocele or other tumors. Treatment should include surgical excision, usually radical inguinal orchiectomy. A long period of follow up is necessary. [ABSTRACT FROM AUTHOR]

Introduction. Varicocele is an abnormal dilatation of the internal spermatic veins of the spermatic cord. It has an estimated prevalence of 15% in young male adults. Even though most of them are asymptomatic, scrotal pain and testicular hypotrophy are frequent in children and adolescents. There is controversy regarding the indications and optimal approach for treatment purposes. We present the results of our 15-year series in the laparoscopic repair of pediatric varicocele. Materials and methods. 238 patients diagnosed with varicocele and undergoing laparoscopic repair from 2006 to 2020 were reviewed. Variables collected included age, symptoms, grade, testicular atrophy, hospital stay, perioperative complications, recurrences, and formation of reactive hydrocele. Mean follow-up was 5.6 years (6 months-9 years). Results. Mean age was 14.1 years. 188 patients had grade III varicocele. In 14 cases, varicocele was bilateral. Testicular atrophy at diagnosis was found in 42% of patients, 74% of whom were over 15 years old. 51 patients had testicular pain. All patients underwent laparoscopic treatment. Mean operating time was 36 min. Median hospital stay was 31 h. Recurrence rate was 2.1%. 43 patients (18%) developed hydrocele, but only 27 (11.2%) required hydrocelectomy according to Lord's plication at least 1 year following laparoscopy. Of the remaining 16 cases, 2 spontaneously resolved and 14 remained stable in the mean 7-year follow-up. In 7.1%, paresthesias were noted in the anterior-internal aspect of the left thigh. Conclusion. Based on our series, we believe laparoscopy should be regarded as the gold standard technique in the pediatric population. Laparoscopic varicocelectomy is technically easy and fast, causes no pain, and has a recurrence rate of 1%. The procedures involving lymphatic vessel preservation could reduce reactive hydrocele rates as a long-term complication to a minimum. [ABSTRACT FROM AUTHOR]

Background: As a minimally invasive procedure, laparoscopic inguinal hernia repair in children was introduced. Percutaneous internal ring suturing (PIRS) is a popular technique. The main concern is that the spermatic cord will be trapped and/or the vasculature of the testes will be damaged in boys. This can be avoided by performing a careful dissection or by skipping the peritoneum over the cord and/or the vessels. The aim of the study was to compare the incidence of recurrence or complication (e.g. hydrocele) in children with skipped peritoneum on the cord and/or vessels compared to those without skipped peritoneum during laparoscopic PIRS repair. Methods: The charts of children who underwent laparoscopic PIRS repair for inguinal hernia between 2017 and 2021 were analyzed. Complications and recurrence were assessed. The video recordings were viewed, and data on skipping (group 1) or not skipping (group 2) the peritoneum on vas deferens was recorded. The rates of recurrence and complications were compared between groups. Results: There were 101 boys with a total of 125 inguinal hernias in the study. There were 45 right-sided hernias, 32 had left-sided hernias, and 24 had bilateral hernias. According to the video investigation, there were 63 hernias in group 1 and 62 hernias in group 2. In each group, there were two recurrences (3% for both groups). There were no other postoperative complications. Conclusions: To avoid spermatic cord or vessel damage, skipping the cord appears to be an acceptable path that does not appear to increase recurrence or complication rates while also ensuring the safety of spermatic structures. [ABSTRACT FROM AUTHOR]

Intratesticular block is an effective local anesthetic technique for castration; however, its use may be limited in cases of testicular masses or infections. Instillation is a simple technique used in several procedures, though studies investigating its application in feline castration remain scarce. Therefore, this study aimed to compare the perioperative analgesic efficacy of lidocaine intratesticular block and spermatic cord instillation in feline castration. Forty-five male cats were randomly divided into three groups: the intratesticular block group (IT), the spermatic cord instillation group (S), and the control group (C). All cats were anesthetized using the same protocol and both techniques were performed based on group assignments. Lidocaine (2 mg/kg) was administrated according to the designated route, while 0.9% normal saline was used for the alternative route and in the C group. Intraoperative parameters were recorded, showing that noninvasive blood pressure in the IT and S groups was significantly lower than in the C group. Although both lidocaine intratesticular block and spermatic cord instillation effectively reduce surgical noxious stimulation, intratesticular block is recommended as it provides more stable intraoperative vital signs and less postoperative pain. Therefore, spermatic cord instillation can be considered as an optional technique for managing pain in feline castration.

Objective: To explore the relevant factors affecting the efficacy of microscopic spermatic cord surgery and build a predictive model for postoperative pain relief., Methods: A retrospective analysis was conducted on the clinical data of 324 patients with spermatic cord pain who visited the Department of Urology at Peking University People's Hospital between October 2015 and April 2023. This cohort included 212 patients with varicocele-related spermatic cord pain and 112 patients with idiopathic spermatic cord pain. All the patients underwent microsurgical procedures: varicocele-related pain was treated with microsurgical varicocelectomy, and idiopathic pain was treated with microsurgical denervation of the spermatic cord. The patients were categorized into effective and ineffective groups based on whether their pain had decreased by more than 50% six months post-surgery compared with pre-surgery levels. Baseline data were preliminarily screened for clinical indicators using t tests and univariate analysis. Clinical predictor variables [age, duration of pain, diameter of varicocele, patient health questionnaire-9 (PHQ-9) score, generalized anxiety disorder-7 (GAD-7) score] were selected using Lasso regression. A clinical prediction model for effective pain relief following microscopic spermatic cord surgery was constructed using Logistic regression and presented as a nomogram. The model's internal validation was performed using the bootstrap method. Its predictive power and clinical utility were evaluated through the concor-dance index, the area under the receiver operating characteristic curve, and calibration plots., Results: Post-microscopic varicocele ligation, 156 patients (73.58%) experienced significant pain relief, as did 94 patients (83.93%) following microscopic denervation. Independent predictors for postoperative outcomes included age, PHQ-9 score, GAD-7 score, chronic pain duration, and varicocele diameter, differing slightly between varicocele-related and idiopathic pain groups. The models demonstrated excellent predictive ability, with areas under the curve of 0.909 and 0.913 for varicocele and idiopathic groups, respectively, and high concordance indices., Conclusion: The postoperative efficacy prediction model based on age, pain duration, PHQ-9 score, GAD-7 score, and varicocele diameter has good predictive ability and clinical applicability, and can be used in clinical practice.

We report the first case of Dirofilaria repens in a 4-year-old male patient in Switzerland. The disease is a vector-borne parasitic infection that is not endemic to Switzerland. A 4-year-old male presented with a tender mass in the left groin. The patient was taken to the operating room for surgical exploration to rule out a pathology that could be harmful to the spermatic cord. A node was found along the spermatic cord and excised. Histopathology and microbiology studies revealed the diagnosis of Dirofilaria repens.

Ultrasonography is effective for imaging superficial organs, such as the scrotum. Using a highfrequency transducer, ultrasonography can identify the location and characteristics of scrotal lesions with high accuracy. The primary role of ultrasound (US) in the evaluation of a scrotal mass is to determine if it is intratesticular or extratesticular. Additional clinical information and other imaging options may be needed to diagnose benign tumors and pseudo-tumors. MRI is an effective problem-solving tool in cases with nondiagnostic US findings. CT is helpful for staging testicular cancer and localizing undescended testis. This review covers the imaging features of testicular and extratesticular tumors.

The main target during management of a male pediatric patient with clinical signs of acute scrotum is the timely diagnosis, in order not to jeopardize the viability of the affected testicle. Thorough evaluation of the patient’s medical history, symptomatology, clinical and ultrasonographic findings, constitutes the basis of the diagnostic procedure. After comprehensive research of the relevant literature, we highlight the remaining difficulties in the evaluation of the clinical and ultrasonographic findings for the accurate diagnosis of the acute scrotum. In conclusion, it is worth emphasizing on the following: a. the most common diseases that come under the diagnosis of the acute scrotum may present with similar symptoms, b. in neglected cases the diagnostic approach becomes more difficult, constituting the evaluation of the pathognomonic clinical signs challenging, and c. inability to exclude the diagnosis of spermatic cord torsion should be an indication for the surgical exploration of the affected hemiscrotum. [ABSTRACT FROM AUTHOR]

BackgroundAnastomosing hemangioma (AH) is a rare vascular tumor and occurs in various organs. It is difficult to distinguish AH from malignant tumors even through multimodal imaging examination. AH located in the inguinal region is even rare. We present the diagnosis and treatment of a patient with spermatic cord AH in detail and conduct a literature review.Case ReportAn 84-year-old Chinese man had swelling pain in his right scrotum. A hard and fixed mass was palpable in the right inguinal region. Preoperative radiological examination considered it a neurogenic or vascular tumor. Malignant soft tissue sarcoma could not be excluded. He underwent radical inguinal right orchiectomy under intraspinal anesthesia. The diagnosis of spermatic cord AH was confirmed by pathological examination. The patient recovered uneventfully and remained disease-free during an 18-month follow-up.ConclusionSpermatic cord AH is quite rare and could be misdiagnosed as a malignant tumor. Pathological evidence might be necessary. The optimal choice of treatment should be determined through a comprehensive assessment of both tumor and patient factors.