Observations on the anatomy of the funiculus spermaticus and the testis in Brachyteles sp. (SPIX, 1823) primates - Atelidae.

BACKGROUND: Analysing the literature about the reproductive anatomy on New World Primates, one can see the need of standardisation on the description methods and, more importantly, the lack of detailed information. The problem is aggravated by the difficult access to specimens of the endangered species such as Brachyteles sp. This paper's objective was to extend knowledge on the male reproductive anatomy of these primates. The testis and funiculus spermaticus of Brachyteles are described in detail. METHODS: We utilised one individual of Brachyteles arachnoides, two hybrids (B. arachnoides × Brachyteles hypoxanthus) and photographs of the testis of a third fresh specimen of a hybrid individual. RESULTS: The septum formed by tunica dartos adheres to the testis and separates the scrotum in two testicular cavities. Passed the spermatic cord, the external spermatic fascia continues with the tunica dartos, covering the cranial half of the testis. The fascia cremasterica divides itself in bundles of fibres and forms loops around the testicles creating a sac like structure that seems to be unique among Neotropical Primates. The appendix testis is described for the first time in platyrrhini. It is presented as a sessile structure in the extremitas capitata of the testis. Previous literature on the reproductive anatomy of platyrrhini is limited. Despite that, it can be said that the large size and volume of the testis, and complex structure of the cremaster, could consist of a heat loss reduction strategy in cold and humid forest environments. CONCLUSIONS: Except for the larger size of the testicles in hybrid individuals, no other significant morphological differences were found between B. arachnoides and hybrids (B. arachnoides × B. hypoxanthus).

Pathologic Conditions at Imaging of the Spermatic Cord.

A wide range of benign and malignant processes can affect the spermatic cord (SC). Familiarity with and recognition of the characteristic imaging features of these entities are imperative for accurate diagnosis and optimal clinical care. While some SC diseases are self-limiting, others can result in infertility and potentially life-threatening infection or bleeding if they are left untreated. Therefore, correct diagnosis is important for life-saving treatment and preservation of fertility. Disorders including anomalies of the vas deferens and the processus vaginalis, arterial and venous diseases (torsion of the SC and varicoceles), infection, trauma, and neoplasms are the most pertinent entities with which radiologists should be familiar when assessing the SC. Knowing what to expect in a patient who has undergone SC interventions is imperative. US has a fundamental role in the initial examination of patients who present with symptoms that indicate abnormalities of the SC, such as suspected posttraumatic testicular retraction or SC torsion. Other imaging techniques including abdominal and pelvic MRI and CT have their own importance. For correct interpretation of the findings and to establish an accurate diagnosis, it is crucial to have a thorough knowledge of the anatomy, the utility and limitations of various imaging modalities, optimal imaging and scanning techniques, and the imaging features of various benign and malignant pathologic conditions that can involve the SC. Online supplemental material is available for this article. ©RSNA, 2022.

Microstructures of the spermatic cord with three-dimensional reconstruction of sections of the cord and application to varicocele.

The aim of the study was to investigate the micro-structures of the spermatic cord using histological examination with three-dimensional (3D) reconstruction of the serial tissue sections of the cord for clinical application in microscopic varicocelectomy. Human spermatic cord specimens obtained from 13 adult male cadavers were used to prepare serial transverse sections. The sections were stained to allow observation of the spermatic cord microstructures. The 3D reconstruction was performed with digitized serial sections by Mimics software. The microscopic varicocelectomy was performed based on the anatomical results of 3D reconstruction of the spermatic cord. The results showed the number of small spermatic veins, large spermatic veins, arteries, lymphatics or nerves were not markedly different between the subinguinal and inguinal regions or between the right and left sperm cord. The number of medium spermatic veins in the subinguinal region was obviously higher than at the inguinal level. The internal spermatic vessels and the vas deferens together with other associated vessels within the cremaster were separately enclosed by two thin and translucent sheaths, the internal spermatic fascia and the vas deferens fascia. We conclude that internal spermatic vessels and the vas deferens together with the associated neurovascular vessels are wrapped by two distinct sheaths separating them from the surrounding tissues. Microscopic varicocelectomy based on the anatomical results of 3D reconstruction of the spermatic cord is feasible. ABBREVIATIONS: 3D: three-dimensional; ISF: internal spermatic fascia; ESF: external spermatic fascia; MHIV: High inguinal microsurgical varicocelectomy; MSIV: subinguinal microsurgical varicocelectomy; CAAD: computer-assisted anatomic dissection; HE: hematoxylin-eosin.

Spinal Cord Injury Following Antegrade Scrotal Sclerotherapy for Varcicocele: A Case Report.

Varicocele is one of the causes of male infertility. Treatment aims to improve the chance of conception despite lasting controversies about benefits of varicocele repair on fertility. Many techniques have been described for varicocele management including the antegrade scrotal sclerotherapy (ASS). Interestingly, ASS is often presented as a safe, easy, and cost-effective procedure with low recurrence and complication rates. However, we report the first case of spinal cord paralysis following ASS probably due to embolization of venous anastomoses between left spermatic and ascending lumbar veins, which were undetected at preoperative phlebography. Based on this case and recent literature, we raise questions about the safety of ASS and try to figure out what would be the best way to improve the detectability of potential harmful anastomoses at preoperative phlebography.

[Anatomic characteristics of the vessels in the spermatic cord of the varicocele patient: A laparoscopic study].

OBJECTIVE: To study the numbers and locations of spermatic veins, testicular arteries, and lymphatic vessels in the spermatic cord of the varicocele patient under the laparoscope. METHODS: Fifty-seven varicocele patients received laparoscopic ligation of spermatic veins, during which we recorded the numbers and observed the locations of spermatic veins, testicular arteries, and spermatic lymphatic vessels. RESULTS: During the surgery, we identified 3.3 ± 1.2 spermatic veins, 1.4 ± 0.9 testicular arteries, and 4.3 ± 1.1 spermatic lymphatic vessels. No statistically significant differences were observed between the two side in the numbers of the spermatic veins, testicular arteries and spermatic lymphatic vessels (P > 0.05). The testicular arteries were seen on the exterior of the spermatic veins and winding around them, while the spermatic lymphatic vessels mostly between the veins. CONCLUSION: The spermatic veins, testicular arteries, and lymphatic vessels in the spermatic cord of the varicocele patient have their specific anatomic characteristics. Laparoscopic identification of these vessels may contribute to the surgical treatment of varicocele.

Ultrasonography in Diagnosis of Congenital Absence of the Vas Deferens.

BACKGROUND Congenital absence of the vas deferens is an important cause of obstructive azoospermia, and the lack of an imaging diagnostic test is a critical problem. The aim of this study is to discuss the use of ultrasonography in congenital absence of vas deferens, including dysplasia of the epididymis and the seminal vesical. MATERIAL AND METHODS Five fresh spermatic cord specimens were detected by ultrasonography (US) to evaluate the image of the spermatic cord segment of the vas deferens. Fifty normal males had scrotal US to confirm whether the normal spermatic cord segment of the vas deferens can be detected and to measure the internal and external diameter on the long axis view. Forty-six males clinically diagnosed as having congenital absence of vas deferens underwent scrotal US to evaluate the spermatic cord segment of the vas deferens and the epididymis. The seminal vesicals were detected with transrectal ultrasonography. We evaluated images of the vas deferens, epididymis, and seminal vesical. RESULTS Scrotal ultrasonography can distinguish the vas deferens from the other cord-like structures in the spermatic cord, and the vas deferens has a characteristic image. Scrotal ultrasonography detected all 50 normal males and measured the diameter. No statistically significant difference was found between the left and right measurements. In the 46 patients, the following anomalies were observed: 1) 42 cases of congenital bilateral absence of vas deferens; 2) 2 cases of congenital unilateral absence of the vas deferens; and 3) 1 case of congenital segmental absence of the vas deferens. All 46 cases were accompanied with epididymis and seminal vesical anomalies. CONCLUSIONS The spermatic cord segment of the vas deferens can be detected by US, which is a valuable tool in diagnosis of congenital absence of the vas deferens. Seminal vesical and epididymis anomalies often associated with congenital absence of the vas deferens were revealed by ultrasonography.

Surgical comparison of subinguinal and high inguinal microsurgical varicocelectomy for adolescent varicocele.

OBJECTIVE: To compare the surgical outcomes of subinguinal and high inguinal approaches for microsurgical varicocelectomy. METHODS: A total of 81 patients with left varicocele were randomly assigned to undergo microsurgical left varicocelectomy by the subinguinal (n = 41) or high inguinal (n = 40) approach. These two techniques were compared with regard to the operative parameters, complications and testicular growth. Anatomical parameters, including the numbers and diameters of internal spermatic arteries, veins and lymphatic vessels, were recorded. RESULTS: The microsurgical step was significantly shorter for the high inguinal approach compared with the subinguinal approach (25.5 vs 33.3 min, respectively, P < 0.01). The numbers of preserved arteries and ligated veins were significantly greater and the artery size was significantly smaller for the subinguinal (1.6 arteries, 11.5 veins and 1.1 mm, respectively) compared with the high inguinal approach (1.2 arteries, 7.3 veins and 1.3 mm; P < 0.001, <0.0001 and <0.01, respectively). There was one patient with postoperative hydrocele, and three with persistent scrotal pain after treatment with the subinguinal approach. The postoperative catch-up growth rates at 24 months were 70% and 78% for the subinguinal and high inguinal approaches, respectively. CONCLUSIONS: The microsurgical subinguinal and high inguinal approaches seem to yield similar success rates in terms of testicular growth. However, the high inguinal approach is easier to carry out, as it requires fewer divisions of veins and is associated with a larger diameter of the spermatic artery.

Microsurgical Anatomy of the Spermatic Cord and Spermatic Fascia: Distribution of Lymphatics, and Sensory and Autonomic Nerves.

PURPOSE: An understanding of the microsurgical anatomy of the spermatic cord and spermatic fascia is important for surgeons during microsurgical varicocelectomy and denervation. We examined the distribution of the lymphatics, and the sensory and autonomic nerves of the spermatic cord. MATERIALS AND METHODS: We collected spermatic cords from 11 men undergoing orchiectomy for localized testicular tumors and we biopsied a third of the spermatic fascia from 36 men undergoing microsurgical varicocelectomy. Immunohistochemical staining of the pan-neuronal marker PGP 9.5 (protein gene product 9.5), the sensory nociceptor marker CPRP (calcitonin gene-related peptide), the sympathetic marker TH (tyrosine hydroxylase), the parasympathetic marker VIP (vasoactive intestinal polypeptide) and the lymphatic marker D2-40 was performed. We counted the number of nerves and lymphatics. RESULTS: PGP 9.5 staining revealed dense nerve distributions in the spermatic cord and fascia. Sensory and autonomic nerve fibers were basically co-localized in the same nerve. Of the nerves 50% were identified near the vas deferens and 20% were identified in the spermatic fascia. Sensory and sympathetic nerve fibers represented most of the nerves but a few parasympathetic nerve fibers were observed. Of the lymphatics 36 per patient were identified in the spermatic cord but only a few were identified in the spermatic fascia. CONCLUSIONS: Sensory and sympathetic nerves accounted for the majority of the nerves. Although the functional aspects of the nerves remain undetermined, information on the distribution of nerves and lymphatics is useful when dealing with nerves and preserving lymphatics during microsurgical varicocelectomy or denervation.

Anatomic relationship between the spermatic cord and the pubic tubercle: are our clamps injuring the cord during symphyseal repair?

OBJECTIVE: Traditional repair of the disrupted pubic symphysis includes application of pointed clamps to the pubic tubercles and/or pubic body for fracture reduction. Recent studies have reported rates of sexual dysfunction of 42%-90% after repair of these injuries. The purpose of this study is to define the anatomy of the spermatic cord relative to the pubic tubercle and other local structures to assess the risk of sustaining an iatrogenic injury during clamp placement. METHODS: Eight intact lower-half fresh male human cadavers were dissected. A window of skin and subcutaneous tissue was excised to expose the low abdominal wall and penile root. Pubic tubercles were identified by palpation and marked. The spermatic cord was identified at the superficial inguinal ring and followed into the scrotum, and any anatomical abnormalities were recorded. The relationship and distance of the spermatic cord to the pubic tubercle, insertion of the inguinal ligament and abdominal wall musculature, and pubic symphysis were recorded. Photographs were taken of the superficial and deep anatomy. RESULTS: Spermatic cords were found to follow a consistent course after exiting the inguinal canal at the lower abdomen: they coursed inferior and medial to a position lateral to the pubic tubercles. In all cases, the spermatic cord lay adjacent, directly lateral to the tubercle with an average separation of 0.8 mm (range, 0-2 mm). The average distances from the lateral aspect of the tubercle and the medial border of the spermatic cord to the pubic symphysis were 26 and 27 mm, respectively. Qualitatively, even with direct visualization, it was not feasible to apply a pointed tenaculum to the pubic tubercles without piercing the spermatic cord, unless one manually retracted the latter. CONCLUSIONS: The spermatic cord is located lateral and immediately adjacent to the pubic tubercle after it exits the inguinal canal and passes into the scrotum. As such, the spermatic cord seems to be at a significant risk of sustaining injury when pointed forceps are placed on the tubercles, as is often recommended during the repair of pubic diastasis.

Parâmetros anátomo-estruturais de orgãos reprodutivos de ovinos sem raça definida (SRD) nativos do Estado da Paraíba, com e sem bipartição escrotal: estudo do escroto e funículo espermático / Anatomical and structural parameters of reproductive organs of crossbred rams native from the state of Paraíba, Brazil, with and without scrotal bipartition: study of the scrotal skin and spermatic cord

Foram utilizados 42 ovinos sem raça definida, divididos segundo a configuração escrotal. Destes animais, 12 foram utilizados na investigação da biometria testicular e histologia da pele escrotal. Os demais foram destinados ao estudo do funículo espermático. Os animais foram agrupados em um grupo de 21 animais sem bipartição escrotal (GEI) e 21 com bipartição escrotal, (GEII), esta não atingindo 50% do comprimento do eixo longitudinal do escroto. Em cada grupo, em 6 animais foram coletados fragmentos da pele do escroto e em 5 do funículo espermáticos, e processados em rotina histológica e analisados em microscopia de luz; e em 10 foram injetados látex na artéria testicular para obtenção de moldes vasculares e obtenção do comprimento da artéria. Quando comparados os grupos GEI e GEII, não foram encontradas diferenças estatísticas significativas (p<0,05) entre a espessura do escroto (epiderme e derme), constituição histológica da pele escrotal, número de glândulas sudoríparas por área, comprimento do funículo espermático ou parâmetros biométricos testiculares. Entretanto, o comprimento total das artérias testiculares do GEI foi maior do que o GEII (p<0,05). Concluiu-se, com base nos parâmetros morfológicos analisados, que a bipartição escrotal em ovinos não influenciou na estrutura da pele, funículo ou biometria testicular quando comparado aos animais que não apresentavam esta característica. Outros estudos merecem atenção para desmistificar o porquê do aparecimento dessa característica em ovinos e se esta característica é ou não desejável para melhoria na produção desses animais em regiões de clima quente.

Forty-two crossbred rams were used, divided according to their scrotal configuration. Twelve of these animals were used to investigate the testicular biometry and scrotal skin histology. The other animals were used to study the spermatic cord. The animals were placed in a group of 21 animals without scrotal bipartition (GEI) and another with scrotal bipartition (GEII) which did not reach 50% of the length of the scrotum's longitudinal axis. In each group, scrotal skin fragments from six rams and spermatic cord fragments from 5 others were collected, processed by routine histological tests and analyzed with a microscope. In 10 rams latex was injected into the testicular artery to obtain vascular molds and the artery length. Comparison of groups GEI and GEII showed no significant statistical differences (p<0.05) between scrotal thickness (epidermis and dermis), histological constituency of the scrotal skin, number of sudoriferous glands per area, scrotal bipartition length or testicular biometric parameters. However, the total length of the testicular arteries of GEI was greater than of GEII (p<0.05). It was concluded from the morphological parameters analyzed that scrotal bipartition in rams did not influence the skin structure, scrotal bipartition or testicular biometry when compared with animals that did not present this characteristic. Further studies should be carried out to elucidate the appearance of this characteristic in rams and whether it is desirable or not for improved production of these animals in warm climate regions.

The secondary external inguinal ring and associated fascial planes: surgical anatomy, embryology, applications.

Classically, two inguinal rings are defined: internal and external. We previously introduced a third one, the secondary internal inguinal ring, deep to the classic internal. Here, we present a fourth ring, the secondary external inguinal ring, initially described by McGregor (Surg Gynecol Obstet 49:273-307, 1929), but now forgotten. Embryologically, this ring may be formed by evagination of Scarpa's fascia during testicular descent. Anatomically, it is located 2 cm below the pubic tubercle. It is formed by Scarpa's fascia that covers the spermatic cord anteriorly; medial and lateral fascial reflections delineate the ring and form the spermatic cord canal. The cord is attached to the posterior wall of the canal. The canal ends at the entrance of the scrotum, where Colles' fascia fuses with coverings of the cord. Adjoining the secondary external ring, at the same surgical layer and communicating with the subcutaneous abdominal space, are four subcutaneous pouches: laterally, the superficial inguinal pouch; medially, the perineal, femoral, and pubic pouches. Surgically, an inguinoscrotal hernia passes though the secondary external ring and obtains an extra outer layer by entering the spermatic cord canal. Underdevelopment of the ring leads to incomplete testicular descent or ectopic testis. We recommend reconstruction of Scarpa's ring after orcheopexies and herniotomies in children. After urethral rupture distal to the urogenital diaphragm, urine may fill the subcutaneous abdominal space, pouches, and scrotum, due to their communication around the secondary external ring. In females, this ring was not found, possibly because of the non-descent of the ovaries through (and beyond) the inguinal canal.

[Microanatomy of blood vessels in spermatic cords and its clinical implication].

OBJECTIVE: Both microsurgical subinguinal varicocelectomy (MSIV) and microsurgical high inguinal varicocelectomy (MHIV) are recommended for the treatment of varicocele, but they differ in technical complexity. This study aimed to determine the microanatomy of spermatic blood vessels in the two surgical approaches. METHODS: We recorded the numbers of spermatic veins, arteries and lymphatics in 80 cases of MSIV and 20 cases of MHIV. We also examined the spermatic cords from 10 adult male cadavers by histological staining. RESULTS: The numbers of medium spermatic veins (2 -5 mm in diameter) were 1.80 +/- 0.83 and 3.98 +/- 1. 99 in MHIV and MSIV, respectively, with significant difference between the two groups (t = -7.536, P < 0.01), and the total numbers of spermatic veins were 6.40 +/- 1.67 and 9.01 +/- 2.70, also with significant difference between the two (t = -4.071, P < 0.01). However, there were no significant differences between MHIV and MSIV in the numbers of small spermatic veins (diameter < or = 2 mm), large spermatic veins (diameter > or = 5 mm), arteries and lymphatics, nor in the numbers of spermatic veins and arteries of the cadavers. CONCLUSION: The total number of spermatic veins and the number of medium spermatic veins may be larger in MSIV than in MHIV, but the medium spermatic veins do not increase surgical difficulty, and MSIV is not more complicated than MHIV.

Expression of the male reproduction-related gene (Mar-Mrr) in the spermatic duct of the giant freshwater prawn, Macrobrachium rosenbergii.

Phosphorylated sperm proteins are crucial for sperm maturation and capacitation as a priori to their fertilization with eggs. In the freshwater prawn, Macrobrachium rosenbergii, a male reproduction-related protein (Mar-Mrr) was known to be expressed only in the spermatic ducts as a protein with putative phosphorylation and may be involved in sperm capacitation in this species. We investigated further the temporal and spatial expression of the Mar-Mrr gene using RT-PCR and in situ hybridization and the characteristics and fate of the protein using immunblotting and immunocytochemistry. The Mar-Mrr gene was first expressed in 4-week-old post larvae and the protein was produced in epithelial cells lining the spermatic ducts, at the highest level in the proximal region and decreased in the middle and distal parts. The native protein had a MW of 17 kDa and a high degree of serine/threonine phosphorylation. It was transferred from the epithelial cells to become a major protein at the anterior region of the sperm. We suggest that it is involved in sperm capacitation and fertilization in this open thelycal species and this is being investigated.

A new method of spermatic cord mobilization in herniorrhaphy.

Spermatic cord mobilization is a routine part of inguinal hernia repair, but the method of cord mobilization varies among surgeons. This study establishes an anatomic plane for spermatic cord mobilization. We studied the anatomy of the superficial cremasteric fascia in 105 male patients during herniorrhaphy for primary inguinal hernias. The mean patient age was 44.8 (18-71) years and mean body mass index was 24.1 kg/m(2) (21.5-27.1 kg/m(2)). The two layers of the superficial cremasteric fascia between the spermatic cord and the inguinal falx were incised to mobilize the cord. We found that spermatic cord mobilization during herniorrhaphy can be easily approached through an anatomic plane between the spermatic cord and the conjoined tendon with subsequent division of the superficial cremasteric fascia. None of the patients experienced any hemorrhage or nerve injury during cord mobilization. We found this method to be both safe and easy to learn.

Comparison of spermatic vein histology in patients with and without varicocele.

The aim of this study was to investigate and compare histological characteristics of spermatic veins in patients with and without varicocele. Between February 2009 and July 2009, spermatic veins were obtained from 13 patients with varicocele. Microsurgical subinguinal low ligation was performed in all patients. Spermatic veins of patients without varicocele were obtained from 12 patients who underwent radical nephrectomy. Histologically, sections of veins were stained with haematoxylin and eosin. Mean tunica adventitia thickness size of the spermatic veins was 0.35 ± 0.08 mm and 0.22 ± 0.1 mm respectively in patients with varicocele and control group (P = 0.001). Similarly, mean tunica media thickness size of the spermatic veins was 0.25 ± 0.05 mm and 0.09 ± 0.04 mm respectively in patients with varicocele and control group (P < 0.001). No significant differences were detected regarding the tunica adventitia and tunica media thicknesses when patients with grade 2 varicocele were compared with patients with grade 3 varicocele (P > 0.05). No significant differences were detected between the tunica adventitia and tunica media thicknesses of patients with varicocele and sperm parameters (P > 0.05). Our study demonstrated that tunica adventitia and tunica media thicknesses seem to be increased in patients with varicocele compared with normal subjects.

Microanatomy of the left and right spermatic cords at subinguinal microsurgical varicocelectomy: comparative study of primary and redo repairs.

OBJECTIVES: To examine and compare the left and right spermatic cord arterial and lymphatic anatomy identified at primary and redo microsurgical subinguinal varicocelectomy. METHODS: We reviewed the operative reports of 335 consecutive microsurgical varicocelectomies performed by a single surgeon: 325 primary repairs and 10 reoperations. We recorded number of testicular arteries (internal and external spermatic) and lymphatic channels preserved at subinguinal microsurgical varicocelectomy, and evaluated the relationship between the right and left vascular anatomy at bilateral varicocelectomy. RESULTS: A total of 235 left-sided and 90 bilateral primary repairs were performed. A mean (+/-standard deviation) number of 2.4+/-1.0 arteries and 4.6+/-1.5 lymphatics were identified during the left-sided repairs. For bilateral repairs, there were 2.4+/-0.9 arteries and 4.4+/-1.2 lymphatics on the left and 2.2+/-0.9 arteries and 4.2+/-1.3 lymphatics on the right with a significant correlation between the number of right and left internal spermatic arteries (r=0.42). For the cohort of secondary (redo) varicocelectomies, we identified 2.3+/-0.6 arteries and 4.8+/-1.6 lymphatic channels (not significantly different from the primary varicocelectomy cohorts). CONCLUSIONS: The number of arteries and lymphatics preserved at microsurgical varicocelectomy is highly variable, but there is some similarity in the microanatomy of the right and left spermatic cords at the level of the external inguinal ring. The data also suggest that the number of arteries and lymphatic channels identified at a redo varicocelectomy is comparable to that observed during a primary varicocelectomy.

Histomorphological differences of spermatic cords regarding subinguinal versus inguinal levels: a cadaveric study.

AIM: Varicocele is a common disorder among male population and is the most common cause of secondary infertility. Microsurgical inguinal or subinguinal operations are the preferred approaches but the two differ in technical difficulty. Therefore, we examined the histomorphological differences of spermatic cords at both subinguinal and inguinal levels in this cadaveric study. METHODS: Spermatic cords from 9 adult male cadavers were examined at both the inguinal and subinguinal levels using a light microscope with an image analysis program in the anatomy and histology laboratories of Ankara University Medical School between July 15, 2006 and February 15, 2007. RESULTS: In terms of number and wall thickness, we did not observe any significant histomorphological differences in spermatic cord veins and arteries between the subinguinal and inguinal levels. CONCLUSION: We conclude that the subinguinal approach is not a harder technique than the inguinal approach concerning vessel dissection, but more studies must be made to compare subinguinal versus inguinal varicocelectomy.

Sarcomas de cordón espermático estado actual y presentación de cuatro casos clínicos / Spermatic cord sarcomas: current status and report of four cases

OBJETIVO: Estudio y revisión de los sarcomas de cordón espermático, de la clínica, diagnóstico y tratamiento de dicha patología.MÉTODOS/ RESULTADOS: Se revisa la literatura nacional e internacional, aportando cuatro nuevos casos: dos liposarcomas de cordón espermático bien diferenciados, uno de ellos tratado mediante tumorectomía simple; un paciente con degeneración liposarcomatoide de un lipoma atípico previo resecado; y otro paciente intervenido de un fibrohistiocitoma maligno retroperitoneal con posterior recidiva local a nivel de la región paratesticular.CONCLUSIONES: Los sarcomas de cordón espermático son una entidad poco frecuente que habitualmente se manifiestan como una masa paratesticular indolente. Su diagnóstico se efectúa mediante métodos de imagen (ecografía, TAC, RNM) y se confirma mediante el estudio histológico. El tratamiento es quirúrgico, existiendo cierta controversia acerca de la eficacia de tratamientos adyuvantes como la quimioterapia o la radioterapia(AU)

OBJECTIVE: To study and review spermatic cord sarcomas, including symptoms, diagnosis, and treat-ment.METHODS/RESULTS: We review the Spanish and international literature and report 4 new cases: 2 patients with well-differentiated spermatic cord liposarcomas (1 treated by simple tumorectomy), 1 patient with liposarcomatous dege-neration of a previously excised atypical lipoma, and 1 pa-tient operated for a malignant retroperitoneal fibrous histio-cytoma with subsequent local recurrence in the paratesticular region.CONCLUSIONS: Spermatic cord sarcomas are rare entities that usually appear as painless paratesticular mass. They are diagnosed by imaging studies (ultrasound, computed tomography, magnetic resonance) and confirmed by histological examination. Spermatic cord sarcomas are treated surgically; the efficacy of adjuvant treatments such as chemotherapy or radiation therapy is still under debate(AU)