Spontaneous Rupture of Testicular Prosthesis With External Leakage of Silicone—a Rare Event

Abstract

Testicular cancer commonly presents between the ages of 20 and 40 years. The first line of treatment is radical orchiectomy, which removes the malignant tumor and also provides a definitive histological diagnosis. Insertion of a testicular prosthesis is now a common procedure after radical orchiectomy, which is to be expected, considering the relatively younger age of these patients. These silicone devices can be implanted with ease in the scrotal sac. Compared to other silicone implants, such as breast prosthesis, the incidence of complications is low which has also contributed to their widespread use. We describe a rare complication of a testicular prosthesis. We report a case of spontaneous rupture of a testicular prosthesis with leakage of silicone resulting in an erythematous rash. CASE REPORT A 46-year-old man presented in September 2002 with leak of gel-like material from the right hemiscrotum 3 days in duration. There was no pain and the patient denied any history of trauma. He had a rash, which had been present for the previous 3 months. The rash was pruritic and was being managed with antihistamines. On examination the patient was clinically well and apyrexial. Examination of the abdomen was unremarkable. The testicular prosthesis had a normal contour. Active leak of silicone was not seen. There was no adenopathy. There was a generalized rash, which was more prominent on the anterior aspect, with relative sparing of the trunk. The rash was erythematous with central clearing. There was no leukocytosis or eosinophilia. The patient had a history of metastatic teratoma and had undergone right radical orchiectomy in 1990 at age 34 years. Subsequently, he received chemotherapy consisting of bleomycin, etoposide and cisplatin, and underwent para-aortic node dissection in March 1991 for a residual cystic paraaortic mass. Along with the procedure, a silicone gel testicular prosthesis (gel mix with dip molded envelope, post-cured weight 30.47 gm) was implanted. He did not have any problems with the prosthesis for 11 years. The patient underwent exploration of the right hemiscrotum through a groin incision. The testicular prosthesis was encased in a dense fibrous capsule. The prosthesis was excised, along with the fibrous capsule and sinus tract. Postoperative recovery was uneventful. The rash disappeared completely in 48 hours. Histological evaluation of the excised fibrous capsule showed extensive giant cell reaction to foreign material. The features were consistent with exposure to silicone. DISCUSSION