Calcinosis escrotal: ¿una entidad idiopática? / Scrotal Calcinosis: an Idiopathic Entity?

La calcinosis escrotal es una enfermedad benigna e infrecuente que se presenta en adultos de mediana edad, con múltiples nódulos asintomáticos a nivel de la piel del escroto. Algunos autores vinculan la aparición de estas lesiones a la calcificación secundaria de quistes epidérmicos o ecrinos. Cuando no se encuentra relacionada con dichas entidades ni con alteraciones del metabolismo fosfocálcico, el cuadro se considera idiopático. El tratamiento de elección es quirúrgico, en caso de impacto en la calidad de vida o relevancia estética para el paciente. (AU)

Scrotal calcinosis is a rare, benign disease that presents in middle-aged adults with multiple asymptomatic nodules on the skin of the scrotum. Some authors link the appearance of these lesions to the secondary calcification of epidermal or eccrine cysts. When it is not related to these entities or to alterations in phosphocalcic metabolism, the condition is considered idiopathic. The treatment of choice is surgical, in case of impact on the quality of life or aesthetic relevance for the patient. (AU)

Reconstrucción escrotal con colgajo pediculado del músculo gracilis bilateral e injerto de piel parcial / Scrotal reconstruction with bilateral gracilis muscle pedicled flap and split-thickness skin graft

Los defectos en la región escrotal son producidos en la mayoría de los casos por la gangrena de Fournier, y en ocasiones por traumatismo o patologías oncológicas. Estas heridas generan mucha dificultad para el desarrollo de una vida normal a los pacientes que lo padecen; por lo general producen dolor, los testículos quedan desprotegidos y la espermatogénesis puede verse alterada. Actualmente no existe un método estándar de reconstrucción escrotal, y las técnicas tradicionalmente utilizadas no ofrecen una cobertura funcional ni estética. Generalmente producen mucho abultamiento en la región genital, que puede dificultar el movimiento de las piernas y el uso de pantalones. En este trabajo se expone una opción quirúrgica para reconstruir el escroto, por medio del colgajo pediculado de músculo gracilis bilateral e injerto de piel parcial. Para tal efecto, se presenta un caso clínico de un paciente de 64 años con secuelas en la región perineal, posterior a una gangrena de Fournier. El paciente presentaba una pérdida total del escroto y exposición de ambos testículos. El método arriba mencionado es una opción válida para reconstruir el escroto y en este trabajo se describe la técnica empleada de forma detallada, donde se puede apreciar que presenta escasas complicaciones y es fácil de reproducir por un cirujano plástico entrenado.

Defects in the scrotal region are caused in most cases by Fournier's gangrene, and sometimes by trauma or oncological pathologies. These wounds generate difficulties for the development of a normal life; They usually produce pain; the testicles are unprotected and spermatogenesis can be altered. Currently there is no standard method of scrotal reconstruction, and the techniques traditionally used do not offer functional or aesthetic coverage. They generally produce a big bulge in the genital region, which can make it hard to move the legs and wear pants. A surgical option is exposed to reconstruct the scrotum, by means of the bilateral gracilis muscle pedicled flap and split-thickness skin graft. For this purpose, a clinical case of a 64-year-old patient with sequelae in the perineal region, after Fournier's gangrene, is presented. The patient presented a total loss of the scrotum and exposure of both testicles. The method mentioned above is a valid option to reconstruct the scrotum and the technique used is described in detail, where it can be seen that it is easy to reproduce by a trained plastic surgeon.

Quiste del rafe medio perineal / Median raphe cysts of the perineum

Introducción: los quistes de rafe medio (QRM) son lesiones infrecuentes del aparato genital masculino, pueden localizarse desde la parte distal del pene hasta la zona perianal. Se deben a defectos del cierre del rafe medio durante el desarrollo embrionario. Objetivo: presentar un lactante con el diagnóstico de QRM, discutir el diagnóstico, tratamiento y seguimiento. Caso clínico: niño de 1 año y 3 meses de edad con 7 lesiones quísticas de 0.5 cm cada una en el rafe medio escrotal desde el nacimiento, la ecografía de partes blandas reporta imagen sólida hipoecogénica de borde definidos y sin vascularización al doppler. Se realizó exéresis quirúrgica y la patología confirmó el diagnóstico de quiste de rafe medio perineal, con buena evolución en el seguimiento. Discusión: 75% de los casos de los QRM son asintomáticos es por ello que muchas veces su diagnóstico es tardío, además su desconocimiento produce confusión con patologías quísticas o tumorales similares. El diagnóstico es clínico, aunque la ecografía puede ayudar para excluir otras anomalías como las vasculares. El tratamiento de elección debe ser la extirpación quirúrgica para evitar episodios de sobreinfección o molestias locales derivadas de su localización y tamaño. Conclusión: debido a lo infrecuente de esta patología es importante darla a conocer. Se recomienda realizar la valoración integral del paciente pediátrico para lograr un adecuado diagnóstico, ofrecer el mejor tratamiento y brindar información adecuada a los padres.

Introduction: median raphe cysts (MRC) are uncommon lesions of the male genitalia. They can be found anywhere from the distal penis to the perianal area. They are caused by an incomplete closure of the median raphe during embryologic development. Objective: to present a case of MRC in an infant and provide a review on diagnosis, treatment and follow-up. Case report: one year and three months old boy, with seven 0.5 cm sized cystic lesions along the scrotum median raphe, noticed since birth. A soft tissue ultrasound demonstrated a well-circumscribed hypoechogenic solid image without any evidence of vascularity at Doppler ultrasound. Surgical excision was conducted and histopathology confirmed the diagnosis of a median raphe cyst of the perineum, showing good progression in follow-up. Discussion: 75% of cases of MRC are asymptomatic, thus their diagnosis is often delayed. Not knowing this condition leads to confuse MRC with other similar cysts or tumors. The diagnosis is mostly clinical, although ultrasound may help to exclude other anomalies such as vascular anomalies. Surgical excision is the treatment of choice to prevent superinfection or local discomfort due to its location and size. Conclusion: Recognition of this uncommon pathology is imperative. A comprehensive evaluation of the pediatric patient is recommended to achieve an adequate diagnosis and treatment and provide appropriate information to the parents.

Lipogranuloma Esclerosante Escrotal Primario. Reporte de caso y revisión de la literatura / Primary Scrotal Sclerosing Lipogranuloma. Case report and literature review

RESUMEN El lipogranuloma esclerosante es una condición extraña y benigna que puede afectar cualquier órgano, especialmente los genitales externos masculinos. Se suele presentar como masas subcutáneas en escroto, periné y pene. Aunque la mayoría de los casos son secundarios a aplicación de cuerpos extraños como parafina, vaselina o silicona con propósitos estéticos para aumentar el tamaño del pene, también puede deberse a degeneración lipídica endógena, secundaria a trauma, infecciones o reacciones alérgicas. No existe consenso en cuanto a su manejo ni datos sobre su prevalencia al ser una entidad poco reportada; se ha descrito el manejo con ciclos cortos de corticoides sistémicos, y cirugía en los casos recidivantes. El objetivo de este trabajo es reportar el caso de un paciente que acudió con induración y eritema en pene y escroto, quien negaba la aplicación de sustancias exógenas y que fue llevado a biopsia de la lesión, con diagnóstico de lipogranuloma esclerosante. MÉD.UIS.2021;34(2): 97-102.

ABSTRACT Sclerosing lipogranuloma is a noncommon and benign disease that could affect any system in the body, especially the male external genitalia. It is usually presented as a subcutaneous mass in scrotum, perineum and penis. Although, most cases are secondary to the injection of foreign bodies such as paraffin, petrolatum or silicone for cosmetic purposes to increase penis size, it could also be due to endogenous lipid degeneration, secondary to trauma, infections or allergic reactions. There is no unanimity regarding its management or data on its prevalence as it is a poorly reported entity. Management with short cycles of systemic corticosteroids and surgery in relapsing cases have been described. The purpose of this article is to present a case of a patient with induration and erythema in penis and scrotum, who denied the application of exogenous substances and has a reported biopsy of the lesion with diagnosis of sclerosing lipogranuloma. MÉD.UIS.2021;34(2): 97-102.

Carcinoma Escamoso Escrotal. Reporte de un caso / Squamous scrotal carcinoma. Report of a case

Se presenta el caso de un paciente de 47 años quien consultó por cuadro de cicatrización tórpida de una lesión cutánea superficial única en hemi-escroto izquierdo. Se procedió a resección biópsica de la lesión con resultado de la anatomía patológica de un Carcinoma Escamoso del tipo Condilomatoso (Warty) el cual confirma su relación con el HPV 16 mediante estudio de inmunohistoquímica. Por ser un caso infrecuente no existe actualmente un consenso sobre el manejo del carcinoma del escroto motivo el cual se realiza una revisión de la literatura y se expone los resultados.

A case of a 47-year-old patient who consulted for torpid healing of skin lesion in left hemi-scrotum is presented. We proceed to resection-biopsy of the lesion and the pathology report informed a warty squamous cell carcinoma (Warty type) and the relationship with HPV 16 is confirmed by immunohistochemical study. As a rare case there is currently no consensus on the management of carcinoma of the scrotum reason that we do a review of the literature and the results are exposed.

The importance of updated criteria in breeding soundness examination of commercial Nellore bulls for the herd reproductive improvement / [Importância de critérios atualizados na avaliação andrológica de touros Nelore a campo para a evolução reprodutiva do rebanho]

The aim of this work was to compare results of breeding soundness examination (BSE) of Nellore bulls (n=1257) according to evaluation criteria from two different classification tables (traditional-Table1 used since 1997 and an updated-Table2-proposed in 2020). Data were separated into 3 categories: questionable animals in Table1 and Table2 (Q1Q2), animals approved in Table1 and questionable in Table2 (A1Q2) and animals approved in Table1 and Table2 (A1A2). BSE parameters were submitted to ANOVA (P<005), according to age groups. Higher (P<0.0001) scrotal perimeter (PE) were observed in A1A2 category (18-24m=33.4±2.4cm; 24-36m=34.5±2.2cm; 36-48m=36.6±1.7cm; >48m=38.6±1.7cm) compared to A1Q2 (18-24m=29.05±0.98cm; 24-36m=30.3±0.6cm; 36-48m=32.9±1.0cm; >48m=34.8±1.0cm) and to Q1Q2 (24-36m=26.8±2.0cm; 36-48m=30.0±0.1cm; >48m=31.3±1.1cm), for all age groups. At the age of 36-48months (Q1Q2=2.7±0.3; A1Q2=3.2±0.3; A1A2=3.3±0.6) and >48months (Q1Q2=3.0±0.4; A1Q2=3.3±0.5; A1A2=3.4±0.5), animals with better andrological classifications presented higher (P<0.05) body condition score (BCS). Additionally, at age >48m, higher sperm Motility (P=0.0250) and Vigor (P=0.0335) were observed in animals A1Q2 (Mot=55.5±14.7%; V=3.21±0.82) and A1A2 (Mot=55.8±12.2%; V=3.23±0.81) compared to Q1Q2 (Mot=50.2±17.4%; V=2.77±0.82). It was concluded that bulls approved using strict selection criteria demonstrated higher PE and BCS, regardless of the age. The utilization of updated classification tables is highly recommended for further reproductive potential development of Nellore bulls in the field.(AU)

O objetivo deste estudo foi comparar os resultados obtidos no exame andrológico a campo de touros Nelore (n=1257) de acordo com os critérios de avaliação de duas tabelas de classificação (uma tabela tradicional - tabela 1 - proposta em 1997 e uma nova tabela atualizada - tabela 2 - proposta em 2020). Os dados foram separados em três categorias: animais questionáveis nas tabelas 1 e 2 (Q1Q2), animais aprovados na tabela 1 e questionáveis na tabela 2 (A1Q2) e animais aprovados nas tabelas 1 e 2 (A1A2). Os parâmetros foram submetidos à análise de variância (P<0,05), por faixa etária. Observou-se maior (P<0,0001) PE no grupo A1A2 (18-24m=33,4±2,4cm; 24-36m=34,5±2,2cm; 36-48m=36,6±1,7cm; >48m=38,6±1,7cm) em comparação ao grupo A1Q2 (18-24m=29,05±0,98cm; 24-36m=30,3±0,6cm; 36-48m=32,9±1,0cm; >48m=34,8±1,0cm) e este maior (P<0,0001) que Q1Q2 (24-36m=26,8±2,0cm; 36-48m=30,0±0,1cm; >48m=31,3±1,1cm) em todas as idades. Nas faixas etárias 36-48m (Q1Q2=2,7±0,3; A1Q2=3,2±0,3; A1A2=3,3±0,6) e >48m (Q1Q2=3,0±0,4;A1Q2=3,3±0,5; A1A2=3,4±0,5), animais com melhor classificação andrológica apresentaram melhor (P<0,05) escore de condição corporal (ECC). Adicionalmente, na idade >48m, maiores motilidade (P=0,0250) e vigor (P=0,0335) foram observados nos animais A1Q2 (Mot=55,5±14,7%; V=3,21±0,82) e A1A2 (Mot=55,8±12,2%; V=3,23±0,81) comparados aos animais Q1Q2 (Mot=50,2±17,4%; V=2,77±0,82). Concluiu-se que touros aprovados na tabela com critérios mais rigorosos de classificação (tabela 2) apresentaram maior PE e ECC, independentemente da idade. Assim, a utilização de tabelas classificatórias atualizadas é fundamental para maior desenvolvimento do potencial reprodutivo de touros Nelore a campo.(AU)

Omentum as non-strangled inguino scrotal hernia content in stallion: case report / [Omento como conteúdo de hérnia inguino-escrotal não estrangulada em garanhão: relato de caso]

Non-strangulated acquired hernias in stallions are rare, especially when the herniated content is not intestinal loops. Thus, the aim of the current study is to describe a case of acquired non-strangulated inguinoscrotal hernia in a stallion, whose herniated content was the omentum. The patient was a Criollo stallion with history of rhabdomyolysis, laminitis and bilateral scrotal volume increase observed in the left scrotal region. The animal presented pain in both thoracic limbs, abnormal blood test, especially hypoproteinemia, and mild pain during palpation in the left inguinal ring region. Hydrocele secondary to hypoproteinemia was suspected. After admission, the animal showed signs of acute abdomen, which were clinically reversed. With this, the animal was subjected to ultrasound examination of the scrotal region, whose findings suggested non-strangulated inguinal hernia, although the content could not be identified. Surgical treatment was chosen in order to identify the herniated content and remove the left testicle. Access to the affected scrotum was performed, in which the presence of fluid and a portion of the omentum was observed surrounding the testis and adhering to it. The animal was discharged after he recovered from the surgery and from laminitis. During the breeding season, the stallion remained with a herd of mares for natural mating. After 15 months of surgery, the animal was reassessed and showed no active signs of inflammatory and degenerative processes in the remaining testis. On this occasion, a pregnancy diagnosis was also performed, and all the mares were pregnant. It is concluded that the presence of omentum as a herniated content does not represent a surgical emergency but can make the reproductive prognosis reserved. In addition, removal of the affected testicle can benefit the spermatogenesis of the remaining testicle.(AU)

As hérnias adquiridas não estranguladas em garanhões são raras, principalmente quando o conteúdo herniado não é de alças intestinais. Assim, o objetivo deste trabalho foi descrever um caso de hérnia inguino escrotal adquirida e não estrangulada em garanhão, cujo conteúdo herniado era composto pelo omento. Foi atendido um garanhão da raça Crioula com histórico de rabdomiólise, laminite e aumento de volume escrotal bilateral, evidenciado na região escrotal esquerda. O animal apresentava dor nos membros torácicos, alterações na avaliação sanguínea, destacando-se a hipoproteinemia, e demonstrava dor leve à palpação na região do anel inguinal esquerdo. Suspeitou-se de hidrocele secundária a hipoproteinemia. Após a internação, o animal apresentou sinais de abdômen agudo, revertidos clinicamente. Com isso, realizou-se ultrassonografia da região escrotal, cujos achados sugeriram hérnia inguinal não estrangulada, sem que o conteúdo pudesse ser identificado. Optou-se pelo tratamento cirúrgico, com o intuito de identificação do conteúdo herniado e remoção do testículo esquerdo. Foi realizado acesso à bolsa escrotal afetada, na qual se observou presença de líquido e de uma porção do omento envolvendo o testículo e aderido a ele. O animal recebeu alta após restabelecimento da cirurgia e da laminite. Na propriedade, durante temporada reprodutiva, o garanhão permaneceu com uma manada de éguas para realização de monta natural. Passados 15 meses da cirurgia, o animal foi reavaliado e não demonstrou sinais ativos de processo inflamatório e degenerativos no testículo remanescente. Nessa ocasião, também foi realizado diagnóstico de gestação e todas as éguas encontravam-se prenhes. Conclui-se que a presença de omento como conteúdo herniado não representa uma emergência cirúrgica, mas pode tornar o prognóstico reprodutivo reservado. Ainda, a remoção do testículo afetado pode trazer benefícios à espermatogênese do remanescente.(AU)

The role of intra-abdominal pressure in human testicular migration

ABSTRACT Objectives: This review aims to study the role of the abdominal wall in testicular migration process during the human fetal period. Materials and Methods: We performed a descriptive review of the literature about the role of the abdominal wall in testicular migration during the human fetal period. Results: The rise in intra-abdominal pressure is a supporting factor for testicular migration. This process has two phases: the abdominal and the inguinal-scrotal stages. The passage of the testis through the inguinal canal occurs very quickly between 21 and 25 WPC. Bilateral cryptorchidism in Prune Belly syndrome is explained by the impaired contraction of the muscles of the abdominal wall; mechanical obstruction due to bladder distention and structural alteration of the inguinal canal, which hampers the passage of the testis during the inguinoscrotal stage of testicular migration. Abdominal wall defects as gastroschisis and omphaloceles are associated with undescended testes in around 30 to 40% of the cases. Conclusions: Abdominal pressure wound is an auxiliary force in testicular migration. Patients with abdominal wall defects are associated with undescendend testis in more than 30% of the cases probably due to mechanical factors; the Prune Belly Syndrome has anatomical changes in the anterior abdominal wall that hinder the increase of intra-abdominal pressure which could be the cause of cryptorchidism in this syndrome.

Testicular torsion and climate changes in macroregions of São Paulo, Brazil / Torção testicular e diferenças climáticas nas macrorregiões do estado de São Paulo, Brasil

ABSTRACT Objective: To analyze the association between climate changes in the macroregions in the state of São Paulo and testicular torsion treated cases. Methods: The cases were selected in the Brazilian Public Health Data System Database from January 2008 to November 2016. All surgical procedure records were identified by the Hospital Admission Authorization document. Two codes were selected to process the search: testicular torsion (surgical cure code) and acute scrotum (exploratory scrototomy code). The macroregions were grouped in five areas linked to climate characteristics by International Köppen Climate Classification. Results: A total of 2,351 cases of testicular torsion were registered in the period. For the areas B, C and E (testicular torsion n=2,130) there were statistical differences found in association of testicular torsion cases and decreased temperature (p=0.019, p=0.001 and p=0.006, respectively), however, in analyses for the areas A and D statistical differences were not observed (p=0.066 and p=0.494). Conclusion: Decrease in temperature was associated with testicular torsion in three macroregions of São Paulo. The findings support the theory of cold weather like a trigger in occurrence of testicular torsion in a tropical climate region.

RESUMO Objetivo: Analisar a associação entre mudanças climáticas nas macrorregiões do estado de São Paulo e os casos tratados com torção testicular registrados. Métodos: Os casos foram selecionados no Banco de Dados do Sistema de Dados de Saúde Pública do Brasil de janeiro de 2008 a novembro de 2016. Todos os registros de procedimentos cirúrgicos foram identificados pelo documento de Autorização de Internação Hospitalar. Dois códigos foram selecionados para processar a busca: torção testicular (código de cura cirúrgica) e escroto agudo (código de escrototomia exploratória). As macrorregiões foram agrupadas em cinco áreas ligadas às características climáticas pela Classificação Internacional de Clima Köppen. Resultados: Foram registrados 2.351 casos de torção testicular no período. Para as áreas B, C e E (torção testicular n=2.130), foram encontradas diferenças estatísticas na associação dos casos de torção testicular e diminuição da temperatura (p=0,019, p=0,001 e p=0,006, respectivamente), mas nas análises das áreas A e D não foram observadas diferenças estatísticas (p=0,066 e p=0,494). Conclusão: A diminuição da temperatura foi associada à torção testicular em três macrorregiões de São Paulo. Os resultados apoiam a teoria do clima frio como um gatilho para ocorrência de torção testicular em uma região de clima tropical.

Potencial reprodutivo (PR) de touros Nelore avaliados por parâmetros andrológicos e comportamento sexual. Classificação por pontos: nova proposição / [Reproductive potential of Nelore bulls evaluated by andrological parameters and sexual behavior. Classification by points - a new proposition]

Este estudo teve por objetivo comparar variações de parâmetros andrológicos e comportamentais de touros Nelore de diferentes faixas etárias, calcular seu potencial reprodutivo (PR) e propor uma nova tabela de classificação por pontos, de acordo com as médias atualmente alcançadas por eles nas características estudadas. Foram utilizados dados de 6162 exames andrológicos de touros da raça Nelore, entre 12 e 80 meses de idade, em regime de monta natural. O número de touros classificados como aptos consistiu em 88,9% dos animais avaliados (n=5480), sendo 51,6% desses considerados excelentes (n=2827), 41,2% muito bons (n=2257) e 7,2% considerados bons (n=394). Entre os animais questionáveis (n=682; 11,1%), 79,6% foram classificados como inaptos temporários (n=542) e 20,4% (n=139) como animais descarte, de acordo com o exame andrológico, independentemente do teste da libido. O número de touros classificados como excelentes se reduziu para 752 (12,2%) quando dados de comportamento sexual foram incluídos para definição do seu PR. Concluiu-se que o uso de tabelas de classificação andrológica por pontos com atualizações técnicas beneficia a seleção mais apurada de touros Nelore. O teste da libido é ferramenta importante para a determinação do PR, o qual permite melhor aproveitamento dos reprodutores.(AU)

This study aimed to compare variations of andrological and behavioral parameters from Nelore bulls of different ages, to calculate their reproductive potential (RP) and propose a new classification table by points, considering current averages in each reproductive trait studied. Data were collected from 6162 breeding soundness examinations of Nelore bulls aged between 12 and 80 months, under natural mating. According to andrological parameters, regardless of the libido test, the number of bulls classified as approved was 88.9% (n= 5480), being 51.6% considered as excellent (n= 2827), 41.2% very good (n= 2257) and 7.2% considered as good (n= 394). Among the animals considered as questionable (n= 682; 11.1%), 79.6% were classified as temporarily reproved (n= 542) and 20.4% (n= 139) as discarded animals. The number of bulls classified as excellent decreased to 752 (12.2%) when sexual behavior data were included to define their RP. It was concluded that the use of tables for andrological classification by points with technical updates improves the reproductive selection of Nelore bulls. The libido test is an important tool for RP determination which provides better utilization of the sires.(AU)

Atypical lymphangioma and hyperkeratosis in a patient with morbid obesity

Abstract Lymphangioma is a rare and understudied pathology that is usually detected in the first decade of life, and its appearance in adults is rare. This report details a 51-year-old man with morbid obesity who presented, for the last eight months, multiple asymmetric tumor lesions with extension to the scrotal region. The diagnosis of circumscribed lymphangioma with associated infection was confirmed. This case report demonstrates an unusual presentation of the characteristics of the lymphangioma that are seldom described in the literature.

Linfedema escrotal masivo: Reporte de caso y revisión de la literatura / Massive scrotal lymphedema: case report and literature review

El lindefema masivo localizado es una condición rara pero su incidencia se encuentra en aumento. El linfedema puede ser primario o secundario a infecciones, radioterapia, cirugías, cáncer, enfermedades del sistema inmune o a compresión. Algunos autores han sugerido un incremento en su incidencia debido a la epidemia de obesidad. El linfedema escrotal produce una morbilidad importante debido a mala higiene, infecciones, incontinencia urinaria, disfunción sexual, pérdida de la libido e inclusive limitación en la deambulación. Las opciones de tratamiento no quirúrgico de la linfedema incluyen el drenaje linfático manual, prendas de compresión, terapia física y ejercicio. Usualmente, el tratamiento conservador falla debido a la dificultad anatómica que presenta la región genital para la aplicación de dichas terapias. El tratamiento quirúrgico puede ser efectivo en casos graves y moderados. Existen diferentes variantes a la técnica quirúrgica, pero la resección del tejido afectado y la reconstrucción con tejido sano es primordial. El pronóstico de esta patología tiende a ser bueno; sin embargo, se reporta una alta tasa de recidiva.

Massive localized lymphedema is a rare but rising condition that could be primary in nature or secondary to infections, radiation, surgery, malignancies, autoimmune or compression. Some authors have suggested and increased incidence due to the raising epidemic of obesity. Scrotal lymphedema causes significant morbidity such as poor hygiene, infections, urinary incontinence, sexual dysfunction, loss of libido and a limited ambulation. Although non operative treatment options for lymphedema include manual lymph drainage, compression garments, exercises, sequential gradient pump. Usually, non-operative techniques fail due to the difficult in the anatomic area. Surgical treatment can be effective in moderate to severe cases of giant scrotal lymphedema. There are many variations of the surgical technique, however, resection of the affected tissue and reconstruction with healthy skin is primordial. The prognosis tends to be good, although there is reported a significant amount of relapse, mostly dependent on the weight lost and diet of the patients

Melanoma de escroto en un paciente de mediana edad / Scrotum melanoma in a middle-age patient

Se describe el caso clínico de un paciente de 42 años de edad, de piel negra, que asistió a la consulta de Cirugía de Tumores Periféricos en el Hospital Oncológico Docente Provincial Conrado Benítez García de Santiago de Cuba, por presentar una lesión oscura hiperpigmentada en el lado izquierdo del escroto, próxima a la región del rafe, de aproximadamente 4 mm y bordes irregulares, que no elevaba la piel ni dolía. Se realizó exéresis de la lesión y el estudio histopatológico reveló la existencia de un melanoma, sin ulceración ni satelitosis, con crecimiento radial, por lo que se profundizó en el área operada en busca de márgenes sin afectación y se resecaron los ganglios linfáticos inguinales bilaterales de manera profiláctica. Luego se indicó quimioterapia e inyecciones de interferón. El paciente mantenía una evolución favorable hasta el año y medio después de operado.

The case report of a 42 years, black skin patient is described, he attended the Peripheral Tumors Surgery Service in Conrado Benítez García Teaching Provincial Cancer Hospital in Santiago de Cuba, due to a hyperpigmented dark lesion in the left side of the scrotum, next to the raphe region, of approximately 4 mm and irregular borders that didn't elevate the skin or hurted. An excision of the lesion was carried out and the histological and pathological study revealed the existence of a melanoma, without ulceration or satelitosis, with radial growth, reason why there was a deep examination of the operated area in search of margins without affectation and the bilateral groin lymph nodes were dried up in a prophylactic way. Then chemotherapy and interferon injections were indicated. The patient maintained a favorable clinical course until a year and a half after the surgery.

Malignant leydig cell tumor in a 91-year-old man: Case report

ABSTRACT Testicle tumors are a rare entity among men population, accounting for only 1-1.5% of all cancers among men. The stromal tumors of the sexual cord correspond just 4% of all testicular cancers. Only 10% of them are malignant. The major representative of the sex cord-stromal tumors is the Leydig cell tumor, corresponding to 75 to 80% of the total. It has bimodal age incidence, involving children and adults between 30 and 60 years. We report the caso of a 91-year-old man with malignant Leydig cell tumor, presenting increase of the volume of scrotum, local pain and hyperemia. The are few cases in the literature, only 1 with pacient above 85 years old.

Primary scrotal melanoma: it is time to destigmatize genital lesions

Abstract Primary male genital melanomas are very rare; they are associated with high mortality and late detection. Scrotal melanoma is the least common presentation and only 23 cases have been reported. Herein, the authors present a 30-year-old patient with stage IIIC (T4b, N2a, M0) scrotal melanoma in order to report the characteristics, treatment, and outcome, as well as to emphasize the importance of examination of the genitals, education of patients about self-examination and destigmatizing genital lesions to increase the likelihood of earlier detection.

Linfedema escrotal gigante en un paciente con falectomía parcial / Giant scrotal lymphedema in a patient with partial falectomy

Se describe el caso clínico de un paciente que, 7 años después de habérsele realizado una falectomía parcial con linfadenectomía inguinal superficial y quimioterapia (cisplatino 150) por un carcinoma epidermoide del pene, acudió al Servicio de Urología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso en Santiago de Cuba por presentar un linfedema gigantesco de escroto, de origen obstructivo linfático, con marcada repercusión sobre la posición bípeda y la marcha. Se realizó el procedimiento quirúrgico (técnica de Homans con modificaciones) y el paciente evolucionó satisfactoriamente. Luego de 2 años de operado, se le dio el alta de la consulta externa, pues se consideró que había recuperado la capacidad físico-motora y su autoestima.

The case report of a patient is described who, 7 years after carrying out a partial falectomy with inguinal superficial lymphadenectomy and chemotherapy (cisplatin 150) due to an squamous cell carcinoma of the penis, he went to the Urology Service of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba presenting a giant scrotal lymphedema, of lymphatic obstructive origin, with marked repercussion on the biped position and during walking. The surgical procedure (Homans technique with modifications) was carried out and the patient had a satisfactory clinical course. Then after 2 years of surgery, he was discharged from the out-patient service, because it was considered that he had recovered the physical motor skills and his self-esteem.

Calcinose idiopática escrotal: uma inabitual desordem de pele / Idiopathic scrotal calcinosis: an unusual skin disorder

A calcinose escrotal idiopática é uma entidade rara, benigna. Não costuma ter outros sintomas associados. O caso reportado se trata de um paciente de 30 anos com diversos nódulos calcificados em bolsa escrotal, com 15 anos de evolução. Como medida terapêutica, foi realizada excisão cirúrgica completa dos nódulos, apresentando boa evolução cirúrgica e resultados estético e funcional satisfatórios.

Idiopathic scrotal calcinosis is a rare benign entity. Patients affected by scrotal calcinosis usually do not have other associated symptoms. We report the case of a 30-yearold man with several calcified nodules in the scrotal sac with onset at age 15 years. A complete surgical excision of the nodules was performed, and the patient recovered well with satisfactory aesthetic and functional results.