A comparative study of smooth muscle cell characteristics and myofibroblasts in processus vaginalis of pediatric inguinal hernia, hydrocele and undescended testis.

BACKGROUND: Congenital inguinal hernia, hydrocele and undescended testis (UDT) are associated with patent processus vaginalis. The smooth muscles present in the processus vaginalis aid in the descent of the testis and undergo programmed cell death after testicular descent leading to obliteration. The persisting amount of smooth muscle in the processus vaginalis influences the clinical outcome as inguinal hernia, hydrocele or UDT. Therefore, a study was conducted to evaluate the processus vaginalis in these three conditions to observe the presence and phenotype of smooth muscle cells and the presence of myofibroblasts. MATERIALS AND METHODS: The processus vaginalis sacs in patients with inguinal hernia, hydrocele and UDT were examined using light microscopy for the presence and distribution of smooth muscle cells and immunohistochemical staining for vimentin, desmin, and α-smooth muscle actin (SMA) to identify the smooth muscle phenotype. Transmission electron microscopy was also performed in all the sacs to observe the presence of myofibroblasts. RESULTS: Seventy-eight specimens of processus vaginalis (from seventy-four patients), distributed as 47%, 27%, and 26% as inguinal hernia, hydrocele and UDT respectively, were included in the study. The sacs from inguinal hernia and hydrocele had significantly more presence of smooth muscles distributed as multiple smooth muscle bundles (p < 0.001). Desmin and SMA staining of smooth muscle cells was observed in significantly more sacs from hydrocele, followed by inguinal hernia and UDT (p < 0.001). The sacs from UDT had a significant presence of striated muscles (p = 0.028). The sacs from inguinal hernia had a significant presence of myofibroblasts, followed by hydrocele and UDT (p < 0.001) and this significantly correlated with the light microscopy and immunohistochemical features. The processus vaginalis sacs from four female patients did not differ statistically from the male inguinal hernia sacs in any of the above parameters. CONCLUSION: The processus vaginalis sacs in pediatric inguinal hernia, hydrocele and undescended testis differ in the presence, distribution and phenotype of smooth muscles and the presence of myofibroblasts. The clinical presentations in these entities reflect these differences.

Mesothelioma of the tunica vaginalis testis.

Mesothelioma of the tunica vaginalis testis (MTVT) is a rare tumour and a cause of hydrocele. This case report concerns a 26-year-old male with hydrocele treated with left hydrocelectomy. Histopathology revealed MTVT, and left radical orchiectomy was performed followed by chemotherapy. Fluorescence in situ hybridization, DNA and RNA next-generation sequencing showed no mesothelioma-associated tumour suppressor gene mutations, but deletion of CDKN2A and a rare TFG-ADGRG7 fusion both reported in pleural mesotheliomas, were detected. Clinicians should consider malignancy in case of discrepancy between symptoms and objective findings in scrotal conditions.

Misdiagnosis of scrotal and retroperitoneal lymphangioma in children.

BACKGROUND: Scrotal and retroperitoneal lymphangioma (SRL) in children is relatively rare and its clinical symptoms are usually difficult to distinguish from other conditions such as hydrocele and incarcerated inguinal oblique hernia. This study aimed to explore the clinical diagnosis and treatment of abdominal scrotal lymphangioma in children, and thus, to increase our understandings of this disease in clinical practice. METHOD: This study enrolled nine boys, aged 1-10, who were admitted to Shanghai Children's Hospital from January 2019 to December 2020 and who were finally confirmed with lymphangioma in the inguinal area. The clinical manifestations, diagnosis, and treatment of these children were analyzed retrospectively. The length of diagnostic process ranged from 3 weeks to 20 months. We also reviewed other cases of initially misdiagnosed cases of SRL in English publications from 2000 to 2022. RESULTS: The nine cases were misdiagnosed as hydrocele, hematoma, or inguinal hernia. Three patients received intracystic injection of bleomycin, three underwent laparoscopic mass resection, and three underwent resection of the inguinal lymphangioma under direct vision. Postoperative pathological analysis of the surgical specimens confirmed the diagnosis of benign cystic lesions and lymphangioma. Meanwhile, among the 14 cases of SRL in literature review, eight were misdiagnosed. Six were initially diagnosed as hydrocele, one as inguinal oblique hernia, and one as testicular tumor, all of which underwent ultrasonography scans. All cases were confirmed as lymphangioma after pathological examination. CONCLUSION: The non-specific clinical manifestations may contribute to the misdiagnosis of scrotal masses in children. A detailed and accurate medical history, careful physical examination, and imaging findings are important factors contributing to the preoperative differential diagnosis of scrotal lumps in children, but the final diagnosis is based on pathological examination.

[Diagnosis and treatment of malignant mesothelioma of the tunica vaginalis testis: a series of 7 cases].

Objective: To investigate the clinical features, diagnosis, prognosis of malignant mesothelioma of the tunica vaginalis testis (MMTVT). Methods: The clinicopathological data of 7 patients with MMTVT who treated at Sun Yat-sen University Cancer Center between January 2010 and October 2022 were retrospectively reviewed. Cases were first diagnosed at (M (IQR)) 49 (23) years old (range: 27 to 64 years old). The main clinical manifestations were scrotal enlargement (7 cases) and hydrocele (2 cases). Results: Three patients underwent radical orchiectomy as initial treatment, 2 cases underwent hydrocelectomy due to diagnosis of hydrocele, followed by radical orchiectomy at Sun Yat-sen University Cancer Center, and 2 cases underwent transscrotal orchiectomy. Common tumor markers of testicular cancer were not significantly elevated in MMTVT. The expression of tumor PD-L1 was positive in 2 out of the 3 cases. One patient received adjuvant chemotherapy and 2 patients received first-line chemotherapy after tumor recurrence. Chemotherapy regimens used include cisplatin+pemetrexed. Up to October 2022, 3 cases relapsed, of which 2 cases died. The median overall survival was 35 months (range: 4 to 87 months) and the median progression-free survival was 6 months (range: 2 to 87 months). Conclusions: MMTVT at early stage should be treated with early radical orchiectomy and followed up closely after surgery. The cisplatin+pemetrexed regimen is a common option for the treatment of metastatic MMTVT, while whether immune checkpoint inhibitors could serve as a second-line treatment option deserves further research.

A Review of Scrotal Ultrasonography in Uyo, Nigeria.

BACKGROUND: Scrotal ultrasonography is a useful, sensitive, readily available and safe imaging modality in the investigation of scrotal pathologies, including those possibly contributory to male infertility. The aim of this study was to review the scrotal ultrasound scans (SUSS) done in the University of Uyo Teaching Hospital over a period of 18 months from July 2018 to December 2019. METHODOLOGY: This was a retrospective study of all the SUSS performed in the Department of Radiology of University of Uyo Teaching Hospital (UUTH) within an 18-month period. All subjects who presented for scrotal ultrasound with adequately filled request forms which included the biodata and clinical information were included in the study. RESULTS: A total of 79 scans were reviewed during the period. The age range of study patients was 4 - 78 years, with a mean of 41.2 ±15 years. The modal age group was 30-39 years, made up of 20 cases (25.6%). Primary and secondary infertility were the major indications for referrals, in 17 cases (21.8%) and 13 cases (16.7%) respectively. Following SUSS, the findings were normal in 11 patients (14.1%), while hydrocele, and varicocele accounted for 19 cases (24.3%) and 9 cases (11.5%) respectively. Microlitiasis was seen in 7 cases (9%) while a diagnosis of testicular tumor was made in 5 (6.4%) of cases. Three (3) of the 5 testicular tumors, were confirmed histologically. CONCLUSION: Infertility was the main indication for SUSS and hydrocele the commonest finding. Ultrasound is recommended as first line imaging modality in the investigation of scrotal lesions.

CONTEXTE: L'échographie scrotale est une modalité d'imagerie utile, sensible, facilement accessible et sûre pour l'examen des pathologies scrotales, y compris celles qui peuvent contribuer à l'infertilité masculine. L'objectif de cette étude était d'examiner les échographies scrotales (SUSS) effectuées à l'hôpital universitaire de l'Université d'Uyo sur une période de 18 mois, de juillet 2018 à décembre 2019. MÉTHODOLOGIE: Il s'agissait d'une étude rétrospective de toutes les SUSS réalisées dans le département de radiologie de l'hôpital universitaire d'Uyo (UUTH) au cours d'une période de 18 mois. Tous les sujets qui se sont présentés pour une échographie scrotaleavec des formulaires de demande adéquatement remplis qui comprenaient des données biologiques et des informations cliniques ont été inclus dans l'étude. RÉSULTATS: Au total, 79 échographies ont été examinées au cours de la période. L'âge des patients étudiés était compris entre 4 et 78 ans, avec une moyenne de 41,2 ±15 ans. La tranche d'âge modale était de 30 à 39 ans, soit 20 cas (25,6 %). L'infertilité primaire et secondaire était la principale indication de consultation, dans 17 cas (21,8 %) et 13 cas (16,7 %) respectivement. Après le SUSS, les résultats étaient normaux chez 11 patients (14,1 %), tandis que l'hydrocèle et la varicocèle représentaient 19 cas (24,3 %) et 9 cas (11,5 %) respectivement. La microlitiasis a été observée dans 7 cas (9 %) tandis qu'un diagnostic de tumeur testiculaire a été posé dans 5 cas (6,4 %). Trois (3) des 5 tumeurs testiculaires ont été confirmées histologiquement. CONCLUSION: L'infertilité était la principale indication de SUSS et l'hydrocèle la constatation la plus fréquente. la plus fréquente. L'échographie est recommandée comme modalité d'imagerie de première ligne dans l'investigation des lésions scrotales. Mots-clés: Échographie scrotale, infertilité masculine, hydrocèle, varicocèle.

Malignant mesothelioma of tunica vaginalis: Two extremely rare case reports.

INTRODUCTION: Malignant mesothelioma (MM) of tunica vaginalis is a very rare tumor and it has a poor prognosis. It is not easy to diagnose the disease preoperatively because there is a lack of comprehensive studies and information about the disease. We would like to present our two cases with severe scrotal edema and hydrocele, which were debrided perioperatively due to scrotal necrosis, followed by radical inguinal orchiectomy and subsequently diagnosed as MM of tunica vaginalis. CASE 1: A 74-year-old male patient with bilateral scrotal swelling for 6 months. Right radical inguinal orchiectomy was performed. The pathology result of right radical inguinal orchiectomy material was compatible with malignant mesothelioma of tunica vaginalis. CASE 2: A 90-year-old male patient with complaints of right scrotal swelling for 3 years. A right radical inguinal orchiectomy was performed. The pathology result of right radical inguinal orchiectomy material was compatible with malignant mesothelioma of tunica vaginalis. CONCLUSION AND DISCUSSION: MM has a very poor prognosis therefore early treatment plan should be made. Surgery is the main treatment for malignant mesothelioma of the testis. Although chemotherapy and radiotherapy play an active role in the treatment of metastatic disease, surgery is the first-line therapy in the treatment of the tumor. Also; long-term hydrocele, recurrent epididymitis, scrotal edema can make it harder to detect the tumor diagnosis. MM should be considered in such patients. Necrosis and abscess appearance was not mentioned before in published case reports. In this respect, it should not be ignored the long-term hydrocele situation and the appearance of abscess-epididymitis that cannot be treated properly.

Incidental Testicular Pathologies in Patients With Idiopathic Hydrocele Testis: Is Preoperative Scrotal Ultrasound Justified?

BACKGROUND/AIM: Hydrocele testis is a common disease with a prevalence of 1% in adults. Although it can be diagnosed by physical examination, scrotal ultrasound represents a standard diagnostic tool, to exclude underlying pathologies among them testicular or scrotal malignancies. PATIENTS AND METHODS: We conducted a retrospective analysis of 156 patients aged between 20 and 60 years who underwent surgical hydrocelectomy between 2003 and 2018. Pre-surgical ultrasound, histological results, complications and patients' characteristics were analysed. RESULTS: Malignancies were found in 0% of patients in the pre-surgical ultrasound. Interestingly, we found a higher incidence of hydrocele testis in patients with increasing age and 27% presented with symptoms other than painless enlargement of the scrotum. Among them recurrent pain was the most common. Surgical complications occurred in only 3.2%. CONCLUSION: Testicular cancer is an important differential diagnosis of hydrocele testis. However, in our study no case of incidental testicular cancer or scrotal malignancy was found in the pre-surgical ultrasound.

Abdominoscrotal Lymphangioma Masquerading as a Communicating Hydrocele: A Case Report.

A 5-year old boy presented with a picture of communicating hydrocele and was discovered to have an abdominoscrotal lymphangioma after undergoing hydrocele surgery. Upon initial presentation the lymphangioma was missed and the child underwent inguinal approach surgery for hydrocele. The lymphangioma was then noticed as an abdominal lump due to a rapid increase in size within 1 week following the hydrocele surgery. The sudden enlargement of the lymphangioma was due to intra-cystic hemorrhage post-operatively. The lymphangioma was then completely excised with no recurrence noted after 1 year of follow up. This is a rare case of a retroperitoneal, abdominoscrotal lymphangioma masquerading as a communicating hydrocele. Keywords: Communicating Hydrocele, Abdominoscrotal lymphangioma, Scrotal Swelling.

Malignant Mesothelioma of the Tunica Vaginalis Testis-A Malignancy Associated With Asbestos Exposure and Trauma: A Case Report and Literature Review.

In this article, we report an unusual case of a malignant mesothelioma of the testis, presenting as hydrocele. The patient has a known medical history of trauma and occupational exposure to asbestos. The clinical features of this injury are discussed together with its immunohistochemistry. Surgical intervention is discussed due to the nature of this pathology.

Incidence of pediatric metachronous contralateral inguinal hernia and the relationship with contralateral patent processus vaginalis.

BACKGROUND: The management of contralateral patent processus vaginalis (CPPV) in children with unilateral inguinal hernia is still controversial. The objective of this study was to verify the relationship between metachronous contralateral inguinal hernia (MCIH) and CPPV, and the risk factors of MCIH. METHODS: Children with unilateral inguinal hernia from three medical centers underwent either open or laparoscopic repairs. Clinical information, including demographics, morphological characteristics of CPPV, follow-up outcomes were collected. RESULTS: Among 2942 patients (92.2%) who received open repair with successful follow-up, 185 (6.29%) developed MCIHs [125 (10.9%) on the right side and 60 (3.3%)] on the left including 156 (7.07%) younger than 3 years old and 29 (3.94%) older than 3 years old. Patients younger than 3 years old with primary left inguinal hernias more easily develop MCIHs and the difference is statistically significant. Among 5370 patients (96.0%) who received laparoscopic repair with successful follow-up, the morphology of ipsilateral patent processus vaginalis were cavernous type in 5318 (99%) and 52 (1%) were fissure type. CPPVs were identified in 2233 (41.5%) cases [1256 (35.01%) on the left side and 977 (54.80%) on the right side, P < 0.001]; 1503 cases were cavernous type (1276 cases younger than 3 years old and 227 cases older than 3 years old) and 730 cases were fissure type (422 cases younger than 3 years old and 308 cases older than 3 years old). The probability of occurence of cavernous type and CPPV in children younger than 3 years old was higher than that in children older than 3 years old. CONCLUSIONS: Not all CPPVS progress into an MIH, and approximate one of 15 CPPVs would progress into MIH. If patient with initial left-sided inguinal hernia is younger than 3 years old, when the morphology of CPPV is cavernous type identified by laparoscopic exploration, the contralateral repair would be recommended.

Giant abdomino scrotal hydrocele: a case report with literature review.

Abdomino scrotal hydrocele (ASH) is a condition in which the hydrocele sac is extended beyond the scrotum to the abdomen via the inguinal canal. The treatment is ordinarily surgical. Different approaches have been described like paramedian laparotomy, an inguinal or inguino scrotal approach. We report a case of giant unilateral hydrocele in an 18 year old male, occupying a large part of the abdomen with urinary symptoms. Ultrasonography and CT showed typical cystic mass in hourglass shape that we have approached surgically by scrotal incision and we removed all the cyst. Pathological examination found a hydrocele with no signs of malignancy. Urinary symptoms disappeared postoperatively. This is a rare entity that evolves often painless and little reported in the literature. The etiology and pathogenesis of this disease is discussed.

[Voluminous unilateral hydrocele with scrotal ulceration: about a case study conducted at the Regional Hospital of Gao]. / Volumineuse hydrocèle unilatérale avec ulcération scrotale: à propos d'un cas à l'hôpital Régional de Gao.

Hydrocele is an accumulation of fluid between the testis and its vaginal coat. It may be very abundant. It commonly affects people who live in tropical regions. We report the case of a 56-year old patient, Mr. YM, living in the sahelian zone with very abundant hydrocele and thickening of vaginal coat associated with bag ulcer. The patient presented with big bag associated with a feeling of heaviness as well as annoyance when walking, evolving for about one year with progressive increase in volume. Clinical examination showed voluminous left bag (A,B) with a plague measuring 3 cm (A). Two diagnosis were suspected: voluminous hydrocele (more probable) and severe scrotal tumor. Ultrasound of the bag showed very abundant effusion of in the vaginal coat (3000 ml) with thickening of the tunica vaginalis measuring 7 mm in diameter. The diagnosis of very abundant unilateral hydrocele associated with pachyvaginalitis was retained. The extractions of 2.8 L of stained fluid was performed during surgery (C). Postoperative course was favorable (D) under triple antibiotic therapy.

Recurrence rates in pediatric patients undergoing microsurgical subinguinal varicocelectomy with and without testicular delivery.

BACKGROUND/PURPOSE: The purpose of the study was to determine if testicular delivery during microsurgical subinguinal varicocelectomy (MSV) reduces varicocele recurrence rates in pediatric patients. Testicular delivery during MSV enables ligation of the gubernacular veins, which is thought to reduce the likelihood of varicocele recurrence. However, recent studies have suggested that testicular delivery during MSV does not offer any beneficial effect and, therefore, may be optional or unnecessary. METHODS: A total of 58 pediatric patients with grade II (nine, 15.5%) or III (49, 84.5%) varicocele met inclusion criteria. Of these 58 patients, 25 (43%) underwent MSV with testicular delivery and 33 (57%) underwent MSV without testicular delivery. Varicocele recurrence, testicular size change, and complications including edema, pain, paresthesia, hydrocele, and testicular atrophy were assessed to evaluate the effects of testicular delivery during MSV. RESULTS: Recurrence rates were 20% and 6.1% in patients who underwent MSV with and without testicular delivery, respectively. Univariate analysis of primary endpoints demonstrated significantly decreased recurrence, scrotal pain, and temporary paresthesia in patients who underwent MSV without testicular delivery compared to those with testicular delivery. Multivariate analysis also demonstrated that recurrence was significantly associated with testicular delivery. CONCLUSIONS: Testicular delivery to enable ligation of the gubernacular veins during MSV resulted in a higher recurrence rate in pediatric patients. Further investigation including prospective studies with long-term follow-up is needed to determine if testicular delivery during MSV is an unnecessary procedure in pediatric patients. LEVEL OF EVIDENCE: 2.