RESUMEN
BACKGROUND: Angiolipoma has been reported in many cases, and it often occurs in the skin of the trunk and limbs. However, angiolipoma in the scrotum is a rare disease with unknown etiology. This condition is difficult to diagnosis with other lumps in the scrotum. CASE SUMMARY: A 32-year-old man presented to the urinary department with a history of an enlarged left scrotum with increasing discomfort for about 5 years. Physical examination revealed that there were a palpable mass measuring about 7.0 cm × 6.5 cm in the left scrotum, with smooth surfaces but without tenderness or adhesion to the skin. Ultrasound showed that there was a hyperechoic mass under the skin of the top scrotum, about 72 mm × 64 mm × 21 mm in size, with clear borders, uneven internal echo, and abundant blood flow signals. Serum human chorionic gonadotropin and alpha-fetoprotein were in normal level. Subcutaneous mass resection at the bottom of the left scrotum was performed under local anesthesia with 1% lidocaine. Postoperative pathological examination resulted in a diagnosis of subcutaneous angiolipoma of the scrotum. No evidence of recurrence was found at 6 mo after surgery and there were no complaints of discomfort. CONCLUSION: Angiolipoma is an extremely rare type of benign tumor extremely rarely found in the scrotum, but needs to be considered when evaluating scrotal masses especially when the mass is solid. According to the characteristics of angiolipoma, surgical resection is the best treatment strategy and it is not prone to recurrence after resection.
RESUMEN
BACKGROUND: Bladder recurrent disease is still a challenge in the treatment of upper tract urothelial carcinoma (UTUC). This controlled study aims to investigate the efficacy of early clipping of the distal ureter prior to nephroureterectomy (NU) to prevent bladder recurrence after UTUC. METHODS: Patients with clinical diagnosis of UTUC were subjected to open trans-peritoneal NU and were randomly divided into two groups. One group received modified NU: clipping the distal ureter prior to NU; while the other group underwent traditional standard NU. Subsequent bladder recurrence was the primary endpoint. RESULTS: From January 2007 to December 2009, 85 eligible cases were enrolled in this study. Modified NU and standard NU were performed on 42 and 43 patients, respectively. Operation time ((215.73 ± 21.26) minutes vs. (220.19 ± 15.35) minutes), blood loss ((105.15 ± 11.32) ml vs. (110.12 ± 9.07) ml), transfusion event (11.20% vs. 9.78%), and the in-patient time (10.0 days vs 9.5 days) were not significant between the two groups. After a median follow-up of 28 months (5 - 60), six (14.3%) cases who received modified NU had bladder recurrence, which was significantly lower compared with 15 (34.9%) patients from the group that underwent standard NU (P = 0.026). In univariate and multivariate analysis, tumor grade (HR 4.33, 95%CI 2.66 - 6.30, P = 0.01) and operation type (HR 2.35, 95%CI 1.53 - 3.48, P = 0.041) were independent risk factors for subsequent bladder recurrence after UTUC. CONCLUSIONS: Clipping the distal ureter at the beginning of NU significantly reduces bladder recurrence after UTUC. It is reasonable to conclude that clipping the distal portion of ureter trans-peritoneal is an effective surgical procedure for the treatment of UTUC.