Paratesticular liposarcoma: Two case reports

BACKGROUND Paratesticular liposarcoma accounts for approximately 7%of scrotal tumors.They are rare lesions of the reproductive system with approximately 90%of the lesions originating from the spermatic cord.Surgery,with the goal of complete resection,is the mainstay for treatment of this disease.However,treatment consisting of extended resection to decrease local recurrence remains controversial.CASE SUMMARY We report the cases of two patients with paratesticular liposarcomas who were treated with radical testicular tumor resection without adjuvant therapy.Followup investigations at 9 mo showed no sign of recurrence.CONCLUSION Surgery is the first-line treatment,regardless of whether it is a recurrent or primary tumor.Extended resection carries a higher risk of complications and should not be performed routinely.Preoperative radiotherapy can reduce the local recurrence rate without affecting the overall survival.

Case Report: The Paratesticular Rhabdomyosarcoma in Children

Rhabdomyosarcoma is a rare and aggressive mesenchymal tumor, whose paratesticular location is the most common genitourinary site. It is the prerogative of the child and the young adult. On physical examination, a painless scrotal tumefaction is observed. His diagnosis is essentially provided by testicular ultrasound. His therapeutic strategy is codified and based on the combination of chemotherapy and surgical excision or radiotherapy. The precocity of the management and the accuracy of the extension and radiology tests are important for the vital and functional prognosis. We report a case of paratesticular rhabdomysarcoma of alveolar type, diagnosed in front of a large left painless scrotal mass, which has been evolving for less than one month in a 7-year-old child. An inguinal orchiectomy was performed. A histological examination of the excised tissue revealed an epididymal RMS of the alveolar type. Our patient had 9 chemotherapy sessions with vincristine, actinomycin C and cyclophosphamide. Each chemotherapy session took place over four days, with a 21-day cycle. He was evaluated for 4 years and demonstrated good clinical improvement. The experience gained from the index case is crucial for the management of patients with intratesticular rhabdomyosarcoma who must always ensure that the radical inguinal orchiectomy with lymph node dissection is covered by chemotherapy and/or radiotherapy. This will potentially reduce the chances of tumor recurrence and/or metastasis, thus improving patient prognosis.

Paratesticular Rhabdomyosarcoma in a 30 Months Old Child at the Lagoon Mother and Child Teaching Hospital (CHUMEL) in Cotonou

Introduction: Rhabdomyosarcoma is the most common soft tissue tumor in children. Modern multidisciplinary approaches make it possible to better characterize the different entities and to adapt the treatment accordingly. Paratesticular localization is rare and aggressive. We report here a case of paratesticular localization in a 30 months old boy. Observation: The parents would have noticed a small, painless and rapidly evolving testicular mass in the 6 months old child. Not having health insurance, they went to the hospital only 5 months later. This was followed by a total ablation of the mass (without orchidectomy) and a pleiomorphic rhabdomyosarcoma had been concluded. No chemotherapy was performed and the mass recurred 2 months later. This time, its ablation was followed by a series of non-adapted chemotherapy sessions with irregular follow-ups leading 8 months later to the child’s admission at our department. He presented with a degraded general condition, associating an infectious and anemic syndrome, an important increase of the scrotal mass and the occurrence of a tumoral mass in the left iliac fossa. The tumoral nature of these masses was confirmed on abdominal ultrasound and scan. The tumor was classified stage II (TNM: initial Tumors, Nodes, Metastasis). The multidisciplinary medical staff indicated a total ablation of the two masses, followed by a new session of adapted chemotherapy, in the absence of radiotherapy means. The child died in the immediate surgery follow-ups due to cardiac arrest. Conclusion: In our context of insufficient technical facilities, only early detection and adapted imperative chemotherapy, would have enabled a durable remission in front of the paratesticular rhabdomyosarcoma.

^(18)F-FDG PET/CT findings of paratesticular alveolar rhabdomyosarcoma

Rhabdomyosarcoma(RMS)originates from primitive mesenchymal cells and is the most common soft tissue tumor in childhood.^(18)F-fluoro-deoxyglucose(^(18)F-FDG)positron emission tomography(PET)/computed tomography(CT)has been reported to be valuable in RMS staging and risk stratification.Paratesticular RMS is a relatively uncommon form of RMS,most of which are of the embryonal histologic type.Paratesticular alveolar RMS is associated with aggressive behavior,high metastatic potential,and poor outcomes.To the best of our knowledge,^(18)F-FDG PET/CT imaging findings of paratesticular alveolar RMS have never been described.Here,we report on a 16-year-old boy's rare paratesticular alveolar RMS with multiple metastases and its findings on^(18)F-FDG PET/CT.This case also demonstrates the potential value of^(18)F-FDG PET/CT in RMS staging and treatment decisions,and may aid in the differential diagnosis.

33例睾丸旁腺瘤样瘤的超声特征分析

目的总结睾丸旁腺瘤样瘤的超声特征及临床资料,提高该病的诊断和治疗水平。方法回顾性分析2012年3月至2021年11月郑州大学第一附属医院33例患者34处经病理确诊的睾丸旁腺瘤样瘤的超声特征及临床资料。结果33例患者的34处睾丸旁腺瘤样瘤病灶中,位于附睾30处(29例)、睾丸网3处、白膜1处,左右侧各17处。31例患者超声检查术前明确诊断仅1例,描述性诊断17例,漏诊1例,误诊12例。33例患者中28例行局部肿物切除术,2例行睾丸去势术,3例行睾丸附睾切除术。33例患者术后随访无一例复发,1例患者术后5 a发现术侧附睾管扩张。结论附睾尾部腺瘤样瘤超声多表现为高回声肿块,其余部位则回声不一,附睾头部腺瘤样瘤多位于睾丸与附睾头之间,结合体格检查有助于减少漏诊,明确诊断。对于有生育需求的典型睾丸旁腺瘤样瘤超声图像患者,可考虑定期复查保守治疗或生育后再行手术治疗。

睾丸旁平滑肌肉瘤2例临床病理观察

目的探讨睾丸旁平滑肌肉瘤的临床病理特征、病理诊断及鉴别诊断、治疗及预后。方法回顾性分析2例睾丸旁平滑肌肉瘤的临床病理特征、免疫组化,并复习相关文献总结其临床和病理特征。结果2例均为男性,年龄分别为74岁及59岁。临床常以睾丸肿块、坠胀不适就诊。大体均为灰白色结节状肿物,切面灰白,质韧;镜下肿瘤界限清楚,局灶可见凝固性坏死,肿瘤细胞由平行或交织条索状排列的梭形细胞组成,瘤细胞异型性明显,瘤细胞核大,深染,常见形状不规则的瘤巨细胞,细胞核呈杆状、圆形或椭圆形或泡状,染色质粗而深染,核仁不明显,核分裂象易见;免疫表型:肿瘤细胞Vimentin、H-Caldesmon、Desmin及SMA均(+),CK、S-100等均为(-),肿瘤细胞Ki-67增殖指数为10%~35%。结论原发性睾丸旁平滑肌肉瘤罕见,临床表现无特异,术前诊断困难,易误诊,确诊需病理检查,术后易复发和远处转移,应长期随访。

睾丸旁促结缔组织增生性小圆细胞肿瘤1例报告及文献复习

目的:探讨睾丸旁促结缔组织增生性小圆细胞肿瘤的临床、病理特征、诊断及治疗。方法:回顾分析1例睾丸旁促结缔组织增生性小圆细胞肿瘤的诊治及随访资料,并复习相关文献。患者,男,27岁,因阴囊内无痛性肿块4个月就诊。体检于左侧阴囊内可扪及囊性肿块,同侧睾丸不能扪及。行左侧睾丸根治性切除术,术后辅以化疗。结果:术中见左侧睾丸旁多发结节状隆起肿块,质偏硬;术后病理检查肿瘤细胞呈巢状或梁索状结构并埋没在增生的纤维结缔组织中;免疫组化显示瘤细胞具有上皮源性、间质性和神经源性等多向分化的特点。术后已随访3年无瘤生存,预后良好。结论:促结缔组织增生性小圆细胞肿瘤有特异的临床病理特征,好发于年轻男性,手术切除肿瘤联合化疗是治疗的主要方法,睾丸旁促结缔组织增生性小圆细胞肿瘤比腹腔型预后相对好。

原发性睾丸旁平滑肌肉瘤1例报告

睾丸及睾丸旁肿瘤发病率较低,仅占中国全部恶性肿瘤的1%~2%,其中生殖细胞肿瘤占95%,非生殖细胞肿瘤种类庞杂,包括支持细胞瘤、间质细胞瘤、支持-间质细胞瘤、黑色素性神经外胚瘤、间皮瘤、黏液性囊腺瘤、腺癌、纤维上皮瘤及横纹肌肉瘤等。平滑肌肉瘤起源于间充质来源的未分化平滑肌细胞,是罕见的软组织肿瘤。从未接受类固醇激素治疗或放射线照射的原发性睾丸平滑肌肉瘤是一种非常罕见的肿瘤,大多位于睾丸旁,起病于睾丸的平滑肌成分,如血管或生精囊[1-3]。现将大连医科大学附属第一医院收治的1例睾丸旁平滑肌肉瘤病例介绍如下,并探讨手术时机及对生殖的影响。

Tunica vaginalis testis metastasis as the first clinical manifestation of pancreatic adenocarcinoma:A case report

BACKGROUND Metastases from pancreas or ampullary malignancies are common,but the spread to testicle and paratesticular tissue is exceedingly rare.To the best of our knowledge,fewer than 30 cases have been reported in the literature.More rarely,metastasis to tunica vaginalis testis occurs without involvement of the testes and epididymis.CASE SUMMARY A 65-year-old male who complained of painless swelling of the left scrotum for over 1 wk was referred to the Department of Urology.Scrotal ultrasound showed left testicular hydrocele with paratesticular masses.Chest computed tomography revealed lung metastasis and enlarged left supraclavicular lymph node.The blood tumor markersalpha-fetoprotein,human chorionic gonadotropin,and serum lactate dehydrogenase were withinnormal limits.The preoperative diagnosis was left testicular tumor with lung metastasis.Then radical orchidectomy of the left testicle and high ligation of the spermatic cord were performed,and postoperative histopathology suggested metastatic tumors that was confirmed by an abdominal computed tomographic scan.The positive computed tomography findings,in conjunction with the expression of cytokeratin 7(CK7),CK20,CK5/6,and absence of expression of Wilms’tumor suppressor gene 1,calretinin,melanocyte,prostate-specific antigen,thyroid transcription factor-1,GATA binding protein 3,caudal type homeobox 2,and napsinA supported the diagnosis of pancreatic adenocarcinoma.The outcome of this patient was unsatisfactory,and he died 3 mo later.CONCLUSION This case suggests that pancreatic metastatic carcinoma must be considered in the differential diagnosis of scrotal enlargement.The advanced age of the patient wassuggestive of a secondary testicular tumor.In addition,careful physical examination and ultrasonography as well as radiological examination have become a standard modality.

附睾脂肪肉瘤腹膜后及腹腔内转移1例报告并文献复习

目的:报告1例罕见的附睾脂肪肉瘤伴腹膜后及腹腔内多次转移病例,提高对本病的诊治水平。方法:回顾分析1例附睾脂肪肉瘤伴腹膜后及腹腔内多次转移患者的临床资料,结合国内外相关文献,探讨附睾脂肪肉瘤的临床表现、诊断及治疗。结果:经腹股沟切口行根治性高位睾丸切除术完整切除肿瘤,10年后出现腹膜后复发转移,肿块上至肾脏上极,下达盆腔,大小15.6 cm×9.4 cm×25.5 cm,包裹左肾及输尿管上段,行左肾及输尿管全长、腹膜后肿瘤切除手术,4年后再次出现腹膜后、腹腔内多发复发转移灶,再次行手术切除,随访1年,死于肺功能衰竭。结论:附睾脂肪肉瘤极为罕见,仔细的临床体检和影像学检查可协助诊断,但最终需病理确诊,应早期行根治性手术切除。放化疗对附睾脂肪肉瘤的作用存在争议。本病有较高的复发率,长期的密切随访是必要的。

睾丸及睾丸旁肿瘤MRI表现并文献复习

目的 探讨睾丸及睾丸旁肿瘤的MRI表现.方法 10例睾丸及睾丸旁肿瘤患者均行磁共振成像（MRI）检查,扫描序列包括常规T1WI、T2WI＋FS及LAVA,扫描方位为横断面、矢状面及冠状面,层厚3～4 mm,从不同扫描序列及扫描方位图像观察病变部位、大小、形态、信号及其与周围组织关系,并与手术病理结果进行对比.结果 精原细胞瘤3例,淋巴瘤4例,卵黄囊瘤1例,浆细胞瘤1例,睾丸旁横纹肌肉瘤1例.MRI对睾丸及睾丸旁肿瘤性病变定位准确,大多数肿瘤的MRI表现有一定特征性.结论 MRI的多方位、多序列扫描技术可清晰显示睾丸及睾丸旁肿瘤及其与周围组织的关系,分析其信号特点,有助于病变的诊断与鉴别诊断.

儿童睾丸旁炎性肌纤维母细胞瘤2例

分析2例儿童睾丸旁炎性肌纤维母细胞瘤患者资料并复习文献。例1,男,7岁。主诉发现左侧阴囊肿物1个月,B超显示左侧睾丸旁实性肿物。例2,男,9岁。主诉右侧阴囊肿大疼痛1个月,B超显示右侧睾丸背上方实性肿块,范围约3.0 cm×1.9 cm×1.4 cm。2例肿瘤均完整切除,例1标本光镜下肿瘤细胞为纤维组织、胶原纤维中间散在淋巴细胞、浆细胞,可见淋巴滤泡形成,免疫组化:ALK(-),desmin部分(+),SMA(+),CD68散在(+),calretinin(-),S-100(-)。诊断为炎性肌纤维母细胞瘤。例2标本光镜下肿瘤细胞大部分为纤维血管组织,表面无包膜,部分为成纤维细胞,其间可见散在及灶状炎细胞浸润,一侧可见附睾管。免疫组化:SMA(+)、Ki67(+)约为2%。诊断为附睾炎性肌纤维母细胞瘤。术后3个月B超复查,例1随诊4年未见复发,例2失访。

成人睾丸旁横纹肌肉瘤诊治五例报告

目的提高成人睾丸旁横纹肌肉瘤（RMS）的诊治水平。方法回顾性分析2004年至2005年收治5例成人睾丸旁RMS患者的临床资料，结合文献复习进行讨论。结果5例患者均行经腹股沟睾丸根治性切除术，病灶直径4～15cm。病理检查证实为睾丸旁RMS，其中胚胎型3例，腺泡状和胚胎型伴腺泡状各1例。4例Ⅰ、Ⅱ期患者接受了腹膜后淋巴结清扫手术，其中3例存在淋巴结转移，术后采用以异环磷酰胺和阿霉素为主的辅助化疗4个周期。1例存在肺转移的Ⅳ期患者化疗后达到完全缓解。5例中位随访时间16个月，1例患者因疾病复发而死亡，2例带瘤生存，2例无瘤生存。结论睾丸旁RMS是少见的男性生殖系统恶性肿瘤，常见病理类型为胚胎型和腺泡状。Ⅰ、Ⅱ期患者首要进行完整的原发灶和腹膜后淋巴结切除，并辅助化疗，Ⅳ期患者化疗短期内有效。

小儿睾旁横纹肌肉瘤的诊治

目的提高小儿睾旁横纹肌肉瘤（PARARMS）的诊治水平。方法回顾性分析我院1977至2008年6月收治的14例睾旁横纹肌肉瘤病例。年龄1～15岁，其中≤5岁6例，平均年龄6岁。左侧9例，右侧5例。全组病例均因单侧阴囊肿大就诊，经影像检查都属I期病变。14例中有4例曾在外院手术，经患侧阴囊切口；1例做睾丸切除，3例保留睾丸、做肿物切除。这4例都再次经腹股沟切口，高位精索离断，3例切除曾被保留的睾丸；并切除原阴囊皮肤切口及其周围组织；余10例也是经腹股沟切口，根治性睾丸切除。病理检查除1例是腺泡型外，其余均为胚胎型中的梭形细胞型。术后化疗主要用VAc（长春新碱＋放线菌素D＋环磷铣胺）。结果14例中13例获得随访，随访时间1～24年，平均6年。随访≥2年者11例，10例（91％）无瘤存活，1例于手术后近2年时复诊，腹膜后转移瘤的最大径达8cm，家长放弃治疗，该例仅接受化疗6次。1例术后10年复查，精液内无精子。结论小儿睾旁横纹肌肉瘤易于被检出，故多为I期病变，且梭形细胞属良好型，经腹股沟切口高位精索离断、睾丸切除＋VAC化疗，存活率达91％。由于环磷铣胺可致精液内无精子，故近年对I期良好型病变可不用环磷铣胺。

成人睾丸旁横纹肌肉瘤(附2例报告)

目的提高成人睾丸旁横纹肌肉瘤的诊断和治疗水平。方法本组病人分别为青年、中年,病理分别为横纹肌肉瘤和恶性横纹肌瘤。术前B超提示腹股沟区低回声肿物,肿物周边及内部可见血流信号。结合文献进行探讨。结果本文2例睾丸旁横纹肌肉瘤均行根治性手术切除,1例术前采用紫杉醇(紫杉醇330mg,静脉点滴,28d为一疗程)新辅助化疗：术后继续辅助紫杉醇(紫杉醇330mg,静脉点滴,28d为—疗程)辅助化疗。本文2例均于诊断后一年内死亡。结论成人睾丸旁横纹肌肉瘤的预后差。睾丸旁横纹肌肉瘤患者生存率的提高有赖于早期诊断和根治性切除。

小儿睾丸旁横纹肌肉瘤的临床诊断学特征

目的探讨小儿睾丸旁横纹肌肉瘤的临床诊断学特征及治疗。方法回顾性分析佛山市中医院泌尿外科2018年6月4日收治的1例睾丸旁横纹肌肉瘤患儿的临床资料,并进行文献复习。结果患儿临床表现为左侧进行性增大的阴囊肿物,生化、免疫、肿瘤指标等实验室检查无异常发现。超声提示左侧阴囊内实性占位,血流信号丰富。核磁共振检查提示左侧阴囊内占位。行左侧睾丸根治性切除术,术后病理免疫组化肌间线蛋白Desmin(+),肌细胞生成素Myogenin(+),诊断为睾丸旁横纹肌肉瘤。术后第3天发现左侧阴囊内无痛性肿物,行左侧半阴囊切除术,后采用长春新碱+放线菌素D+环磷酰胺(VAC)方案化疗。现随访8个月,无瘤生存。结论小儿睾丸旁横纹肌肉瘤表现为阴囊内占位性病变,因特殊的生长位置易误诊为睾丸肿瘤。完整的手术切除及病理学检查可以对该类病变进行治疗并明确诊断。