Giant paratesticular spindle cell lipoma: A rare case report.

INTRODUCTION: Spindle cell lipoma (SCL) is a rare condition primarily occurring in subcutaneous tissue. Only 4 cases of paratesticular SCL have been reported. CASE PRESENTATION: A 51-year-old man presented with a painless mass in his left testicle that has grown for nine years. Physical examination revealed a soft, smooth-surfaced left scrotal mass measuring 30 × 30 cm, which did not transilluminate. A contrast-enhanced abdominal-pelvic CT scan showed a paratesticular mass measuring 31.1 × 15.1 × 30.5 cm extending to the spermatic cord. Preoperative tumor markers, including Alpha-Fetoprotein (AFP), Human Chorionic Gonadotropin (HCG), and Lactate Dehydrogenase (LDH), were within normal ranges. Surgical exploration and excision successfully removed the tumor, measuring 39.0 × 37.0 × 16.0 cm and weighing 10 kg, revealing a spindle cell lipoma on pathology examination. Immunohistochemistry testing for CD34 was positive. Three months post-surgery, the patient was in good health with normal sexual function. DISCUSSION: Paratesticular SCL is a benign neoplasm. Distinguishing spindle cell lipoma from liposarcoma radiologically is challenging. Therefore, a biopsy and histopathological examination are essential. CD34 Immunohistochemistry aids in determining SCL from liposarcoma. Complete excision following thorough preoperative preparation and accurate diagnostic procedures is recommended. CONCLUSION: Paratesticular SCL cases are rare, with good preoperative preparation and accurate post-operative diagnosis; good results will likely be expected, and this case report will likely contribute to ongoing research to enhance the understanding and management of paratesticular SCL cases.

Primary Neuroendocrine Tumor of the Testis Associated With Cardiac Symptoms: A Case Report and Literature Review.

Well-differentiated neuroendocrine tumors of the testis are exceedingly rare. Here, we report the case of a 47-year-old male patient complaining of cardiac symptoms with a right testicular mass. A right radical orchiectomy was performed. The histopathological findings showed a well-differentiated neuroendocrine tumor with positive synaptophysin and chromogranin A immunostains.

Antenatal diagnosis and management of fetal inguinoscrotal hernia: A case report with literature review.

Primary inguinal hernia is a common pediatric surgical condition with an incidence of 1%-4%, which is higher in male or premature newborns. It is characterized by the protrusion of abdominal contents through inguinal canal in newborns. However, prenatal fetal inguinal hernia is a rare condition because the pressure of amniotic fluid is similar to intra-abdominal pressure. Only 19 English publications were found with 21 reported cases until now. We report belatedly discovered inguinoscrotal hernia at 38+0 weeks' gestation. Usually, the fetal testicular descent begins from 24 to 25 weeks' gestation, and it is found after 32 weeks of gestational age in 97% of the fetuses. Therefore, it is necessary to get into the habit of checking fetal testicles during routine US after at least 32 weeks of gestational age.

[Hydrocele]. / Hydrozele.

The hydrocele is overall a rare condition in urology. A differentiation between primary and secondary hydrocele is essential for further treatment. A primary hydrocele with a patent vaginal process tends to spontaneously regress in the first 2 years of life in newborns. If treatment is necessary, open as well as laparoscopic methods are available with good results. The treatment of scrotal pathologies, especially secondary hydrocele, often poses a challenge in the clinical practice. Despite the benign nature, supposedly simple surgical techniques and good chances of healing, postoperative complications are frequent. In comparison to open surgery, sclerotherapy provides a good alternative for the treatment of secondary hydrocele.

A case report of giant paratesticular myxoid liposarcoma.

Liposarcomas are an uncommon occurrence in the paratesticular region that makes about 20 % of all sarcomas. The clinical appearance is an inguinal lump, which can resemble a hydrocele or hernia. There would be no conventional treatment accessible because it is such a rare disease. We report the case of a 68-year-old man with paratesticular myxoid liposarcoma. Ultrasound and CT-scan came back in favor of a paratesticular tumor. A high inguinal orchidectomy has been done and the diagnostic of myxoid liposarcoma was first evoked by histology and confirmed by molecular biology. At 12 months follow up the patient remains tumor free.

Inguinoscrotal Hernia, a Possible Cause of Rapidly Developing Fetal Scrotal Mass: Case Report and Literature Update.

Inguinoscrotal hernia is a common pediatric disease but a rare condition in the fetus. We present a case, from our institution, of fetal inguinoscrotal hernia with possible rapid development. In addition to our case, we present a literature update on fetal inguinoscrotal hernia in order to enhance the ability to recognize it from the other scrotal masses on ultrasound. Antenatal management, differential diagnosis and postnatal management are also discussed.

Scrotal Dermatofibrosarcoma Protuberans in a Patient with Schizophrenia: A Case Report and Review of the Literature.

Dermatofibrosarcoma protuberans (DFSP) is a rare spindle cell soft tissue sarcoma of the dermis and subcutaneous tissue. We present the fourth case of scrotal DFSP in the literature, identified in a 32-year-old male with schizophrenia. Wide surgical excision and radical orchiectomy were performed revealing an uninvolved testicle and DFSP of the scrotum. A unique challenge to this case was concurrent aortic dissection and schizophrenia. Social determinants of health are associated with delay in presentation and poor appointment compliance in patients with schizophrenia. Ultimately, DFSP of the scrotum is an extremely rare condition with this presentation being only the fourth report in the literature. It is important to document these unique cases to establish differential diagnoses and optimize management.

A Giant Scrotal Neurofibroma in a Child Masquerading as Filariasis: Uncommon Presentation of a Common Disease.

Neurofibroma of the scrotum is a very uncommon benign neoplasm, specifically when it affects teenagers and is not associated with neurofibromatosis type I. To the best of our knowledge, only a couple of cases of neurofibroma in children have been documented. Here, we report a case study of a 17-year-old boy who had a giant scrotal lump for ten years masquerading clinically as filariasis. A provisional diagnosis of benign nerve sheath neoplasm was made based on cytology findings. The lump was surgically removed from the patient, and a histopathological and immunohistochemistry examination established the diagnosis of neurofibroma. The combined clinical, preoperative cytological, histological, and immunohistochemistry findings were not presented in the literature in any of the formerly documented cases of scrotal neurofibroma. The current case expands the spectrum of differential diagnoses for scrotal tumours that clinicians have previously observed.

Rare case of a scrotal leiomyoma-a diagnostic dilemma: A case report.

INTRODUCTION: Leiomyomas are rare benign mesenchymal tumors originating from smooth muscle cells. Scrotal leiomyomas, in particular, are exceptionally rare, with a prevalence rate of 1 in 1000 among all scrotal tumors. METHODS: This case Report has been Reported in line with SCARE Criteria. PRESENTATION OF THE CASE: A 55-year-old Caucasian male presented with a five-year history of painless scrotal swelling, gradually increasing in size. Clinical examination revealed a non-tender oval lump on the right hemiscrotum. The right testis and cord structures were distinguishable from the mass. While the initial clinical assessment was suggestive of a sebaceous cyst, further evaluation was performed. A wide local excision of the lump was performed and sent for histopathological evaluation. Microscopy indicated a well-circumscribed, non-atypical leiomyoma with no necrosis or increased mitosis, providing us with a definitive diagnosis. DISCUSSION: Scrotal leiomyomas are a rare subset of genital leiomyomas, mostly found in middle-aged Caucasian men. Pathological examination is the mainstay to distinguish these tumors into typical and atypical leiomyomas, impacting treatment decisions. Simple surgical excision is curative, and Irradiation is contraindicated. CONCLUSION: Scrotal leiomyomas should be considered in the differential diagnosis of scrotal masses. This case emphasizes the necessity of wide local excision, with adequate clearance, and regular follow-up to rule out recurrence, particularly given the potential for atypia and progression to leiomyosarcoma. The prognosis overall is good as recurrence rates are low.

Aggressive angiomyxoma of the epididymis: A case report.

BACKGROUND: Aggressive angiomyolipoma is an extremely rare benign mesenchymal tumor that was originally described as a locally recurrent mucinous spindle cell tumour. Aggressive angiomyolipoma originates from myofibroblasts, vascular smooth muscle cells, or fibroblasts, and displays various phenotypes of myofibroblasts and abnormal muscle arteries. Aggressive angiomyolipoma was first identified in 1983 and fewer than 50 male patients have been reported to date. It is an extremely rare mesenchymal tumour and often confused with other diseases. Patients with epididymal aggressive angiomyolipoma lack typical symptoms, most of which occur incidentally, although some patients may experience mild pain, discomfort, and swelling. Pain may be exacerbated by pressure from the mass. CASE SUMMARY: A 66-year-old male was admitted to the hospital on January 14, 2022 with chief complaint of swelling in the left scrotum for one year. There was no apparent cause for the swelling. The patient did not consult with any doctor or receive any treatment for the swelling. The enlarged scrotum increased in size gradually until it reached approximately the size of a goose egg, and was accompanied by discomfort and swelling of the left cavity of the scrotum. The patient had no history of any testicular trauma, infection, or urinary tract infection. The patient urinated freely, 1-2 times at night, without urgency, dysuria (painful urination), or haematuria. There was no significant family history of malignancy. The patient underwent excision of the enlarged tumour and the left epididymis under general anaesthesia on January 18, 2022. Twelve months of follow-up revealed no recurrence. The patient was satisfied with the treatment. CONCLUSION: Aggressive angiomyolipoma is extremely rare clinically and often confused with other diseases. The pathogenesis of aggressive angiomyolipoma is unclear and the clinical presentation is mostly a painless enlarged mass. The diagnosis of aggressive angiomyolipoma requires a combination of medical history, preoperative imaging such as computed tomography and magnetic resonance imaging, cytological examination and preoperative and postoperative pathological biopsy. The preferred treatment is surgery, with the possibility of a new alternative treatment option after hormonal therapy. Aggressive angiomyolipoma should be considered in the differential diagnosis of parametrial tumors of the male genital area that present as clinically significant masses. The high recurrence rate of aggressive angiomyolipoma may be related to incomplete tumor resection, and patients with aggressive angiomyolipoma are advised to undergo annual postoperative follow-up and imaging for recurrence.

An Unusual Case of Inflammatory Pseudotumor of Paratesticular Region.

Inflammatory pseudotumors (IPT) are rare benign tumors that can develop in various regions of the body. Notably, IPTs have been uncommonly described in the Genitourinary system including occasional reports from the paratesticular region. This origin from this area is significant because of the ambiguity in differentiating this pathology from malignant lesions arising from the testis. We would like to report a case of a 32-year-old male who presented with a painless left scrotal mass for two years. Ultrasonography was done followed by a radical orchidectomy and histopathological examination of the excised lesion showed features suggestive of inflammatory pseudotumor from the paratesticular region. We feel this case merits reporting owing to the rarity of IPT occurring in the paratesticular region and the essential need for increased awareness and differentiation from the malignant counterparts.

Encysted Hydrocele of Spermatic Cord in Adult: A Rare Case Report.

Hydrocele represents a commonly encountered pathological condition characterized by the development of scrotal swelling. In contrast, spermatic cord hydrocele is a relatively rare condition that arises from the abnormal closure of the processus vaginalis. This condition entails the accumulation of fluid within the spermatic cord, and although hydrocele itself is a frequently observed ailment affecting roughly 100 out of 100,000 men, encysted hydrocele of the spermatic cord is a seldom-seen variant. Furthermore, it is noteworthy that spermatic cord hydrocele tends to be more prevalent in the pediatric population compared to adults. In our clinical practice, a patient presented with swelling localized to the right hemi-scrotum and was initially diagnosed as suffering from a chronic right-sided hydrocele of the tunica vaginalis. However, during the surgical intervention, the true nature of the condition became evident, as it was determined to be an encysted hydrocele of the cord. This case report chronicles the diagnostic journey surrounding hydrocele, highlighting the distinction in surgical management between encysted hydrocele and vaginal hydrocele of the testis.

Case Report: Giant paratesticular liposarcoma was resected and refused radical orchiectomy.

Paratesticular liposarcoma (PLS) causes scrotal mass changes, rarely in the urinary system. Before surgery, PLS causes scrotal mass changes that are difficult to distinguish from other causes. There has been a report of a giant paratestis liposarcoma resection and refusal to undergo orchiectomy. A 65-year-old man presented with finding the left scrotal mass after 2 years. Physical examination showed that the left scrotal mass was obviously difficult to retract. Pelvic CT showed that the left scrotal mass and flaky fat density shadow accompanied with left inguinal hernia. During surgery, laparoscopic exploration was performed to rule out inguinal hernia, and a scrotal exploration was also performed concurrently. The intraoperative frozen pathology considered lipogenic tumor, and the patient's wife refused to undergo simultaneous left radical orchiectomy. Later the mass was completely removed, and postoperative pathology confirmed paratestis liposarcoma. During a 15-month routine follow-up, the tumor did not recur locally or metastasize distantly. PLS should be focused on early diagnosis and treatment, preoperative examinations and postoperative pathology should be combined, and highly personalized treatment will be implemented.

Scrotal lymphangioma in a middle-aged man.

Scrotal lymphangioma is a rare, acquired, idiopathic conditions. Surgical resection can result in successful outcomes. A 43-year-old man presented with a painless scrotal mass. Ultrasonography and magnetic resonance imaging revealed a multifocal cystic mass in the scrotum that showed partial hypervascularity without connection to the skin. We performed complete surgical resection of the mass and histopathologically diagnosed the patient with lymphangioma. Acquired scrotal lymphangiomas are rare. Moreover, there was no apparent cause, such as injury; thus, this case was considered idiopathic. Complete surgical resection led to a successful resolution.

Unmasking the Uncommon: A Case Report of Scrotal Epidermoid Cysts in a Nine-Year-Old Boy.

Scrotal epidermoid cysts are rare. Intratesticular epidermoid cysts are more common than extra scrotal cysts and are the most commonest benign tumors of the testicles. Midline scrotal raphe cysts are reported, but only a few have intrapelvic extensions deep into the pelvis. A nine-year-old boy presented with a painless scrotal swelling. Magnetic resonance imaging (MRI) of the pelvis confirmed the cystic nature with an extension of the swelling up to the base of the prostate. On surgical exploration, the cyst had a tapering stalk with cranial extension up to the base of the prostate. The patient underwent an excision of the cyst and made an uneventful recovery and was asymptomatic at the end of three months of surgery. The histopathology of the lesion was typical of an epidermoid cyst. Extratesticular scrotal epidermoid cysts with pelvic extension are a rarity with less than five cases reported in the literature. Our case stands to be the youngest reported case of a scrotal epidermoid cyst based on our knowledge. Scrotal epidermoid cysts are a very rare and benign entity, and upon recognition and confirmation of the extent of spread, extratesticular scrotal cysts can safely be removed. No other management may be required with no recurrences reported.

Primary scrotal lipoma posing a diagnostic quandary: Experience from northern Tanzania, a case report.

Primary scrotal lipoma is a rare urological diagnosis. It is usually diagnosed incidentally as most of time initial diagnosis may be confused with other common etiology of scrotal masses. A rare case of scrotal lipoma with initial misdiagnosis of hydrocele at primary health facility is presented in this article.

Bilobed testicle diagnosed by ultrasound in a 9-year-old boy.

Bilobed testis is an extremely rare congenital malformation, and even rarer on the right side. Only 7 cases have been reported in the literature. We describe the case of a 9-year-old boy with a right bilobed testicle confirmed on ultrasound and discovered incidentally as a mass on physical examination. The aim of our work is to consider the bilobed testicle as a differential diagnosis of a testicular mass despite its rarity and to show the importance of ultrasound and MRI for its definitive diagnosis to avoid unnecessary surgery.

Adult Para Testicular Spindle Cell Rhabdomyosarcoma: A Case Report From Pakistan.

Para testicular or intra-scrotal Rhabdomyosarcomas (RMS) are rare. The spindle cell variant of rhabdomyosarcoma is the least common variant among embryonal subtypes. They are mostly seen in childhood but rarely reported in adults. We present a case of a 56-year-old man who presented with a three-year history of painless left inguinoscrotal swelling, which he initially ignored and misinterpreted as an Inguinal hernia but later sought medical help upon a progressive increase in the size of the swelling. Clinically and radiologically, there was sparing of the left testis and spermatic cord with normal testicular tumor markers and no evidence of lymphadenopathy or metastasis. Surgical exploration was performed with complete excision of the mass, followed by histopathology and immunocytochemistry, confirming the diagnosis of spindle cell rhabdomyosarcoma. Prompt recognition, early diagnosis, and appropriate surgical treatment are the hallmarks of management. Regular and strict follow-up is needed due to the rarity of diagnosis.

Testicular Germ Cell Tumor Presenting as Torsion in a Young Patient.

Testicular torsion is a relatively common urological emergency, which involves the twisting of the spermatic cord and its contents leading to ischemia to the testes, which usually presents as sudden, severe scrotal pain. In comparison, testicular neoplasms are far less commonly encountered in the emergency department as they often present as painless hard masses that grow slowly over longer periods of time. Extremely rare cases of testicular neoplasms present as sudden scrotal pain that causes a challenging task in the emergency department as physical examinations and ultrasound findings could vary and not be specific enough in confirming the diagnosis. In this case, we report a 22-year-old male who was referred from the emergency department (ED) as a case of testicular torsion from the presenting history; however, his physical examination and Doppler ultrasound findings were suspicious of testicular malignancy. The patient presented with a history of right scrotal pain for a few hours with no predisposing factors; however, examination and imaging were highly suspicious of an underlying neoplasm. The patient underwent an inguinal orchidectomy, and histology confirmed the presence of a germ cell tumor of varying components. In conclusion, a high index of suspicion for testicular torsion should always be present when a patient presents with sudden onset testicular pain; however, the differential diagnosis including testicular neoplasms should not be overlooked as it can change the management and outcome.

Aggressive angiomyxoma as a rare cause of scrotum enlargement in a 10-month-old boy: a case report.

BACKGROUND: Aggressive angiomyxoma (AAM) is a locally infiltrative mesenchymal tumour that most commonly affects the pelvis and/or perineum in adult women. AAM is very rare in males, especially in infancy. CASE PRESENTATION: A 10-month-old fulani (African) male infant was referred to our department for a large painless mass in the right testicule. The mass was detected during the neonatal period and gradually increased in size. Ultrasound examination revealed a large heterogeneous lesion; computed tomography results led to the conclusion that the mass was a mesenteric hernia. An inguinal and scrotal surgical approach was adopted. Exploratory surgery found a normal right testicle displaced upwardly and a large scrotal mass. Radical excision of the mass and orchidopexy were performed. Subsequent histology and immunohistochemstry studies indicated that the mass was a scrotal angiomyxoma. The postoperative course was uneventful. No recurrence occurred during the 6-month follow-up. CONCLUSION: To the best of our knowledge, this is the youngest patient with AAM reported to date. Angiomyxoma should be included in the differential diagnosis of scrotal masses, for which radical excision is justifiable to prevent recurrence.