Informe de un caso de liposarcoma paratesticular

Los liposarcomas son neoplasias que se originan de las células mesenquimales, y su localización paratesticular es infrecuente. Se dividen en cuatro subtipos histológicos, siendo el mixoide el más raro. Se muestra el informe de un caso de liposarcoma paratesticular mixoide y una revisión de la literatura, con el objetivo de brindar información sobre esta rara enfermedad. El caso es un paciente masculino de 70 años de edad, que acude a consulta por tumefacción escrotal derecha e indolora de 13 meses de evolución, diagnosticado inicialmente como una hernia inguinal unilateral. Se realizó orquiectomía inguinal radical derecha y ligadura de cordón alto. En anatomía patológica se recibe la pieza quirúrgica de 2500 g. Al estudio histológico se evidencia liposarcoma mixoide. La tomografía computarizada de tórax, abdomen y pelvis no mostró metástasis. La presencia de un liposarcoma debe tenerse en cuenta durante el estudio diagnóstico de masas escrotales, para minimizar la tasa de diagnóstico erróneo y manejo inadecuado.

Liposarcoma are neoplasms that originate from mesenchymal cells, and their paratesticular location is infrequent. They are divided into four histological subtypes, the myxoid being the rarest. The report of a case of myxoid paratesticular liposarcoma and a review of the literature are shown, with the aim of providing information on this rare disease. The case is a 70-years-old male patient who assists the clinic due to painless right scrotal swelling of 13 months evolution, who was initially diagnosed with a unilateral inguinal hernia. Right radical inguinal orchiectomy and high cord ligation were performed. The pathological piece of 2500g is received in pathological anatomy. Myxoid liposarcoma is evidenced at histological study. Chest, abdomen and pelvis computed tomography showed no metastasis. The presence of liposarcoma should be taken into account during the diagnostic study of scrotal masses to minimize the rate of misdiagnosis and inadequate management.

Indicaciones e histología de 489 orquiectomías analizadas según la edad del paciente / Indications and histology of 489 orchiectomies analyzed by patient age

Objetivo Evaluar indicaciones e histología de nuestra serie de orquiectomías, analizando los resultados dependiendo de la edad del paciente. Métodos Estudio de las orquiectomías realizadas en nuestro centro entre 2005 y 2020 a pacientes mayores de 18 años. Evaluamos: datos demográficos, indicaciones, histología y efectividad del diagnóstico ecográfico según 3 grupos de edad. Resultados Se realizaron 489 orquiectomías, 364 (74%) en los pacientes entre 18-50 años (grupo A), 59 (12%) entre los pacientes de 51-70 años (grupo B) y 66 (13,4%) en mayores de 70 años (grupo C). En el grupo A, 284 (78%) orquiectomías fueron indicadas por sospecha tumoral, 261/284 (91,9%) fueron neoplasias malignas, 253 (89%) germinales. La ecografía testicular tuvo un valor predictivo positivo (VPP) para tumor testicular maligno del 90%. En el grupo B, 34 (57%) orquiectomías fueron indicadas por sospecha tumoral y 25/34 (73,5%) presentaron neoplasias malignas. La ecografía tuvo un VPP para malignidad del 68%. En el grupo C, la orquiepididimitis fue la causa más frecuente de orquiectomía con 30 casos (45,5%). Entre las 20 orquiectomías por sospecha de tumor (30,3%), se encontró malignidad en 6. La ecografía tuvo un VPP para malignidad del 31%. Conclusión En menores de 70 años la indicación principal de orquiectomía fue la sospecha tumoral y en mayores, la orquiepididimitis. Los tumores germinales fueron la histología más frecuente en los menores de 70 años; en los mayores la malignidad fue infrecuente. Con la edad, disminuyó el VPP de la ecografía testicular para neoplasia maligna. En los mayores de 50 años se debería mejorar el proceso diagnóstico antes de indicar orquiectomía por sospecha tumoral (AU)

Objective To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. Methods We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. Results We included 489 orchiectomies, which 364 (74%) belonged to group A (patients between 18-50 years), 59 (12%) to group B (50-70 years) and 66 (14%) to group C (older than 70 years). In group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. Conclusion In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done (AU)

Granulomatosis con poliangeítis simulando una torsión testicular / Granulomatosis with poliangiitis mimicking testicular torsion

La granulomatosis con poliangeítis (GPA) es una vasculitis autoinmune que raramente afecta al tracto genitourinario inferior. Presentamos el caso de un varón de 53 años que debutó con una masa retroperitoneal y posteriormente desarrolló un hidrocele multiseptado izquierdo que condicionó un infarto testicular. El informe anatomopatológico de la orquiectomía reveló hallazgos sugestivos de GPA.(AU)

Granulomatosis with polyangiitis (GPA) is an autoimmune vasculitis which rarely affects the lower genitourinary tract. We share the case of a 53-year-old man who presented with a retroperitoneal mass and thereafter developed a left multiseptated hydrocele that conditioned a testicular infarction. The pathology report of the orchidectomy was consistent with GPA.(AU)

Granulomatosis with poliangiitis mimicking testicular torsion.

Granulomatosis with polyangiitis (GPA) is an autoimmune vasculitis which rarely affects the lower genitourinary tract. We share the case of a 53-year-old man who presented with a retroperitoneal mass and thereafter developed a left multiseptated hydrocele that conditioned a testicular infarction. The pathology report of the orchidectomy was consistent with GPA.

Leiomiossarcoma paratesticular: relato de caso e revisão de literatura / Paratesticular leiomysarcoma: a case of report and review of the literature

Introdução: O leiomiossarcoma é um tumor maligno de células mesenquimais. Este estudo tem como objetivo apresentar um caso clínico de sarcoma paratesticular subtipo leiomiossarcoma, tendo em vista sua escassez na literatura. Relato de caso: Paciente, 40 anos, sexo masculino, negro, hígido, iniciou quadro de dor em região de bolsa escrotal. Foi submetido à ultrassonografia que evidenciou tumor testicular à esquerda. Foi realizada abordagem cirúrgica. Considerações finais: O leiomiossarcoma é um tumor maligno com envolvimento de músculo liso. Devido à raridade do leiomiossarcoma paratesticular, não existe protocolo estabelecido na literatura. A importância da equipe multidisciplinar e especializada com acompanhamento longitudinal tem o intuito de instituir a terapia padrão-ouro e evitar recorrência.

Introduction: Leiomyosarcoma is a malignant tumor of mesenchymal cells. This study aims to present a clinical case of paratesticular sarcoma subtype leiomyosarcoma given its scarcity in the literature. Case report: The patient, 40 years old, male, black, healthy, started with pain in the scrotal region. He was submitted to ultrasonography which showed a testicular tumor on the left. A surgical approach was performed. Final consideration: Leiomyosarcoma is a malignant tumor with smooth muscle involvement. Due to the rarity of paratesticular leiomyosarcoma, there is no established protocol in the literature. The importance of a multidisciplinary and specialized team with longitudinal follow-up to establish the gold standard therapy and avoid recurrence.

Indications and histology of 489 orchiectomies analyzed by patient age.

OBJECTIVE: To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age. METHODS: We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age. RESULTS: We included 489 orchiectomies, which 364 (74%) belonged to Group A (patients between 18-50 years), 59 (12%) to Group B (50-70 years) and 66 (14%) to Group C (older than 70 years). In Group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In Group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In Group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%. CONCLUSION: In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done.

Satisfaction with testicular prosthesis: a Portuguese questionnaire-based study in testicular cancer survivors.

Radical orchiectomy in testicular cancer patients can have a negative impact on body image and self-esteem. Reconstructive surgery with testicular prosthesis might mitigate this burden. We conducted a questionnaire-based study aiming to evaluate our patients' satisfaction with testicular prosthesis. Overall satisfaction was rated as excellent or good in 97.7%. The main complaints were related to the prosthesis' inappropriate texture (45.5%), size (18.1%) or position (15.9%). Among men interviewed, 59% considered that having a normal looking scrotum was either extremely important or important for their self-esteem. The majority (88.2%) stated they would make the same decision again, and nearly all patients would recommend it to other men with testicular cancer. We believe testicular implants should always be offered, leaving the final decision to the patient.

The synergistic effects of testosterone and phophodiesterase-5 inhibitor combination on oxidative stress markers, matrix metalloproteinases and oxidative DNA damage: A randomized controlled experimental study / Efecto sinérgico del uso combinado de testosterona y el inhibidor de fosfodiesterasa en los marcadores del estrés oxidativo, metaloproteinasas de la matriz y daño oxidativo del AND: estudio experimental contolado y aleatorizado

Purpose: To investigate the effects of combined tadalafil and testosterone usage on oxidative stress, DNA damage and MMPs in testosterone deficiency.Methods: Fifty rats were randomly divided into 5 groups (group-1: sham group-placebo, group-2: bilateral orchiectomy (ORX), group-3: bilateral ORX+tadalafil, group-4: bilateral ORX+testosterone, group-5: bilateral ORX+tadalafil+testosterone). Group-3 received tadalafil (5mg/kg/day, oral). Group-4 was administered testosterone undecanoate (100mg/kg i.m., single dose). Group-5 was administered a combination of tadalafil and testosterone undecanoate. All groups were compared with regard to serum nicotinamide adenine dinucleotide phosphate oxidase-4 (NOX-4), total thiol, matrix metalloproteinase-2 (MMP-2), MMP-3 and MMP-9, tissue inhibitor of metalloproteinases-1 (TIMP-1) and TIMP-2 and 8-hydroxy-2-deoxy guanosine (8-OHdG) levels.Results: Total thiol levels of group-2 were significantly lower than the other groups and thiol levels were higher in group-1 and group-5 than in the other groups. NOX4, MMP2 and 9 levels in group-2 were higher than in the other groups. MMP-9 levels in group-5 were lower than in groups 3 and 4 (p=.001). The level of 8-OHdG in groups 2 and 3 was higher than in the other groups (p=.001). In correlation analysis, 8-OHdG, MMP2, and 9 levels were negatively correlated with total thiol, whereas NOX4 and 8-OHdG levels were positively correlated with MMPs values.Conclusions: The combination of testosterone with PDE-5 inhibitor suppresses MMP-9 levels and increases total thiol levels better than testosterone alone and tadalafil alone. Therefore, testosterone can be considered for use with PDE-5 inhibitor from the initial stage in case of testosterone deficiency. (AU)

Objetivo: Investigar los efectos del uso combinado de tadalafil y testosterona en cuanto a estrés oxidativo, daño del ADN y metaloproteinasas de la matriz (MMPs) en la deficiencia de testosterona.Métodos: Se dividió aleatoriamente a cincuenta ratas en cinco grupos (grupo-1: grupo de simulación-placebo, grupo-2: orquiectomía bilateral (ORX), grupo-3: ORX bilateral+tadalafil, grupo-4: ORX bilateral+testosterona, grupo-5: ORX bilateral+tadalafil+testosterona). El grupo 3 recibió tadalafil (5mg/kg/day, oral). El Grupo 4 recibió undecanoato de testosterona (100mg/kg i.m, dosis única). El Grupo 5 recibió una combinación de tadalafil y undecanoato de testosterona. Se comparó a todos los grupos con respecto a los niveles séricos de nicotinamida adenina dinucleótido fosfato oxidasa-4 (NOX-4), tiol total, metaloproteinasa de la matriz 2 (MMP-2), MMP-3 y MMP-9, inhibidor tisular de metaloproteinasas-1 (TIMP-1) y TIMP-2, y 8-hidroxi-2-deoxi guanosina (8-OHdG).Resultados: Los niveles totales de tiol del grupo 2 fueron significativamente menores que en el resto de grupos, y los niveles de tiol fueron mayores del grupo 1 y el grupo 5 con respecto a los demás grupos. Los niveles de NOX4, MMP2 y 9 en el grupo 2 fueron mayores que los del resto de grupos. Los niveles de MMP-9 del grupo 5 fueron menores que los de los grupos 3 y 4 (p=0,001). El nivel de 8-OHdG de los grupos 2 y 3 fue mayor que los del resto de grupos (p=0,001). En el análisis de correlación, los niveles de 8-OHdG, MMP2, y 9 guardaron una correlación negativa con tiol total, mientras que los niveles de NOX4 y 8-OHdG se correlacionaron positivamente con los valores de MMPs.Conclusiones: La combinación de testosteronay el inhibidor de PDE-5 suprime los niveles de MMP-9 e incrementa los niveles totales de tiol, de mejor manera que testosterona y tadalafilen solitario. Por tanto, puede considerarse el uso de testosterona con el inhibidor de PDE-5 en las etapas iniciales de deficiencia de testosterona. (AU)

Satisfaction with testicular prosthesis: a Portuguese questionnaire-based study in testicular cancer survivors / Satisfacción con las prótesis testiculares: estudio portugués basado en cuestionario de los supervivientes de cáncer de testículo

Radical orchiectomy in testicular cancer patients can have a negative impact on body image and self-esteem. Reconstructive surgery with testicular prosthesis might mitigate this burden. We conducted a questionnaire-based study aiming to evaluate our patients’ satisfaction with testicular prosthesis. Overall satisfaction was rated as excellent or good in 97.7%. The main complaints were related to the prosthesis’ inappropriate texture (45.5%), size (18.1%) or position (15.9%). Among men interviewed, 59% considered that having a normal looking scrotum was either extremely important or important for their self-esteem. The majority (88.2%) stated they would make the same decision again, and nearly all patients would recommend it to other men with testicular cancer. We believe testicular implants should always be offered, leaving the final decision to the patient (AU)

La orquiectomía radical en los pacientes de cáncer de testículo puede tener un impacto negativo en su imagen corporal y autoestima. La cirugía reconstructora con prótesis testiculares podría mitigar esta carga. Realizamos un estudio basado en el uso de un cuestionario con el objetivo de evaluar la satisfacción de nuestros pacientes con las prótesis testiculares. La satisfacción general fue calificada como excelente o buena en el 97,7% de los casos. Las principales quejas guardaron relación con la textura inadecuada de las prótesis (45,5%), el tamaño (18,1%) o su posición (15,9%). Entre los varones entrevistados, el 59% consideró que tener un escroto con aspecto normal era extremadamente importante, o importante para su autoestima. La mayoría (88,2%) afirmó que volverían a tomar la misma decisión de nuevo, y casi todos los pacientes lo recomendarían a otros varones con cáncer de testículo. Consideramos que siempre deberían ofrecerse los implantes testiculares, dejando que el paciente tome siempre la decisión final. (AU)

Linfoma testicular primario. A propósito de 2casos nuevos / Primary testicular lymphoma. Two new case reports

El linfoma testicular primario es una entidad muy poco frecuente; sin embargo, su curso clínico es desfavorable, con una elevada tasa de recaídas y baja supervivencia. A propósito de su baja prevalencia, presentamos 2casos con la actualización en el tratamiento y evolución. (AU)

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease. (AU)

The synergistic effects of testosterone and phophodiesterase-5 inhibitor combination on oxidative stress markers, matrix metalloproteinases and oxidative DNA damage: A randomized controlled experimental study.

PURPOSE: To investigate the effects of combined tadalafil and testosterone usage on oxidative stress, DNA damage and MMPs in testosterone deficiency. METHODS: Fifty rats were randomly divided into 5 groups (group-1: sham group-placebo, group-2: bilateral orchiectomy (ORX), group-3: bilateral ORX+tadalafil, group-4: bilateral ORX+testosterone, group-5: bilateral ORX+tadalafil+testosterone). Group-3 received tadalafil (5mg/kg/day, oral). Group-4 was administered testosterone undecanoate (100mg/kg i.m., single dose). Group-5 was administered a combination of tadalafil and testosterone undecanoate. All groups were compared with regard to serum nicotinamide adenine dinucleotide phosphate oxidase-4 (NOX-4), total thiol, matrix metalloproteinase-2 (MMP-2), MMP-3 and MMP-9, tissue inhibitor of metalloproteinases-1 (TIMP-1) and TIMP-2 and 8-hydroxy-2-deoxy guanosine (8-OHdG) levels. RESULTS: Total thiol levels of group-2 were significantly lower than the other groups and thiol levels were higher in group-1 and group-5 than in the other groups. NOX4, MMP2 and 9 levels in group-2 were higher than in the other groups. MMP-9 levels in group-5 were lower than in groups 3 and 4 (p=.001). The level of 8-OHdG in groups 2 and 3 was higher than in the other groups (p=.001). In correlation analysis, 8-OHdG, MMP2, and 9 levels were negatively correlated with total thiol, whereas NOX4 and 8-OHdG levels were positively correlated with MMPs values. CONCLUSIONS: The combination of testosterone with PDE-5 inhibitor suppresses MMP-9 levels and increases total thiol levels better than testosterone alone and tadalafil alone. Therefore, testosterone can be considered for use with PDE-5 inhibitor from the initial stage in case of testosterone deficiency.

[Primary testicular lymphoma. Two new case reports]. / Linfoma testicular primario. A propósito de 2casos nuevos.

Primary testicular lymphoma is a very rare entity. However, its clinical course is poor with a high recurrence and low survival rate. Given its low prevalence, we present 2cases with an update on the treatment and progression of this disease.

Explorando un seminoma, encontrado en una ruptura testicular: reporte de caso

Dentro de los traumas testiculares, el cerrado representa la mayoría de los casos, y por lo general afecta a hombres de 15 a 40 años de edad. Presentamos un hallazgo de seminoma clásico luego de un trauma incidental con posterior exploración quirúrgica y orquiectomía radical de testículo izquierdo. Se resalta la dificultad de las herramientas de investigación como la ecografía testicular para apoyo del médico. Los seminomas suelen ser masas homogéneamente hipoecoicas. Las imágenes por resonancia magnética pueden ayudar a confirmar que una masa es intratesticular y proporcionar datos para la estadificación local. La tomografía computarizada proporciona información valiosa para la estadificación, incluida la presencia y el tamaño de los ganglios linfáticos retroperitoneales. El manejo es limitado. Sin embargo, el seminoma testicular se trata con orquiectomía inguinal radical y es altamente curable incluso en etapas avanzadas de la enfermedad. La mayoría de los médicos eligen la orquiectomía seguida de vigilancia para pacientes con enfermedad seminomatosa en estadio I y quimioterapia o radiación, seguida de una cirugía para el manejo de masas residuales, para pacientes con enfermedad en estadio II y superior. Destacamos la importancia de la sospecha clínica en estos tipos de pacientes jóvenes y tener una búsqueda activa ante estos traumas triviales.   (provisto por Infomedic International)

Among testicular traumas, blunt testicular trauma represents the majority of cases and usually affects men between 15 and 40 years of age. We present a finding of classic seminoma after an incidental trauma with subsequent surgical exploration and radical orchiectomy of the left testicle. The difficulty of research tools such as testicular ultrasound for physician support is highlighted. Seminomas are usually homogeneously hypoechoic masses. Magnetic resonance imaging can help confirm that a mass is intratesticular and provide data for local staging. Computed tomography provides valuable information for staging, including the presence and size of retroperitoneal lymph nodes. Management is limited. However, testicular seminoma is treated with radical inguinal orchiectomy and is highly curable even in advanced stages of the disease. Most physicians choose orchiectomy followed by surveillance for patients with stage I seminomatous disease and chemotherapy or radiation, followed by surgery for management of residual masses, for patients with stage II and higher disease. We stress the importance of clinical suspicion in these types of young patients and having an active search for these trivial traumas. (provided by Infomedic International)

Fusión esplenogonadal asociada a síndrome de Moebius y Poland: primer caso reportado / Splenogonadal fusion associated with Moebius and Poland syndromes: first case reported

Introducción: La fusión esplenogonadal es una anomalía congénitarara, de etiología desconocida, causada por la fusión anormal entre eltejido esplénico y gonadal. Caso clínico: Paciente de dos años, con parálisis del 6°, 7° y 9°nervio craneal, boca en tienda, paladar hendido, hipoplasia del músculopectoral mayor derecho y defecto disruptivo de la extremidad superior derecha, masa visible en región inguinal izquierda. Al realizar laherniorrafia inguinal encontramos un conducto peritoneo vaginal concontenido no reductible y a la apertura del saco herniario observamosun segmento de tejido esplénico que desciende y se fusiona con elpolo superior del testículo izquierdo. El paciente fue diagnosticado confusión esplenogonadal. El tejido esplénico fusionado al polo superiordel testículo es resecado y el resto del tejido esplénico se reduce haciala cavidad abdominal. Comentarios: La fusión esplenogonadal es una patología de difícildiagnóstico y su conocimiento puede evitar orquiectomías innecesarias.(AU)

Introduction: Splenogonadal fusion is a rare congenital anomalyof unknown etiology caused by an abnormal fusion of the splenic tissueand the gonadal tissue. Clinical case: 2-year-old patient with paralysis of the 6 th , 7 th , and9th cranial nerves, tent-shaped mouth, cleft palate, right pectoralis majorhypoplasia, disruptive defect of the right upper limb, and a mass locatedat the left inguinal region. At inguinal hernia repair surgery, a processusvaginalis with non-reducible content was observed. When opening thehernia sac, a descending segment of splenic tissue merging with theupper pole of the left testis was found. The patient was diagnosed withsplenogonadal fusion. The splenic tissue merging with the testis uppe pole was resected, and the remaining splenic tissue was reduced towardsthe abdominal cavity. Discussion: Splenogonadal fusion is difficult to diagnose. Beingfamiliar with it allows unnecessary orchiectomies to be prevented.(AU)

Perforación del recto por espina de pescado / Rectal perforation caused by a fish bone

RESUMEN La ingestión de cuerpos extraños (en su mayoría espinas de pescado y huesos de pollo) durante la alimentación es frecuente. En gran parte de los casos ocurre accidentalmente, de manera inadvertida, habitualmente silente, en personas alcohólicas, con enfermedad mental o que usan prótesis dental. Generalmente pasan a través del tubo digestivo sin causar daño, y son expulsadas cerca de los siete días después de la ingestión. En cambio, en algunos pacientes puede ocasionar oclusión o perforación del tubo digestivo. Entre las zonas más afectadas están: la región ileocecal y la rectosigmoidea, por su angulación. Se presenta un paciente de 54 años de edad, bebedor habitual y fumador, con perforación del recto por espina de pescado, la cual fue ingerida de forma inadvertida días anteriores. Se le realizó una transversostomía para descompresión; posteriormente desarrolló una gangrena de Fornier en la región genital, y se le realizó una necrectomía y orquiectomía derecha.

ABSTRACT Foreign body ingestion (mostly fish bones and chicken bones) during feeding is common. In most cases, it occurs accidentally, inadvertently, usually silently, in people who are alcoholics, mentally ill, or who wear dental prostheses. They generally pass through the digestive tract without causing damage, and are expelled about seven days after ingestion. On the other hand, in some patients it can cause occlusion or perforation of the digestive tract. The ileocecal and rectosigmoid regions are the most affected areas, due to their angulation. We present a 54-year-old male patient, a habitual drinker and smoker, with a rectal perforation caused by a fish bone, which was inadvertently ingested days before. A decompressing transversostomy was performed; later he developed Fornier's gangrene in the genital region, and a necrosectomy and right orchiectomy were performed.

Dermatofibrosarcoma protuberans in atypical inguinal location: Diagnosis, treatment and follow-up scheme. / Dermatofibrosarcoma protuberans de localización atípica inguinoescrotal: diagnóstico, tratamiento y esquema de seguimiento.

OBJECTIVE: To review dermatofibrosarcoma protuberans (DFSP), which is a soft tissue neoplasm of the skin that can rarely affect the genitals. MATERIAL AND METHOD: We report a case of inguinal DFSP in a 40-year-old male who presented a slow-growing mass adjacent to the spermatic cord. RESULTS: After extensive surgical resection pathological analysis confirmed the diagnosis of DFSP with resection margins affected, so reoperation with margin exeresis and inguinal orchiectomy was required. CONCLUSIONS: DFSP is rarely localized in the inguinoescrotal region and it requires wide excision and sometimes orchiectomy.

OBJETIVO: Realizar una revisión del dermatofibrosarcoma protuberans (DFSP), que es una neoplasia de los tejidos blandos de la piel que en raras ocasiones puede afectar a los genitales.MATERIAL Y MÉTODO: Presentación de un caso de DFSP inguinal en un varón de 40 años que presentó una masa de crecimiento lento adyacente al cordón espermático. RESULTADOS: Tras resección quirúrgica amplia el análisis anatomopatológico confirmó el diagnóstico de DFSP con márgenes de resección afectos, por lo que precisó reintervención con exéresis de márgenes y orquiectomía inguinal. CONCLUSIONES: El DFSP es poco frecuente en la región inguinoescrotal y requiere exéresis amplia y en ocasiones orquiectomía.

Dermatofibrosarcoma protuberans de localización atípica inguinoescrotal: diagnóstico, tratamiento y esquema de seguimiento / Dermatofibrosarcoma protuberans of atypical inguinoscrotal location: diagnosis, treatment and follow-up scheme

Objetivo: Realizar una revisión del dermatofibrosarcoma protuberans (DFSP), que es una neoplasiade los tejidos blandos de la piel que en raras ocasionespuede afectar a los genitales.Material y método: Presentación de un caso de DFSPinguinal en un varón de 40 años que presentó una masade crecimiento lento adyacente al cordón espermático.Resultados: Tras resección quirúrgica amplia el análisisanatomopatológico confirmó el diagnóstico de DFSP conmárgenes de resección afectos, por lo que precisó reintervención con exéresis de márgenes y orquiectomía inguinal.Conclusiones: El DFSP es poco frecuente en la regióninguinoescrotal y requiere exéresis amplia y en ocasionesorquiectomía.(AU)

Objetive: To review dermatofibrosar comaprotuberans (DFSP), which is a soft tissue neoplasm of theskin that can rarely affect the genitals.Material and methods: We report a case of inguinalDFSP in a 40-year-old male who presented a slow-growingmass adjacent to the spermatic cord.Results: After extensive surgical resection pathologicalanalysis confirmed the diagnosis of DFSP with resectionmargins affected, so reoperation with margin exeresis andinguinal orchiectomy was required.Conclusions: DFSP is rarely localized in the inguinoescrotal region and it requires wide excision and sometimesorchiectomy.(AU)

Rabdomiosarcoma paratesticular: Reporte de caso y revisión de la literatura / Paratesticular rhabdomyosarcoma: Case report and literature review

Objetivo:Ofrecer un alcance de la relevancia del diagnóstico oportuno del cáncer testicular, a partir de un caso infrecuente de rabdomiosarcoma paratesticular en un adulto. Se trata de un paciente varón Reporte de Caso:de 39 años, que ingresa al servicio de cirugía - urología por un aumento de volumen de contenido escrotal, de forma progresiva desde hace 2 años, con crecimiento paulatino de la masa. En la ecografía testicular se evidencia un notorio aumento de volumen de bolsas escrotales por aparente tumoración o masa de consistencia dura, de estructura heterogénea y aspecto sólido de bordes mal definidos. Considerando los hallazgos clínicos, marcadores testiculareseimagenológicossediagnosticóuntumorparatesticular derecho. Se realizó una orquiectomía derecha más exéresis de tumor paratesticular derecho. Patología concluyó en rabdomiosarcoma embrionario paratesticular con cápsula rota. Paciente fue dado de alta con seguimiento por consulta externa y referido a hospital oncológico de cuarto nivel.

Objetive:Offer a scope of the relevance of the timely diagnosis of testicular cancer, based on a infrequent case of paratesticular rhabdomyosarcoma in an adult.The patient is a 39-year-old male who was admitted to Case report:the urology-surgery department because of an increase in scrotal volume, which has been progressive over the past two years, with gradual growth of the mass. Testicular ultrasound shows a notorious increase in volume of scrotal bags due to an apparent tumour or mass of hard consistency, of heterogeneous structure and solid aspect with ill-defined edges. Considering the clinical findings, testicular markers and imaging, a right paratesticular tumor was diagnosed. Aright orchiectomy plus right paratesticular tumor exeresis was performed. Pathology concluded in paratesticular embryonic rhabdomyosarcoma with a broken capsule. Patient was discharged with outpatient follow-up and referred to the fourth level cancer hospital

Rabdomiosarcoma paratesticular: Reporte de caso y revisión de la literatura / Paratesticular rhabdomyosarcoma: Case report and literature review

RESUMEN Objetivo: Ofrecer un alcance de la relevancia del diagnóstico oportuno del cáncer testicular, a partir de un caso infrecuente de rabdomiosarcoma paratesticular en un adulto. Reporte de Caso: Se trata de un paciente varón de 39 años, que ingresa al servicio de cirugía - urología por un aumento de volumen de contenido escrotal, de forma progresiva desde hace 2 años, con crecimiento paulatino de la masa. En la ecografía testicular se evidencia un notorio aumento de volumen de bolsas escrotales por aparente tumoración o masa de consistencia dura, de estructura heterogénea y aspecto sólido de bordes mal definidos. Considerando los hallazgos clínicos, marcadores testiculares e imagenológicos se diagnosticó un tumor paratesticular derecho. Se realizó una orquiectomía derecha más exéresis de tumor paratesticular derecho. Patología concluyó en rabdomiosarcoma embrionario paratesticular con cápsula rota. Paciente fue dado de alta con seguimiento por consulta externa y referido a hospital oncológico de cuarto nivel.

ABSTRACT Objetive: Offer a scope of the relevance of the timely diagnosis of testicular cancer, based on a infrequent case of paratesticular rhabdomyosarcoma in an adult. Case report: The patient is a 39-year-old male who was admitted to the urology-surgery department because of an increase in scrotal volume, which has been progressive over the past two years, with gradual growth of the mass. Testicular ultrasound shows a notorious increase in volume of scrotal bags due to an apparent tumour or mass of hard consistency, of heterogeneous structure and solid aspect with ill-defined edges. Considering the clinical findings, testicular markers and imaging, a right paratesticular tumor was diagnosed. A right orchiectomy plus right paratesticular tumor exeresis was performed. Pathology concluded in paratesticular embryonic rhabdomyosarcoma with a broken capsule. Patient was discharged with outpatient follow-up and referred to the fourth level cancer hospital.

Effects of flunixin meglumine, meloxicam, and firocoxib on the acute-phase proteins in horses following standing castration

ABSTRACT: Excessive infection and inflammation are the most common complications associated with castration. The objective of this study was to compare the efficacy of flunixin meglumine (FM), meloxicam (MX), or firocoxib (FX) for inflammation control after castration in horses using acute-phase proteins (APP) as markers of inflammation. Thirty healthy, unbroken, mixed-breed horses (body weight 358.62±45.57kg and age 4.99±2.63 years) were randomly (n=10 animals/group) allocated to receive one of three different post-castration anti-inflammatory medicines: Group 1 (FM 1.1mg/kg bwt, IV, s.i.d for 5 days); Group 2 (MX 0.6mg/kg bwt, IV, s.i.d for 5 days); and Group 3 (FX 0.1mg/kg bwt, IV, s.i.d for 5 days). All horses were castrated in standing position, using the open technique. Serum and peritoneal APP concentrations were measured by sodium dodecyl sulfate (SDS) polyacrylamide gel electrophoresis (PAGE) and determined before castration (0), and 3, 5, 24, 48, 72, 120 and 168 hours after castration. The results were submitted to analysis of variance using the SAS statistical program, and means were compared by the Student-Newman-Keuls test (p 0.05). Three animals from the MX group developed hyperthermia (with rectal temperatures of 39.8, 39.3 and 38.9°C on day 4, 5 and 6, respectively) and showed local clinical signs of inflammation (inguinal and excessive scrotal edema) and reluctance to walk, as well as a rigid gait of the hind limbs. The same complications were observed in one FX horse. No complications were observed among the FM animals. The castration resulted in significant changes in serum and peritoneal values of total proteins, ceruloplasmin (Cp), transferrin (Tf), albumin (Alb), haptoglobin (Hp) and 1-acid glycoprotein (Gp) in animals of all experimental groups. However, the animals of the MX and FX groups presented more intense acute phase response compared to the animals of the FM group. Changes in the APP were associated with the surgical trauma of castration, but the differences between groups were associated with the ability of the nonsteroidal anti-inflammatory drug to control the inflammation. In conclusion, and based on the findings of acute phase proteins, flunixin is more efficient to control the magnitude of inflammation following castration as compared to meloxicam and firocoxib.

RESUMO: Infecção e inflamação excessivas são as complicações mais comuns associadas à castração. O objetivo deste estudo foi comparar a eficácia do flunixin meglumine (FM), meloxicam (MX) ou firocoxib (FX) no controle da inflamação após a castração em cavalos usando proteínas da fase aguda (APP) como marcadores de inflamação. Trinta equinos saudáveis (358,62±45,57kg; 4,99±2,63 anos) foram em função dos anti-inflamatórios utilizados após as castrações aleatoriamente (n= 10 animais/grupo) alocados em três diferentes grupos: Grupo 1 (FM 1,1mg/kg de peso, IV, sid por 5 dias); Grupo 2 (MX 0,6mg/kg de peso, IV, s.i.d por 5 dias); e Grupo 3 (FX 0,1mg/kg de peso, IV, s.i.d por 5 dias). Todos os cavalos foram castrados em posição quadrupedal, utilizando a técnica aberta. As concentrações de APP sérica e peritoneal foram separadas por eletroforese em gel de poliacrilamida (PAGE) com dodecil-sulfato de sódio (SDS) e determinadas no momento 0 (antes da castração) e com 3, 5, 24, 48, 72, 120 e 168 horas após a castração. Os resultados foram submetidos à análise de variância pelo programa estatístico SAS e as médias foram comparadas pelo teste de Student-Newman-Keuls (p 0,05). Três animais do grupo MX desenvolveram hipertermia (com temperatura retal de 39,8, 39,3 e 38,9° C nos dias 4, 5 e 6, respectivamente) e mostraram sinais clínicos locais de inflamação (edema inguinal e escrotal excessivo) e relutância em andar, bem como marcha rígida dos membros posteriores. As mesmas complicações foram observadas em um cavalo do FX. Não foram observadas complicações entre os animais do FM. Independente do grupo, a castração resultou em alterações significativas nos valores séricos e peritoneais de proteínas totais, ceruloplasmina (Cp), transferrina (Tf), albumina (Alb), haptoglobina (Hp) e glicoproteína ácida 1 (Gp). No entanto, os animais dos grupos MX e FX apresentaram resposta de fase aguda mais intensa quando comparados aos animais do FM. Alterações na resposta de fase aguda deveram-se ao trauma cirúrgico da castração, mas as diferenças entre os grupos foram associadas à capacidade do anti-inflamatório em controlar a inflamação. Em conclusão, baseado da resposta de fase aguda, o flunixin em comparação com o meloxicam e o firocoxib é mais eficiente no controle da inflamação após a castração em equinos.