Concomitant testicular infection by Zika virus and Schistosoma mansoni in a Brazilian young boy / Infecção testicular associada com Zika vírus e Schistosoma mansoni em jovem brasileiro

Sumary The identification of a escrotal mass without pain or report of trauma should be investigated to rule out scrotal cancer. We report the case of a young Brazilian boy who underwent orchiectomy after magnetic resonance imaging (MRI) and duplex scan (DS) indicating a high possibility of cancer. Blood exams ruled out the possibility of cancer. Testicular biopsy was not indicated. After surgery the diagnostic was extensive orchiepididymitis by Schistosoma. In endemic areas orchiepididymis by Schistosoma should be investigate to avoid unnecessary surgeries. This patient was also infected with Zika virus.

Resumo A identificação de massa escrotal sem relato de dor ou trauma deve ser investigada a fim de afastar a possibilidade de câncer escrotal. O artigo reporta o caso de um jovem brasileiro que apresentou massa escrotal com essas características. Ressonância nuclear magnética (RNM) e ultrassonografia (US) indicaram grande possibilidade de câncer. Os marcadores tumorais sanguíneos estavam normais, e a biópsia não poderia ser realizada. O resultado anatomopatológico diagnosticou extensa fibrose esquistossomótica, associada a quadro clínico e sorológico de Zika vírus concomitantemente. Em regiões endêmicas, pacientes com alterações escrotais devem ser pesquisados a fim de evitar cirurgias desnecessárias.

Methotrexate and etanercept-induced primary cutaneous CD4 positive small/medium-sized pleomorphic T-cell lymphoma

Abstract: Immunosuppressive drugs and biological agents may represent a potential risk of lymphoma development in patients with rheumatoid arthritis. But most cases are diffuse, large B-cell lymphomas. Primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, a provisional entity in the 2005 WHO-EORTC classification of cutaneous lymphomas, is only described in a limited number of reports. To our knowledge, our case is a rare instance of primary cutaneous CD4+ small/medium-sized pleomorphic T-cell lymphoma, after associated treatment with methotrexate and etanercept, in a patient with moderate rheumatoid arthritis who had undergone an orchidectomy incorrectly.

Testicular schistosomiasis as differential diagnosis for testicular nodules: a case report

Despite its infrequent occurrence, testicular schistosomiasis forming pseudo-tumors can be considered in the differential diagnosis of testicular tumors, especially in areas where the parasitic disease is endemic. In this report, we present a case of testicular schistosomiasis caused by Schistosoma mansoni and mimicking a testicular neoplasm. We describe the patterns of a testicular nodule on ultrasonography and magnetic resonance images in a 46-year-old man. The nodule was removed after a pre-operative diagnosis of a non-malignant lesion. Histology demonstrated granulomas with epithelioid macrophages and eosinophils around S. mansoni eggs within a fibrous tissue that formed a nodular structure.

Testis tumor associated to microlithiasis / Tumor de testiculo asociado a la microlitiasis / Tumor de testiculo associado a microlitiase

OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children. .

OBJETIVO: Discutir las implicaciones de la microlitíasis testicular en el niño con relación al riesgo oncológico implicado y la posibilidad de cirugía de preservación testicular en casos elegidos. DESCRIPCIÓN DEL CASO: Pre-adolescente presentando aumento microlitíasis testicular y aumento del testículo izquierdo, con lesión tumoral quística. La lesión fue resecada, con preservación del testículo y diagnóstico histológico de tumor dermatoide testicular. COMENTARIOS: La relación entre tumores de testículo y microlitíasis testicular es mal definida en niños y hay la necesidad de desarrollar protocolos de seguimiento específicos para esa franja de edad. .

OBJETIVO: Discutir as implicações da microlitíase testicular na criança com relação ao risco oncológico envolvido e a possibilidade de cirurgia de preservação testicular em casos escolhidos. DESCRIÇÃO DO CASO: Pré-adolescente apresentava microlitíase testicular e aumento do testículo esquerdo, correspondendo a tumor testicular cístico. Ressecou-se o tumor, com preservação do testículo. O diagnóstico histológico foi de tumor dermoide testicular. COMENTÁRIOS: A relação entre tumores de testículo e microlitíase testicular é mal definida em crianças e há a necessidade de desenvolver protocolos de seguimento específicos para essa faixa etária. .

Diagnóstico ecográfico de leiomiosarcoma paratesticular con microlitiasis testicular: presentación de un caso / Ultrasound diagnosis of paratesticular leiomyosarcoma with testicular microlithiasis: a case report

El leiomiosarcoma es un tumor paratesticular maligno con una mayor incidencia a partir de la sexta década de la vida, aunque se describen casos a partir de la cuarta década. Suponen el 5 por ciento de todos los sarcomas y el 2 por ciento de todos los tumores urológicos. No se conoce el origen de este tipo de tumores, pero se especula con la posibilidad del papel de una degeneración de un leiomioma previo, originado a partir de estructuras funiculares de músculo liso, que puede localizarse en las fibras musculares cremastéricas, en el deferente, en los vasos funiculares, incluso en restos vestigiales de músculos de la pared escrotal, de las fibras conjuntivas del conducto peritoneovaginal o de restos mesoblásticos atrapados en el cordón funicular. Se presenta el caso de un paciente de 37 años con diagnóstico de leiomiosarcoma paratesticular asociado a microlitiasis testicular.

Leiomiosarcoma is a malignant paratesticular tumor with a greater incidence from the sixth decade of life, although cases from the fourth decade are described. They suppose 5 percent of all sarcomas and 2 percent of all the urological tumours. The origin of this type of tumors is not known, but it is speculated with the possibility of a degeneration role of a previous leiomyoma, originated from funicular structures of smooth muscle, that it can be located in cremasteric muscular fibers, in the deferens, funicular vessel, even in vestigial rest of the scrotal wall muscles, from conjuntive fibers of processus vaginalis or mesoblastic rest caught in the funicular cord. A case of 37 years patient appears with diagnosis of paratesticular leiomiosarcoma associated to testicular microlithiasis.

Sarcoidose testicular: um diagnóstico a ser considerado / Testicular sarcoidosis: a diagnosis to be considered

Sarcoidosis is a disease of unknown etiology, characterized by the presence of noncaseating granulomas in multiple organs. We present a case of testicular sarcoidosis in a white, 55-year-old man who has come to our department complaining of bilateral testicular discomfort and weight loss.

[Testicular infarction. Case report and review of the literature]

Testicular infarction is a rare pathology whose etiology has not yet been identified. The main presenting symptom is severe testicular pain in the absence of trauma or torsion, often simulating a tumor, but tumor markers are normal and urine is sterile. Ultrasonography shows a hypoechogenic area, which on Doppler is avascular. Magnetic resonance imaging [MRI] remains the diagnostic tool of choice. Treatment usually consists of orchidectomy. In case of segmental testicular infarction a resection of the segment in question can be done instead. The authors report on a case of segmental testicular infarction for which they propose a policy of watchful waiting

Perineal ectopic testis - a rare encounter in paediatric surgical practice

Perineal ectopic testis is a rare form of testicular maldescent. We report 2 patients with perineal ectopic testes, in one of them, the condition was bilateral [only the 6th case of this variety]. Surgery was performed in both cases and testicles were mobilized and fixed in the scrotum. Gubernaculum testis was found to be fixed in the perineum. Examination of patient with empty scrotum [maldescent testes] should include examination of sites like perineum to look for ectopic testis

Concomitant bilateral testicular epidermoid cysts

Epidermoid cyst of the testis is a rare benign germ cell tumor, comprising 1-2% of all resected benign testicular masses. Approximately 300 cases have been reported to date. Unilateral involvement has often been reported in the English literature. However, bilateral occurrence is very rare and to the best of our knowledge, there are only 3 previous reports of bilateral testicular epidermoid cysts. The fact that they are completely benign makes them amenable to treatment by local excision, thereby saving patient from orchidectomy. Recognition of their characteristic ultrasonographic features is very important to avoid unnecessary intervention. We present here, a case of bilateral epidermoid cyst in which characteristic ultrasound US findings allowed testis-sparing enucleation instead of radical orchiectomy

Testicular schistosomiasis caused by Schistosoma mansoni: a case report from Brazil

Testicular schistosomiasis by Schistosoma mansoni is exceedingly rare, with only 11 cases reported in PubMed. We report a new case from Brazil. A 31-year-old man from the northeast region of the country presented with a 2 cm nodule in the right testis. Ultrasonography showed a well-delimited hypoechoic tumor, suggestive of a granulomatous lesion. Magnetic resonance imaging revealed an irregular tunica albuginea signal. A biopsy showed interstitial tissue with schistosome ova and granuloma formation. The nodule was excised, and the patient was treated with oxamniquine. He has remained symptom free for 10 years. A testicular nodule should raise suspicion of numerous pathologies, including schistosomiasis. Treatment should include therapy with oxamniquine or praziquantel, and nodule excision should be done whenever possible.

Calcifying pseudotumor of scrotum: a case report.

Calcifying fibrous pseudotumors of the testicular and paratesticular soft tissue are relatively rare. We would like to report the first documented case of calcifying fibrous pseudotumor of the tunica vaginalis in Indian medical literature. This is a case of a 55 year old male who presented with a painless scrotal mass of 10 years duration. Histological sections showed dense hyalinised bands of collagen with focal collections of plasma cells and lymphocytes. Multiple round to oval concentrically laminated psammomatous bodies were seen.

Aspectos ultra-sonográficos das alterações não-neoplásicas do testículo / Sonographic findings in non-neoplastic testicular lesions

Processos patológicos dos testículos são muito comuns, incluindo-se lesões tumorais e não-tumorais neste contexto. A ultra-sonografia com transdutor de alta freqüência tornou-se a modalidade de imagem de escolha para a avaliação desses órgãos. Este método ajuda a melhor caracterizar lesões intratesticulares e em muitas situações sugere um diagnóstico mais específico, principalmente nos casos em que há manifestações clínicas similares, tais como dor, inchaço e aumento volumétrico locais. O mapeamento com Doppler colorido é importantíssimo para demonstrar padrões anormais de perfusão testicular e auxilia no diagnóstico de condições clínicas agudas. Neste ensaio iconográfico os autores sumarizam os mais comuns achados clínicos, patológicos e as principais características diagnósticas de lesões testiculares, tais como microlitíase, cisto simples, espermatocele, varicocele, ectasia tubular da rete testis, orquite, hematomas e condições mais raras. A familiaridade com as características ecográficas e clínicas destas alterações é essencial para o estabelecimento do diagnóstico correto e início da terapêutica mais eficaz, quando necessária.

Pathological processes of the testis are very frequently found, and include non-tumoral and tumoral lesions. Ultra-sonography performed with a high-frequency transducer has become the imaging modality of choice for examination of these organs. This method is of help to improve intratesticular lesions characterization, and in many instances the findings suggest a more specific diagnosis, especially in the presence of similar clinical manifestations such as pain, swelling and local increase in volume. Color Doppler is an invaluable tool for demonstrating anomalous patterns of testicular perfusion and aids in the diagnosis of acute clinical conditions. In the present iconographic essay, the authors summarize the most frequent clinical, pathological findings as well as the main diagnostic features of benign intratesticular lesions such as microlithiasis, simple cysts, spermatocele, varicocele, tubular ectasia of the rete testis, orchitis, hematomas and more rare conditions. Familiarity with clinical and sonographic features is essential for the correct diagnosis and starting of the most effective therapy, as necessary.

Fluxión funiculotesticular, una complicación frecuente en la herniorrafia inguinal / Spermatic cord and testicular swelling as a complication of inguinal hernia repair

El presente estudio presenta a la fluxión funiculotesticular (FFT) como la complicación más frecuente de la herniorrafia inguinal, destacando que es poco mencionada en publicaciones sobre el tema a nivel internacional. El objetivo del presente estudio es dar a conocer la frecuencia de esta complicación en los pacientes intervenidos en el Centro de Referencia de Salud (CRS) Cordillera, analizar sus manifestaciones clínicas y su etiopatogenia. El estudio observacional, descriptivo, prospectivo se realizó en 304 varones portadores de hernia inguinal derivados desde los consultorios de las comunas de Peñalolén y Macul al CRS Cordillera Oriente. Los pacientes fueron intervenidos consecutivamente con anestesia local y técnicas quirúrgicas estándar y en forma ambulatoria. El control postoperatorio lo realizó un miembro del equipo quirúrgico a la semana y al mes de la intervención buscando dirigidamente signos de FFT. Ésta se encontró en 22 por ciento siendo severa en el 2,5 por ciento de los casos. Esta frecuencia fue similar para hernias directas e indirectas. La FFT fue significativamente mayor en las hernias recidivadas, las inguinoescrotales y en los casos en los que se instaló una malla. Esta complicación pone en evidencia una cadena de hechos que se inician con el trauma quirúrgico producto de la disección necesaria en una herniorrafia inguinal que produce inflamación, congestión venosa y linfática. En casos más graves puede producirse trombosis venosa y eventualmente daño isquémico del testículo.

Background: A complication of inguinal hernia repair that is seldom mentioned is spermatic cord and testicular swelling. Aim: To study the frequency of this complication, its clinical manifestations and to analyze its pathogenesis. Material and Methods: A descriptive observational, prospective study in 304 men (aged 15 to 89 years), subjected to an inguinal hernia repair. Operation was performed under local anesthesia in an ambulatory basis, with standard surgical techniques. The postoperative assessment was done by a member of the surgical staff one week and one month after surgery. Results: A mild or moderate swelling occurred in 19.5 percent of patients and a large, severe spermatic cord and testicular swelling developed in 2.5 percent of the cases. The frequency was similar in patients with direct or indirect hernias. Those with recurrent hernias, with hernias growing into the scrotum or that required a mesh for hernia repair, had a significantly higher frequency of spermatic cord and testicular swelling. No patient developed testicular ischemia. Conclusions: Spermatic cord and testicular swelling is the consequence of the dissection required for hernia repair, that is followed by a variable grade of damage to the tissues, inflammation, venous and lymphatic congestion and edema. In seldom occasions venous thrombosis and testicular damage may take place.

Isolated tuberculosis of testis.

Isolated epididymo-orchitis is an uncommon presentation of tuberculosis. We report a case of left sided epididymo-orchitis and scrotal involvement due to tuberculosis in a young male patient. The diagnosis was suspected on clinical examination of scrotum and confirmed by FNAC of scrotal and testis. Patient improved after taking antitubercular treatment. Key words: infection, scrotum, treatment.

Intratesticular varicocele and extratesticular varicocele in a patient with nephrotic syndrome complicated by left renal vein thrombosis

Intratesticular varicocele is a rare condition, with a reported incidence of less than 2% [1]. Its clinical significance is not well established. The condition is characterized by dilatation of the intratesticular veins in and around the mediastinum testis. Color Doppler ultrasound can confirm the diagnosis. We present a case of a young man with nephrotic syndrome complicated by left renal vein thrombosis and left-sided extratesticular and Intratesticular varicocele. To our knowledge, no case of intratesticular and extratesticular varicocele in a patient with nephrotic syndrome and a complicated left renal vein thrombosis has been reported concomitantly in the same patient