Cord Lipoma Research Articles

The meta-analysis of surgical treatment of pediatric asymptomatic lipomas in the spinal cord

Objective To explore the risk and significance of prophylactic surgery in the treatment of asymptomatic pediatric spinal cord lipomas. Methods We collected and reviewed studies of asymptomatic spinal cord lipomas in children from databases including PubMed, Embase, Scopus, Web of Science and Cochrane databases. RevMan5.3 and R software were used to conduct comparison between cases undergoing prophylactic surgery and those who were followed up without operations. Results Five non-randomized controlled studies were reviewed and reported a total of 403 patients followed up for 4.4-10.0 years, among whom 124 patients received merely follow-up including 32 (25.8%) cases demonstrating neurological deterioration. The other 279 patients received prophylactic surgical treatment and 30 (10.8%) reported neurological dysfunction. The difference was statistically significant (P=0.05). At the same time, 9 literatures of merely surgery (278 cases) and 1 report (56 cases) of natural history were combined. The rate of neurological dysfunction was 10.0% post operation, which was significantly different from 28.6% (16/56) in the group with only follow-up based on the random effect model (P<0.01). Conclusion For asymptomatic spinal cord lipomas in children, limited literatures have suggested that prophylactic surgery might be beneficial to prevention of neurological deterioration, which needs evidences with large sample sizes in future research. Key words: Neural tube defects; Asymptomatic diseases; Neurosurgical procedures; Child; Meta-analysis; Lipoma

From Inguinal Hernias to Spermatic Cord Lipomas: Pearls, Pitfalls, and Mimics of Abdominal and Pelvic Hernias.

Abdominal and pelvic hernias may be indolent and detected incidentally, manifest acutely with pain and distress, or cause chronic discomfort. Physical examination findings are often ambiguous and insufficient for optimal triage. Therefore, accurate anatomic delineation and identification of complications are critical for effective treatment planning. Imaging, particularly computed tomography, provides a vital understanding of the hernia's location and size, involved viscera, and severity of associated complications. Reader familiarity with the imaging appearances and anatomic landmarks of hernias is important for correct diagnosis, which may impact preoperative planning and reduce morbidity. This article reviews the appearance of anatomic structures in the abdominal wall and pelvis that are important for diagnosing common and uncommon abdominal and pelvic hernias, and it highlights key imaging features that are helpful for differentiating hernias, mimics, and their complications. Online DICOM image stacks are available for this article . ©RSNA, 2017.

Paratesticular Soft-Tissue Masses in Orchiectomy Specimens: A 17-Year Survey of Primary and Incidental Cases From One Institution.

The paratestis (PT) is defined by the testicular tunics, epididymis, spermatic cord, rete testis, and embryonic remnants. It gives rise to a large diversity of pathologies, including those of soft tissue, which may prompt orchiectomy. We performed a 17-year search of our database for orchiectomies for a PT soft-tissue mass. In a total of 4741 orchiectomy specimens, 138 orchiectomies were performed for primary neoplastic or nonneoplastic masses of the PT soft tissue or had an incidental PT soft-tissue mass. Of these, 65.9% were neoplastic. The mean age was 40.2 years (range: <1 to 87 years) and was similar for neoplastic and nonneoplastic lesions. The most common malignancies were rhabdomyosarcoma (31/63 malignancies), liposarcoma (19/63), and leiomyosarcoma (5/63), with the former occurring in younger patients (average: 18.3 years). No malignancies were incidental. The most common benign neoplasm was spermatic cord lipoma (24/28 of benign neoplasms); however, most were incidental. This was followed by leiomyoma (3/28) and hemangioma (1/28). The most common nonneoplastic lesions were adrenal rests (22/47 nonneoplastic cases); however, all were incidental findings. Of 47 nonneoplastic masses, 22 prompted orchiectomy, and of these, the most common diagnosis was fibrous/nodular periorchitis (11/47). Of 88 nonincidental lesions, 25 were either benign neoplasms (3/25) or nonneoplastic (22/25). These data indicate that PT soft-tissue neoplasms prompting orchiectomy are disproportionately rhabdomyosarcomas, though these are principally in young patients. In older patients, malignancies are more frequently liposarcomas. However, almost one-third of orchiectomies performed for PT soft-tissue masses yield benign lesions, indicating an opportunity to reduce unnecessary procedures.

An Important Mimic of Inguinal Hernia

Spermatic cord malignancy is a rare and challenging diagnosis, often misdiagnosed as an inguinal hernia or cord lipoma. In these images, we show a 61-year-old male for whom laparoscopic repair of clinically diagnosed hernia was attempted. Laparoscopy revealed closed internal ring without hernia. Imaging showed large paratesticular mass; radical inguinal excision of testicle, cord, and mass was performed. Pathology showed mixed low-grade and high-grade sarcoma. Liposarcoma should be considered in cases of unusual inguinal mass; appropriate imaging can guide surgical approach and optimize outcomes.

Aggressive Angiomyxoma of the Scrotum: A Case Report and Literature Review

Aggressive Angiomyxoma is a rare mesenchymal benign myxoid tumor of the pelvis and perineum which occurs almost exclusively in adult females. It rarely occurs in males and involves scrotum, locally infiltrative but nonmetastasizing. The clinical presentation was one of progressing scrotal edema and enlargement with subsequent development of scrotal abscesses. The clinical differential diagnosis at presentation commonly includes inguinal hernia, testicular neoplasm, spermatic cord lipoma, hydrocele, spermatocele, and scrotal filariasis. We report a case of incidentally diagnosed Angiomyxoma of scrotum presenting as scrotal edema. Case Report: A 41 years old male presented with a painless scrotal swelling since 2 years prior to admission that gradually progressed in size. Clinical examination revealed diffuse scrotal swelling measuring about 15×12cm. with a thickened of scrotal skin. Ultrasound examination report was found of fluid collection with debris in the scrotum suspected as scrotal abscess, subcutaneous edema and cutaneous scrotal wall thickening. Result: The patient underwent wide excision and scrotoplasty, the pathology result of the excised scrotal edema was an Angiomyxoma of the scrotum up to tunica vaginalis. Conclusion: Aggressive Angiomyxoma in the scrotal region may present as a scrotal edema and enlargement, often mistaken for an inguinal hernia, testicular neoplasm, spermatic cord lipoma, hydrocele, spermatocele, and scrotal filariasis.

Dorsal Intramedullary Lipoma without Spinal Dysraphism: A Rare Case Report and Review of Literature

Study Design Case report. Objective The study aims to report a rare case of dorsal intramedullary lipoma, its management, and outcome. Background We are reporting the rare case of a 23-year-old man with dorsal intramedullary lipoma without spinal dysraphism. The clinical presentation, diagnosis, and management are discussed with relevant review of literature. Conclusion Intramedullary cord lipoma without spinal dysraphism can be a cause of myelopathy, and proper diagnosis with MRI and subtotal excision preserving the vital cord parenchyma should be the goal, which can give a better outcome.

Risk of Spermatic Cord Injury During Anterior Pelvic Ring and Acetabular Surgery: An Anatomical Study.

Anterior pelvic ring surgery includes a variety of plating techniques and insertion of retrograde superior pubic ramus screws. Anterior acetabular surgery also includes fixation through an ilioinguinal or Stoppa approach. These exposures risk injury to the spermatic cord and accompanying genital branch of the genitofemoral nerve. The primary aim of this study was to identify the distance between the midline and the spermatic cords in adult male cadaveric specimens. The secondary aim was to determine spermatic cord diameters and measure the distance between the spermatic cord and implant during instrumentation of a retrograde superior pubic ramus medullary screw. Extended Pfannenstiel and Stoppa approaches were performed on 18 embalmed male cadavers bilaterally. Spermatic cord characteristics were recorded and a number of measurements were performed to determine the distance of implants and the midline from the spermatic cord. The average distance between the midline and spermatic cords was 34.2 mm. The average distance between the spermatic cord and implant was 18.2 mm. Eleven of the thirty-six dissections had abnormalities including cord lipomas and inguinal hernias. The average cord diameter was 18.6 mm. The average cord diameter in those with abnormalities was 24.9 mm and 16 mm in those without abnormalities, this difference was statistically significant. Due to the proximity of the spermatic cord, the surgeon should either formally expose the cord or limit lateral dissection from the midline during Pfannenstiel and Stoppa exposures. Similarly, the surgeon should use soft-tissue sleeves and oscillating drills to avoid injury to the contralateral spermatic cord during the insertion of retrograde superior pubic ramus medullary screws.

Inguinal Abnormalities in Male Patients with Acetabular Fractures Treated Using an Ilioinguinal Exposure.

Surgeons performing an ilioinguinal exposure for acetabular fracture surgery need to be aware of aberrant findings such as inguinal hernias and spermatic cord lesions. The purpose of this study is to report these occurrences in a clinical series of adult males undergoing acetabular fracture fixation and a series of adult male cadavers. The secondary aim is to characterize these abnormalities to aid surgeons in detecting these abnormalities preoperatively and coordinating a surgical plan with a general surgeon. Clinical study- Retrospective review of treated acetabular fractures through an ilioinguinal approach. Incidence of inguinal canal and spermatic cord abnormalities requiring general surgery consultation were identified. Corresponding CT scans were reviewed and radiographic characteristics of the spermatic cord abnormalities and/or hernias were noted. Cadaveric study- 18 male cadavers dissected bilaterally using an ilioinguinal exposure. The inguinal canal and the contents of the spermatic cord were identified and characterized. Clinical Study- 5.7% (5/87) of patients had spermatic cord lesion and/or inguinal hernia requiring general surgical intervention. Preoperative pelvic CT scan review identified abnormalities noted intraoperatively in four of the five patients. Cord lipomas visualized as enlargements of the spermatic cord with homogeneous density. Hernias visualized as enlarged spermatic cords with heterogeneous density. Cadaver Study- 31% (11/36) of cadavers studied had spermatic cord and/or inguinal canal abnormalities. Average cord diameter in those with abnormalities was 24.9 mm (15-28) compared to 16 mm (11-22) in normal cords, which was statistically significant. The clinical and cadaveric findings emphasize the importance of understanding inguinal abnormalities and the value of detecting them preoperatively. The preoperative pelvic CT scans were highly sensitive in detecting inguinal abnormalities.

The Oblique Rectus Abdominis Musculocutaneous Flap for Reconstruction after Resection of a Spermatic Cord Liposarcoma.

The Oblique Rectus Abdominis Musculocutaneous Flap for Reconstruction after Resection of a Spermatic Cord Liposarcoma.

Lipoma of Spermatic Cord

Lipoma of spermatic cord is rare. They should be considered in the patient with groin pain and normal examination results. A case of lipoma of cord in a 82 year old man is presented. Presentation was as a painless swelling for which he never sought medical advice. Ultrasonography showed hyper echoic lesion. Fine needle aspiration of swelling yielded adiposities. Excision of swelling was done.

Per-operative findings in patients operated for spinal dysraphism: A study of 96 cases

This study was conducted to study the perioperative findings in patients of spinal dysraphism. This observational study was conducted in Neurosurgery Department of Post Graduate Medical Institute, Lady Reading Hospital, Peshawar from January 2008 to December 2009. All the patients of spinal dysraphism less than 2 years of age were included in this study, while patients with ruptured spinal dysraphism at the time of presentation and with concomitant established hydrocephalus were excluded. Data was collected and analyzed by descriptive statistics using software SPSS version 17. Out of 96 patients operated for spinal dysraphism; 62 (64.58%) were males and 34 (35.42%) females. Eighty three patients (86.45%) were less than 1 yr, while 13 (13.54%) were above 1 yr. Peri-operative findings were: myelomeningocele in 50 (52.08%) patients, meningocele (MC) in 29 (30.20%), lipomyelomeningocele in six (6.25%), lipoma of cord with tethered cord in five (5.2%), MC with tethered cord in three (3.12%) patients, diastematomyelia in two (2.08%), while dermal sinus was found in one (1.04%) patient. In patients of spinal dysraphism less than 2 yr of age, more than 2/3rd of the patients presented with myelomeningocele and MC, while other features (such as lipomyelomeningocele, lipoma of cord with tethered cord, MC with tethered cord, diastematomyelia and dermal sinus) comprise only less than 20% of the spectrum.

Single-port onlay mesh repair of recurrent inguinal hernias after failed anterior and laparoscopic repairs.

Background and Objectives:Despite the exponential increase in the use of laparoscopic inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, a growing number of patients are presenting with recurrent hernias after conventional anterior and laparoscopic repairs have failed. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair of these hernias.Methods:Patients referred with two or more recurrences of inguinal hernia underwent SIL-IPOM from November 1, 2009, to June 24, 2014. A 2.5-cm infraumbilical incision was made, and an SIL port was placed intraperitoneally. Modified dissection techniques were used: chopstick and inline dissection, 5.5-mm/52-cm/30° angled laparoscope, and conventional straight dissecting instruments. The peritoneum was incised above the pubic symphysis, and dissection was continued laterally and proximally, raising the inferior flap below the previous extraperitoneal mesh while reducing any direct, indirect, femoral, or cord lipoma before placement of antiadhesive mesh, which was fixed to the pubic ramus, as well as superiorly, with nonabsorbable tacks before the inferior border was fixed with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh.Results:Nine male patients underwent SIL-IPOM. Their mean age was 53 years and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes, with a hospital stay of 1 day. The umbilical scar length was 23 mm at the 6-week follow-up. There were no intra-/postoperative complications, port-site hernias, chronic groin pain, or recurrence of the hernia during a mean follow-up of 24 months.Conclusion:Inguinal hernias recurring after two or more failed conventional anterior and laparoscopic repairs can be safely and efficiently treated with SIL-IPOM.

Intramedullary lipoma of the cervico-thoracic spinal cord

Most of the spinal cord lipomas reported in the literature are intradural extramedullary, and true intramedullary lipomas are very rare. We present a case of intramedullary spinal cord lipoma of the cervico-thoracic region with extensions over many spinal segments. Magnetic resonance (MR) examination showed an intramedullary lipoma of the cervico-thoracic spinal cord of both high T1 and T2-weighted signal intensity and suppression on fat saturation sequence. MR imaging assessment is critical in the detection of intramedullary lipomas which may present without any neurological deficit at an early stage. Early diagnosis may lead to prevention of the irreversible deterioration of neurological functions.

Total Resection of Complex Spinal Cord Lipomas: How, Why, and When to Operate?

This article shows the long-term advantage of total resection of complex spinal cord lipomas over partial resection and over non-surgical treatment for children with asymptomatic lipomas. The classification, embryogenesis, and technique of total resection of complex lipomas are described. The 20-year outcome of 315 patients who had total resection is measured by overall progression-free survival (PFS, Kaplan-Meier), and by subgroup Cox multivariate hazard analysis for the influence of four variables: lipoma type, symptoms, prior surgery, and post-operative cord-sac ratio. These results are compared to 116 patients who underwent partial resection, and to two published series of asymptomatic lipomas followed without surgery. The PFS after total resection for all lipomas is 88.1% over 20 years vs. 34.6% for partial resection at 10.5 years (p < 0.0001). The PFS for total resection of asymptomatic virgin lipomas rose to 98.8% vs. 60% and 67% for non-surgical treatment. Partial resection also compares poorly to non-surgical treatment for asymptomatic lipomas. Multivariate analyses show that a low cord-sac ratio is the only independent variable that predicts good outcome. Pre-operative profiling shows the ideal patient for total resection is a young child with a virgin asymptomatic lipoma, who, with a PFS of 99.2%, is essentially cured. The technique of total resection can be learned by any neurosurgeon. Its long-term protection against symptomatic recurrence is better than partial resection and conservative management. The surgery should be done at diagnosis, except for asymptomatic small infants in whom surgery should be postponed till 6 months to minimize morbidity.

Aberrant Adrenocortical Tissue Associated with Resected Lipoma of Spermatic Cord in an Adult

Aberrant adrenocortical tissue in spermatic cord is rare in adult population. We report an unusual case of a 52-year-old male patient with an aberrant adrenocortical tissue which is incidentally resected within lipoma of spermatic cord and identified on microscopic examination. Although he was diagnosed with right inguinal hernia, there was no significant hernia orifice intraoperatively. When the 2nd operation by anterior open approach was undergone, there was a fat-like tissue adhered to the spermatic cord. It was removed and the histopathological finding first revealed aberrant adrenocortical tissue in the resected lipoma of spermatic cord (Figure 1). This abnormal tissue is usually found incidentally during inguinal operation. In general, most of the aberrant adrenal tissue becomes atrophic by adult life. Moreover, it is not clinically significant and also not associated with endocrine abnormalities.

Single-incision laparoscopic intraperitoneal onlay mesh repair for the treatment of multiple recurrent inguinal hernias.

Introduction:Despite an exponential rise in laparoscopic surgery for inguinal herniorrhaphy, overall recurrence rates have remained unchanged. Therefore, an increasing number of patients present with recurrent hernias after having failed anterior and laparoscopic repairs. This study reports our experience with single-incision laparoscopic (SIL) intraperitoneal onlay mesh (IPOM) repair for these hernias.Materials and methods:All patients referred with multiply recurrent inguinal hernias underwent SIL-IPOM from November 1 2009 to October 30 2013. A 2.5-cm infraumbilical incision was made and a SIL surgical port was placed intraperitoneally. Modified dissection techniques, namely, “chopsticks” and “inline” dissection, 5.5 mm/52 cm/30° angled laparoscope and conventional straight dissecting instruments were used. The peritoneum was incised above the symphysis pubis and dissection continued laterally and proximally raising an inferior flap, below a previous extraperitoneal mesh, while reducing any direct/indirect/femoral/cord lipoma before placement of antiadhesive mesh that was fixed into the pubic ramus as well as superiorly with nonabsorbable tacks before fixing its inferior border with fibrin sealant. The inferior peritoneal flap was then tacked back onto the mesh.Results:There were 9 male patients who underwent SIL-IPOM. Mean age was 55 years old and mean body mass index was 26.8 kg/m2. Mean mesh size was 275 cm2. Mean operation time was 125 minutes with hospital stay of 1 day and umbilical scar length of 21 mm at 4 weeks' follow-up. There were no intraoperative/postoperative complications, port-site hernias, chronic groin pain, or recurrence with mean follow-up of 20 months.Conclusions:Multiply recurrent inguinal hernias after failed conventional anterior and laparoscopic repairs can be treated safely and efficiently with SIL-IPOM.

Long term outcome of non-dysraphic intramedullary spinal cord lipomas in adults: case series and review.

Study DesignIt is a case series involving clinical presentation, radiological findings, surgical technique and long term outcome of Non-dysraphic intramedullary spinal cord lipomas in adults along with the review of the literature.PurposeThe purpose of the study is to find out from our series as well as from literature what determines the long term outcome and how it can be improved in patients diagnosed to have intramedullary spinal cord lipomas.Overview of LiteratureNon-dysraphic spinal intramedullary lipomas in adults are extremely rare. Majority of cases occur in children and in cervico-dorsal regions. Only eight cases of dorso-lumbar spinal lipomas without spinal dysraphism in adults have been reported in the English literature till 2013.MethodsHere we report our experience with three such cases in the dorsolumbar region and discuss the surgical technique and the long term outcome of such cases.ResultsReview of literature and from our own cases we conclude that long term outcome after surgery is determined by the preoperative neurological status.ConclusionsEarlier surgical intervention with preserved neurological status results in better outcome. Radical subtotal excision without producing iatrogenic postoperative neurological deficit should be the goal of the surgery and it stabilizes the disease process in the long run. When early clinico-radiological signs of recurrence develop, such patient's to be reoperated immediately to prevent them from developing a fixed neurological deficit.

How I Do It: Spinal Cord Lipomas

Basados en la experiencia de 82 casos; en 5% se observaron anomalías pélvicas asociadas. En los menores de 3 años el motivo de consulta (85%) fue la tumoración. En los mayores de 3 años (42%) tenía problemas neurológicos. Solo el 24% preocupados por la tumoración. El objetivo de la cirugía es desanclar la médula y no remover la totalidad del lipoma. El lipoma de filum es el que es mas simple para operar. Aún cuando la escuela francesa propone operar solamente cuando hay síntomas favorezco cirugía preventiva. Favorezco una segunda cirugía si hay signos de anclaje postoperatorio, aún cuando observamos empeoramiento postoperatorio motor en 2.5% de los operados y urológico a largo plazo en 6% de los operados.

An unusual case of massive funicular lipoma

Intrascrotal lipomas are benign diseases that originate from adipose tissue inside the scrotal sac or constituting the scrotal wall itself. Paratesticular spermatic cord lipomas are a rare type of intrascrotal lipomas. A 78 years old patient in good health comes to our attention for massive tense-elastic swelling of left hemiscrotum appeared about 3 years ago and slowly increasing. Ultrasound evaluation of the intrascrotal mass showed inhomogeneous images mainly hyperechoic, not infiltrating the ipsilateral testis and scrotal wall. The ultrasonography found a lipomatous lesion with benign characteristics and a surgical excision has been performed. The lipomatous mass removed presented a size equal to 25 cm x 14 cm x 11 cm and a weight of about 490 gr. The microscopic examination of the tissue showed only the presence of mature adipocytes in the absence of cellular atypia, of other cellular types and of vascular abnormalities.

Complex forms of spinal dysraphism

Spinal dysraphisms are a heterogeneous group of congenital malformations involving the bony component of vertebrae or spinal cord or both. Simple forms include the contiguous, solitary malformations such as myelomeningocele and diastematomyelia, and can be either aperta or occulta type. Complex forms include various types of spinal malformations occurring in combination, one type of malformations occurring at multiple levels in noncontiguous manner or spinal dysraphisms with other organ anomalies. Anomalous development in gastrulation, primary neurulation, and secondary neurulation stage in variable proportions give rise to these types of complex malformations. These cases can be diagnosed postnatally in early infancy by the strong clinical suspicion, supplemented by whole spinal axis and cranial magnetic resonance imaging (MRI) screening, to detect any occult spinal dysraphisms like split cord malformations, neurenteric cyst, lipoma, or cranial anomalies like Chiari malformations and hydrocephalus. Computed tomography and MRI are the gold standard to detect bony anomalies and cord malformations, respectively. Complex spinal dysraphisms, to our mind, should always be tried to be corrected in single operative stage, however, in case of ruptured defects, correction through multiple operations can be considered. Overall, prognosis of complex forms of spinal dysraphism is poor in comparison to their simple forms and depends on preoperative neurological status and the nature of complex dyraphism. We discuss the classification, embryogenesis, investigation, and treatment protocol with review of literature of such complex anomalies.