腹股沟疝合并精索恶性肿瘤的临床及影像学诊断

Clinical and imaging diagnosis of inguinal hernia with spermatic cord malignant tumor

目的探讨腹股沟疝合并精索恶性肿瘤临床和影像学特征。方法回顾性分析2000年8月至2019年8月首都医科大学附属北京朝阳医院收治的腹股沟疝合并精索恶性肿瘤19例患者的临床、影像学与病理资料,结合相关文献复习及对其临床诊治进行讨论。结果患者均以单侧腹股沟疝合并精索肿物收入院,行患侧精索肿物广泛性切除术。术后病理诊断分别为:精索高分化脂肪肉瘤8例,精索去分化脂肪肉瘤7例,精索平滑肌肉瘤4例。病理回报恶性肿瘤后患者转泌尿外科进一步接受根治性睾丸切除术。除1例患者术后随访1年后复发行放疗外,余18例患者随访至今均无复发。结论精索恶性肿瘤是一种少见的疾病,影像学及实验室检查多无特异性。术前诊断困难,推荐的治疗方法为根治性睾丸切除术及局部肿瘤广泛性切除术。

Objective To explore the clinical and imaging features of inguinal hernia with malignant tumor of spermatic cord.Methods The clinical,imaging and pathological data of 19 cases of inguinal hernia with malignant tumor of spermatic cord in Beijing Chaoyang Hospital,Capital Medical University from August 2000 to August 2019 were analyzed retrospectively.The related literatures were reviewed and clinical diagnosis and treatment were discussed.Results All patients were admitted to the hospital with unilateral inguinal hernia with spermatic cord tumors,and underwent extensive resection of the tumor.The postoperative pathological diagnosis was:8 well-differentiated liposarcoma of the spermatic cord(well differentiated liposarcoma,WDLS),7 dedifferentiated liposarcoma of the spermatic cord(dedifferentiated liposarcoma,DDLS),4 leiomyosarcoma of the spermatic cord(leiomyosarcoma,LMS).After pathology reporting of malignant tumor,all patients were transferred to the urological department for further radical orchiectomy.Except for 1 patient who accepted radiotherapy due to recurrence one year after the operation,no recurrence was found in the remaining 18 patients during follow-up.Conclusion Malignant tumor of spermatic cord is a rare disease with nonspecific imaging and laboratory examination.Preoperative diagnosis is difficult.The recommended treatment for this disease is radical orchiectomy and extensive resection of local tumor.