Inguinal Mass Research Articles

TRIORCHIDISM WITH TORSION OF ACCESSORY TESTIS: A CASE REPORT

Polyorchidism is an extremely rare congenital anomaly of the urogenital system and is defined as the presence of more than two testes. The majorities of patients are asymptomatic or present with painless inguinal or scrotal masses. We present the case of an 31-year-old male presented in surgery opd with pain and sudden increase in size of swelling right groin. Although it was present since birth but it was painless and small in size. No history of trauma, fever, pus discharge. On examination single ovoid mobile tender swelling was present in right groin, overlying skin was normal and bilateral testis and penis was normal. USG and CT scan showed triorchidism with torsion of accessory testis. Exploration was done under LA and accessory testis was removed. Polyorchidism is a rare congenital anomaly. Patients with polyorchidism can be managed conservatively unless there are no accompanying problems such as inguinal hernia, cryptorchidism or torsion.
 Keywords: polyorchidism, Acessory testis, Triorchidism.

Desmoplastic small round cell tumor presenting as an inguinal mass in a 2-year old boy

Abstract Desmoplastic small round cell tumor (DSRCT) is a highly aggressive soft tissue sarcoma that most commonly arises in the abdomen and pelvis and spreads over serosal surfaces, leading to abdominal pain or distention. Despite aggressive multimodal therapy, outcomes remain poor. It is most common in adolescents and young adults and reports in younger children are rare. We present a case of a 2-year-old male with the atypical presentation of a right groin mass, found to be DSRCT within an inguinal hernia.

SAT-465 Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis: Diagnosis or Distraction?

In 1966 a case of episodic encephalopathy with anti-thyroid antibody (ATAb) positive Hashimoto’s thyroiditis was first reported. Controversy persists regarding Hashimoto’s encephalopathy, now known as steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) and any relationship with ATAb. There is no literature supporting an etiologic role of ATAb in SREAT. Nor has there been correlation shown between ATAb titer and severity of thyroid dysfunction or SREAT(1).A 56 yo female was admitted to a community hospital three times with visual hallucinations and slurred speech. Brain MRI, LP and standard tests including C3/C4, folate, B12, ANA and ANCA were unrevealing. Thyroglobulin antibodies (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) were positive. Diagnosed with SREAT with relief of symptoms on high dose IV corticosteroids. Discharged on oral prednisone. Seven months later she began experiencing progressive proximal weakness of all extremities associated with exertional dyspnea, fatigue and weight gain. EMG studies indicated steroid-induced myopathy of the proximal extremities. After prednisone tapering, she was admitted to our institution with acute confusion, blurred vision, fever, tachycardia, tachypnea and hypoxemia.Examination showed Cushingoid features. Labs showed hyperglycemia, ANA (+), TPOAb (+), TgAb (+), low FreeT4, low T3, normal TSH and elevated IgG in the CSF. Brain MRI showed meningeal enhancement of parieto-occipital lobes and left tentorium. Empiric antibiotics started to cover infectious meningoencephalitis. Endocrinology consulted for iatrogenic Cushing’s syndrome with hyperglycemia, abnormal thyroid function tests (TFTs) with positive ATAb and evaluation for SREAT. We recommended tapering steroids and evaluation for infectious, autoimmune or paraneoplastic causes of encephalopathy, before presuming SREAT. Rheumatological and infectious work-up was negative. CT chest showed nodular densities and CT abdomen showed hepatic, splenic and right inguinal region masses. Biopsy of inguinal mass showed Diffuse Large B-cell Lymphoma confirmed on bone marrow biopsy. CSF flow cytometry was unrevealing, likely due to prior steroids. Leptomeningeal enhancement likely reflected leptomeningeal metastases. Treated with systemic R-CHOP, high dose MTX, intrathecal MTX, cytarabine and corticosteroid tapering. Complete remission was achieved with normalization of TFTs, resolution of her Cushingoid and encephalopathic features.This case illustrates SREAT as a diagnosis of exclusion. ATAbs may be positive in non-thyroid autoimmune disorders, other neurological conditions and 10-20% of the general population (2). B cell lymphoma with leptomeningeal metastasis caused encephalopathic features which improved with corticosteroids. Ascribing a diagnosis of SREAT led to delayed cancer diagnosis and treatment.

Expression profiling and analysis of some miRNAs in subcutaneous white adipose tissue during development of obesity

BackgroundMicroRNAs are emerging as new mediators in the regulation of adipocyte physiology and have been approved to play a role in obesity. Despite several studies have focused on microRNA expression profiles and functions in different metabolic tissues, little is known about their response to nutritional interventions in white adipose tissue during obesity stages, and whether they differ in this response to weight-reduction strategy is poorly understood. Our objectives were to study the dysregulation of some miRNAs in subcutaneous inguinal white adipose tissue during weight change, expansion/reduction; in response to both a high-fat diet and switching to a normal diet feeding, and to evaluate them as potential biomarkers and therapeutic targets for early obesity managementMethodA hundred 6-week-old male Wister rats were randomly divided into a normal diet group (N.D), a high-fat diet group (H.F.D), and a switched to a normal diet group (H.F.D/N.D). At the beginning and at intervals 2 weeks, serum lipid, hormone levels, total body fat mass, and inguinal subcutaneous white adipose tissue mass (WAT) measurements were recorded using dual-energy X-ray absorptiometry (DEXA). The expression levels of microRNAs were evaluated using real-time PCR.ResultsSignificant alterations were observed in serum glucose, lipid profile, and adipokine hormones during the early stages of obesity development. Alteration in rno-mir 30a-5p, rno-mir 133a-5p, and rno-mir 107-5p expression levels were observed at more than one time point. While rno-let-7a-5p, rno-mir 193a-5p, and rno-mir125a-5p were downregulated and rno-mir130a-5p was upregulated at all time points within 2 to 4 weeks in response to H.F.D feeding for 10 weeks. The impact of switching to normal diet has a reversed effect on lipid profile, adipokine hormone levels, and some miRNAs. The bioinformatics results have identified a novel and important pathway related to inflammatory signalling.ConclusionOur research demonstrated significant alterations in some adipocyte-expressed miRNAs after a short time of high caloric diet consumption. This provides further evidence of the significant role of nutrition as an epigenetic factor in regulation of lipid and glucose metabolism genes by modulating of related key miRNAs. Therefore, we suggest that miRNAs could be used as biomarkers for adiposity during diet-induced obesity. Perhaps limitation in calories intake is a way to manipulate obesity and associated metabolic disorders. Further studies are needed to fully elucidate the role of microRNAs in the development of obesity

Cyst of the Canal of Nuck in adult females: A case report and systematic review

Defects in the Canal of Nuck are rare abnormalities of the female genitalia, which are typically detected and repaired in young age. In the present report, a case of a Nuck cyst in a 40-year old female patient is described. Additionally, the current literature concerning cases of women with hydrocele of Nuck canal was systematically reviewed. A total of 16 case reports of 16 patients with Nuck hydrocele (mean age of 35.18 years), have been reported to date. A right inguinal mass was noted in 13 patients (81.3%) whereas in 3 patients a left-sided mass was noted. The surgical approach was open in 13 cases and laparoscopic in 3 cases. Two cases underwent hydrocelectomy and inguinal ring ligation, whereas in 7 cases a simple cystectomy was performed. In 2 cases the round ligament was excised along with the hydrocele. In one of these 2, ligamentum rotundum necrosis and presence of a haemorrhagic cyst of the canal of Nuck were identified. Hernia repair and hydrocelectomy was performed in 5 cases. A cyst of the Canal of Nuck is relatively rare, but should be considered during the diagnosis of inguinal masses in female patients.

Malignant mesothelioma of the tunica vaginalis testis: A Rare Malignant Tumor without Asbestos Exposure

: Malignant mesothelioma of the tunica vaginalis testis is an extremely rare and often a deadly tumor. Preoperative diagnosis is very difficult due to lack of specific clinical manifestations, mainly including hydrocele formation and painless inguinal mass. In this abstract we present a case of a young patient with hydrocele and dull pain of left testes, was planned for laparoscopic repair of left inguinal hernia, during which a mass attached to the scrotal cord was discovered. Dissection and release of the mass from the cord structure were done, and postoperative pathological examination revealed a malignant mesothelioma arising from the left tunica vaginalis testis. Case was then referred to oncology center where intraperitoneal hyperthermic chemotherapy with cytoreductive surgery were done.

High-grade neuroepithelial tumor with medulloepithelioma-like areas out of the central nervous system in an infant with hemihypertrophy: a unique association

High-grade neuroepithelial tumor with areas resembling medulloepithelioma was diagnosed in an infant with coccygeal and inguinal masses. Hemihypertrophy is associated with Wilms tumor, hepatoblastoma and pancreatic tumors in children. The authors report on the first case of peripheral HNET associated with hemihypertrophy in an infant, with special discussion on histopathological differential diagnosis and management of this rare and highly malignant tumor. HNET should be included into the list of hemihypertrophy associated tumors. Complete surgical excision with free margins is essential for the successful treatment of such cases and should be tried in suitable cases at the time of diagnosis. Continued treatment should be decided individually on a case to case basis.

Tubercular Iliopsoas Abscess: A Rare Case Report

A psoas (or iliopsoas) abscess is an accumulation of pus in the region of iliopsoas muscle compartment. In regions where Mycobacterium tuberculosis is endemic, this is a frequent cause of psoas abscess. When an inguinal mass in a patient with a psoas abscess is painless, tuberculosis is a more likely cause than a bacterial infection. Here, the author report a rare case of psoas abscess of tubercular origin in a 31-year-old patient who presented with back pain and limping, with features of inflammation. Diagnosis was done based on history, physical examination, ultrasonography, microbiological investigation and Contrast-Enhanced Computed Tomography (CECT) scan of abdomen which revealed a large psoas abscess caused by M. tuberculosis. Patient was diagnosed with a psoas abscess due to Mycobacterium tuberculosis with secondary infection and treated empirically with Directly Observed Treatment Short-Course (DOTS) category I and antibiotics. He presented again with a chest abscess due to Multidrug-Resistant (MDR) tuberculosis.

1181 Laparoscopic Management of Hernia Uterus Inguinale with Associated Unicornuate Uterus: A Case Report

Video Objective This video demonstrates the laparoscopic management of a surgical emergency due a non-communicating herniated rudimentary uterine horn and ipsilateral torsed adnexa. Setting NA. Interventions This case is a 36-year-old healthy woman undergoing elective oocyte cryopreservation with normal baseline pelvic ultrasounds. On day 7 of oocyte stimulation, an enlarging inguinal mass was identified associated with severe inguinal pain; an incarcerated ovary was suspected. She was taken to the operating room for surgical management. The diagnosis of a Mullerian anomaly was made laparoscopically, noting that she had a right unicornuate uterus with associated normal-appearing right adnexa and ureter. Notably, the left non-communicating rudimentary uterine horn was found herniated through the deep inguinal ring, drawing with it a portion of the left tube and ovary, torsed around its associated pedicle. A left ureter could not be visualized. After decompressing and de-torsing the left inguinal mass, the rudimentary horn, fallopian tube, and necrotic portion of the left ovary were excised using a bipolar sealing device; the inguinal hernia was repaired. The viable left ovarian tissue was retained. A postoperative renal ultrasound confirmed left renal agenesis. Two months later, she successfully underwent oocyte cryopreservation with eggs aspirated from both ovaries. Conclusion Hernia uterus inguinale is a rare condition in which uterine tissue and occasionally adnexa herniate through the inguinal ring. It can present as an asymptomatic palpable mass or rarely as pelvic pain. Most reports have focused on its association with persistent Mullerian duct syndrome, which affects phenotypically male infants. While there are few reports of hernia uterus inguinale occurring in adult females, this case highlights the importance of keeping it in the differential in a patient with an inguinal mass and recognizing the potential for its associated morbidity and the ability to manage it surgically, if needed, through a minimally invasive approach.

Feasibility of Delivering Immunotherapy with Concomittant Ablative Radiosurgery to Ultra-high DoSes (ICARUS)

Immune checkpoint inhibitors, such as pembrolizumab (pembro), have been shown to be efficacious in improving survival. However, there is only an overall response rate of 5% after 3rd/4th line therapy with pembro alone. Our initial trial combining SBRT with pembro (NRG BR001) was shown to be safe (<9% grade 3 toxicity) with promising local control and overall survival using a biologically effective dose (BED) of roughly 100 Gy. One strategy to increase the response rate is to increase the BED. However, SBRT doses are limited by dosimetric constraints of surrounding organs at risk (OARs). The purpose of this work was to determine if ultra-high radiation (BED >200) could be delivered while still respecting OAR tolerances for patients receiving SBRT + pembro. Five patients enrolled on an institutional phase I trial investigating the safety of SBRT + pembro were analyzed. Disease sites included liver (3/5), inguinal region (1/5) and pelvis (1/5). The trial dictated that gross tumor volumes (GTVs) >65 cc were contracted to a 65cc subvolume for planning target volume (PTV) definition (3 mm margin). Volumetric modulated arc therapy (VMAT) was used to plan treatments prescribing 90Gy in 3 fractions (BED10 = 360 Gy). Plans utilizing both 6FFF and 10FFF beams were created and compared to the clinical plans delivering 45 Gy in 3 fractions (BED10 = 112.50 Gy). The target coverage primary goal was V100% > 95% with a secondary goal of V70% > 99%. OAR tolerances were prioritized. OAR objectives followed the trial protocol. To demonstrate deliverability, plans were delivered to a quality assurance phantom containing a diode array and evaluated for fidelity using gamma analysis. Using 6FFF, all liver tumors and the pelvic mass met the primary coverage goal and the inguinal mass met the secondary coverage goal. Using 10 FFF, the inguinal, pelvis and one liver mass met the primary coverage goal and the remaining two liver masses met the secondary coverage goal. Most importantly, for all plans, OAR dose constraints were met. GTV D100% ranged from BEDs of 167-504 Gy using 6FFF and 106-470 Gy using 10FFF. Target coverage was generally degraded in the 10FFF vs. 6FFF plans; however, the 10FFF allowed for improved skin sparing and provides a logistical advantage of 2x faster dose rate. Gamma analysis of delivered plans using 3%/1mm criteria passed with average rate of 98.14%. This study suggests that VMAT approaches are capable of delivering radiation doses in excess of 300 Gy BED10 to tumors at various body sites, while maintaining safe OAR doses. These plans have been shown to be deliverable using standard QA approaches and will be incorporated into an upcoming clinical trial. In the era of precision image guided radiation therapy, these results argue that we may have the capability to vastly increase SBRT doses safely and improve the efficacy of concomitant SBRT and immunotherapy.

Bilateral Inguinal Hernias in a Phenotypic Female Should Raise the Suspicion for a Disorder of Sexual Development (DSD)

Disorders of sexual development are rare and carry high potential for medical and psychosocial co-morbidities. A 4 year old female presented with non-reducible bilateral inguinal masses. Physical exam was consistent with a healthy child with a normal external female genitourinary exam, sexual maturity rating 1. Elective general surgical repair was scheduled. Pre-surgical ultrasound imaging revealed isolated loops of bowel in each inguinal canal, no other inguinal masses, a visualized cervix, and non-visualized uterus. Further work up was initiated upon recommendations from urology given rare …

Sertolioma in a Canadian Husky: Relationship between Tumor, Hormones, Neurons and Skin

Background: Sertolioma is a slow-growing, non-invasive, firm and nodular tumor, malignant in 10% to 22% of cases and with low metastatic potential. Old age and cryptorchidism increase up to 26 times its chances of development and associates it with malignancy. Paraneoplastic syndrome, shown in 20% to 30% of the animals, is due to the aromatization of testosterone or the direct production of estrogen by tumor cells, leading to signs of feminization and bone marrow aplasia. The objective of this article is to report a case of sertolioma in a dog with dermatological characteristic symptoms, but presenting an unusual aggressive behavior, both completely reverted after castration.Case: A 9-year-old, uncastrated, aggressive and uncontrollable Canadian Husky dog was treated at the Institutional Veterinary Hospital with parapenial volume increase and generalized alopecia. A scrotal testis of reduced size and flaccid consistency and a mass in a parapenial region of 11 x 7.5 x 8 cm in diameter, with a cystic contour, adhered to the abdominal musculature and painless to palpation were detected. Cytology of the parapenial mass presented an image compatible with seminoma or sertolioma, and the preputial smear revealed a predominance of superficial cells. Ultrasound examination showed a heterogeneous inguinal mass, with expansive cystic area, compatible with mass in retained inguinal testis. Therapeutic course consisted of bilateral orchiectomy. Ectopic testis was firm to the cut, had whitish to yellowish coloration and was surrounded by a tunica containing 200 mL of serosanguinolent liquid. The histology of the mass revealed sertolioma-compatible cell characteristics, with cell proliferation circumvented by fibrous connective tissue forming poorly delimited lobes, moderate polymorphism with elongated cells, arranged in a palisade at the periphery of the lobes, vacuolated eosinophilic cytoplasm and vesiculous round nuclei. The unretained testicle revealed signs of atrophy. After surgery the patient showed a progressive improvement of the dermatological symptoms. However, what most caught the attention was the change in aggressive behavior, and fifteen days after surgery the animal was extremely docile and easily restrained during the clinical examination.Discussion: Hyperesthyrogenism due to sertolioma results from: 1) direct synthesis of estrogen by neoplastic tumor cells 2) increase in metabolism by central conversion (testicular cells) or peripheral hepatocytes, myocytes, adipocytes, hair follicles and neural tissue) androgens into estrogen through the aromatization of testosterone and 3) androgen and estrogen rate imbalance. Testosterone is considered responsible for the aggressive behavior in males, evidenced by the decrease of this behavior when the testicles are removed, and by the reinstallation of this behavior when the hormonal replacement is done. However, research on mice showed that estrogen-sensitive regulatory pathways also play a role in promoting this behavior. Although practically undetectable in male circulation, its presence stems from in vivo synthesis from the aromatization of testosterone, and it is this local estrogen, peripherally synthesized in the brain, that would be responsible for the control of dimorphic behaviors in males. The importance of the estrogen signaling pathway in aggression has also been reported in a study in knockout mice for estrogen receptors, in which males rarely exhibited aggressiveness. Such information is sufficient to support the hypothesis that the disappearance of the aggressiveness of the reported animal was obtained due to castration and correction of hyperestrogenism, showing the importance of including it as an important cause of aggressive behavior in uncastrated male dogs.

ROLE OF ACUTE EXERCISE-INDUCED BRAIN BDNF ON APP PROCESSING AND BACE1

Perturbations in metabolism results in the accumulation of beta-amyloid, which is a pathological feature of Alzheimer's Disease (AD) (1). Beta-site amyloid precursor protein cleaving enzyme 1 (BACE1) is the rate limiting enzyme in the pathway responsible for beta-amyloid production (2). Exercise has been shown to reduce BACE1 activity, although the exact neurobiological mechanisms responsible are unknown (3). Exercise has also been shown to increase brain-derived neurotropic factor (BDNF) content and signaling (4), however whether this neurotrophic factor mediates the effects of exercise on BACE1 regulation requires further investigation. C57BL6 male mice were placed on a low (LFD; n=24) or high fat diet (HFD; n=24) for 10-weeks. Following the intervention, the mice either remained sedentary (n=12) or underwent an acute bout of treadmill running (n=12), proceeded by glucose/insulin tolerance tests and a Barnes maze test (spatial memory). Mice were euthanized and the prefrontal cortex was collected for protein quantification. Markers of the amyloidogenic pathway, along with targets of the BDNF signaling pathway, were examined. The 10-week HFD intervention led to increased body mass, inguinal and epididymal white adipose tissue mass, and liver mass (p < 0.05). HFD groups had impairments in glucose and insulin tolerance, as well as spatial memory (time in incorrect zones) (p < 0.05). A HFD led to increases in Akt phosphorylation (insulin signalling) and decreases in ERK phosphorylation (downstream of BDNF) (p < 0.05). An acute bout of exercise was able to recover ERK phosphorylation in the HFD group (p < 0.05) and significantly increase BDNF protein content in both LFD and HFD groups (p < 0.05). However, there were no changes in BACE1 protein content with diet or exercise (p > 0.05). Results from this study suggest that exercise can increase BDNF protein content in an obesogenic rodent model. Furthermore, a HFD potentially contributes to memory impairments by aberrant insulin signalling and impairments in BDNF signalling, which can be recovered through exercise. Although BACE1 protein content did not change, future analysis will examine BACE1 activity. Through these mechanisms, we gain further insight into using BDNF, mediated through exercise, as a therapeutic intervention.

A Case Study Evaluating the Diagnosis and Treatment of a Rare Mesenchymal Tumor

The objective of this study is to report a benign mesenchymal neoplasm, cellular angiofibroma. We describe a 34-year-old male with a 4-month history of a painless right inguinal mass. CT scan of the abdomen and pelvis showed a 6.6 cm, oval-shaped mass without any distinguishing radiographical features. Surgical excision of the mass was performed. Tissue was extracted for immunohistochemical analysis, which stained positive for CD34 and Desmin, confirming cellular angiofibroma of the spermatic cord. Thus, this report highlights the importance of a challenging diagnostic case for providers due to the narrow range of imaging modalities and therefore limited treatment options.

1987-P: Nampt Deletion Changes Metabolism in Adipose Tissue and Prevents Diet-Induced Obesity

Nampt is the rate-limiting enzyme in salvage pathway in which NAD is mainly synthesized in mammalian cells. NAD plays very important role in various biological processes, such as energy production, energy consumption, aging, cell death, and DNA damage repair as a coenzyme of redox reactions or as a substrate of Sirtuins or Poly (ADP-ribose) polymerases. Besides, Nampt is highly expressed in mature adipocyte and secreted into extracellular. The extracellular Nampt is known to regulate systemic metabolic state. In short, Nampt works as a metabolic sensor and NAD integrates systemic metabolism. Recently, metabolism is thought to be closely related to cell differentiation. However, how NAD metabolism affects to adipogenesis remains unknown. In this study, we generated the adipose tissue specific Nampt knock out mice, Adiponectin-Cre Nampt flox/flox (KO) and conducted targeted-metabolomic analysis to investigate the metabolic effect, employing liquid-chromatograph mass spectrometry and gas-chromatograph mass spectrometry. Interestingly, KO showed resistant against diet-induced obesity (DIO), fed high fat high sucrose diet. Body weight and both inguinal and epididymal fat mass were significantly reduced in KO compared to wild type control mice. On the other hand, we revealed that Nampt-mediated NAD synthesis was up-regulated during differentiation of 3T3-L1 preadipocytes and the inhibition of Nampt significantly suppressed the differentiation. Our metabolomic analysis and ChIP-qPCR assay showed NAD contributed to the differentiation through the metabolic reprogramming and the subsequent epigenetic alteration to activate the transcription of adipogenic genes. This result indicated Nampt-mediated NAD synthesis regulated differentiation of preadipocytes to mature adipocytes. Together, our data suggested that adipose tissue specific Nampt deletion resulted in the resistance against DIO and it could be partly attributed to the inhibited differentiation of preadipocytes. Disclosure K. Okabe: None. A. Nawaz: Research Support; Spouse/Partner; Astellas Pharma Inc., Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly and Company. Research Support; Self; Japan Society for the Promotion of Science. Research Support; Spouse/Partner; Merck Sharp &amp; Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Pfizer Inc., Sanofi, Shionogi &amp; Co., Ltd., Takeda Pharmaceutical Company Limited. S. Fujisaka: None. K. Yagi: None. T. Kado: None. I. Usui: None. T. Nakagawa: None. K. Tobe: Advisory Panel; Self; Novo Nordisk A/S. Board Member; Self; Japan Diabetes Society. Research Support; Self; Bristol-Myers Squibb Company. Funding Japan Society for the Promotion of Science

Vasitis: a rare diagnosis mimicking inguinal hernia: a case report

BackgroundVasitis or inflammation of the vas deferens is a rare condition, and few case reports with computed tomography images have been published since 1980.Case presentationA 50-year-old man presented with severe right inguinal and lower abdominal pain. Initial diagnosis at the emergency department was incarcerated or strangulated inguinal hernia. The computed tomography scan revealed diffuse edematous changes of right spermatic cord and vas deferens with peripheral fat stranding. Correlating with his clinical symptoms, signs, and imaging findings, the diagnosis of vasitis was made. We report a case of acute vasitis about the cause, symptom, pathogen, differential diagnoses, image findings, and treatment.ConclusionAlthough very rare, vasitis should be listed as one of the differential diagnosis for inguinal mass lesions. Cross-sectional imaging may be necessary to confirm the diagnosis and exclude differentials such as an inguinal hernia. Recognition of the characteristic image findings can help to make the correct diagnosis and avoid unnecessary surgery.

Poor prognosis of retroperitoneal mixed extragonadal germ cell tumors in an HIV-infected man with severe immunosuppression and bilateral cryptorchidism: a case report

BackgroundNonseminomatous germ cell tumors (NSGCTs) represent one of the main groups of germ cell tumors (GCTs), and they have a more invasive course than seminomatous GCTs. Human immunodeficiency virus (HIV) positivity is considered to be a risk factor for testicular seminoma patients, but reports about HIV-infected individuals with NSGCTs are rare.Case presentationWe report a case of a retroperitoneal mixed extragonadal germ cell tumor in an HIV-infected man who has been diagnosed with bilateral cryptorchidism since birth. A 30-year-old man presented with a large heterogeneously mixed echo mass located in the right lower abdomen according to an abdominal ultrasound; he was HIV-positive and had a low CD4 count of 70 cells/ml in the followed test, which suggested severe immunosuppression, and ultrasound-guided biopsy histology revealed a malignant yolk sac tumor of the testis. First, the patient received combination antiretroviral therapy; then, to relieve his symptoms, an exploratory laparotomy and retroperitoneal neoplasm resection under general anesthesia were performed for subsequent treatment. The postoperative histopathological examination indicated that the patient exhibited malignant mixed GCTs of the undescended testis that were composed predominantly of yolk sac tumors with foci of embryonal cell carcinoma and seminoma; It is a rare type in various GCTs, especially in HIV-infected patients. After the operation, the patient underwent computed tomography follow-up scans at 1 week and 2 weeks, and the results showed that the size of the right inguinal mass gradually increased, which suggested a poor outcome. To limit the growth of the tumors, right inguinal mass resection under local anesthesia was performed 17 days after the initial operation, and pathological examination revealed mixed GCT metastasis. Subsequently, the patient received salvage chemotherapy with a regimen of cisplatin, etoposide, and ifosfamide. Unfortunately, the patient died 1 week after the first cycle of chemotherapy because of severe immunosuppression, a low platelet count and cancer cachexia.ConclusionsBecause of severe immunosuppression, the treatment of advanced extragonadal NSGCTs in an HIV-infected patient resulted in a poor prognosis. This outcome should be considered in further research, and appropriate management for achieving long-term survival needs to be established.

Metachronous metastasis to inguinal lymph nodes from sigmoid colon adenocarcinoma with abdominal wall metastasis: a case report

BackgroundInguinal lymph node metastasis from rectum is uncommon but well-known occurrence, whereas that from colon adenocarcinoma is extremely rare. Inguinal lymph node metastasis from colon adenocarcinoma has only been reported in previous cases involving primary tumor invasion of the abdominal wall, or in those involving colon cancer metastasis to external iliac lymph nodes. We describe a case of inguinal lymph node metastasis from colon cancer without primary tumor invasion to the abdominal wall.Case presentationA 42-year-old female, who had undergone twice cesarean sections before, underwent open sigmoidectomy for sigmoid colon adenocarcinoma and received 12 cycles of FOLFOX regimen as adjuvant chemotherapy. Two years after sigmoidectomy, a follow-up CT scan revealed enlarged inguinal lymph nodes as well as growth of enhanced mass lesions on the abdominal wall at site of the cesarean section scar. Biopsy of both lesions revealed well-differentiated adenocarcinoma, and immunohistochemistry demonstrated positive expression of CDX2, substantiating its gastrointestinal origin. We therefore performed dissection of left inguinal lymph nodes and mass lesion of the abdominal wall. The patient died 51 months after lymph node dissection.ConclusionsThis is the first reported case of inguinal lymph node metastasis from colon cancer without invasion of the primary tumor to the abdominal wall or without involvement of the external iliac lymph nodes, suggesting that the pathway of inguinal metastasis originated from the abdominal wall metastasis. When inguinal lymph node metastasis from colon cancer is suspected, if an R0 resection was possible, inguinal lymph node dissection may be a potentially effective treatment.

Delayed onset of obesity and glucose tolerance in interleukin 18 deficient mice by single housed condition

Interleukin 18 (IL18) is a kind of proinflammatory cytokine that belongs to the interleukin-1 family. IL18 is associated with obesity and type 2 diabetes. To discover whether body composition parameters in IL18 deficient mouse are altered in single-housed condition, body weight, glucose tolerance, lipid profiles, fat masses, and size of white adipocytes were examined. Mice were housed singly and were divided as follows: C57BL/6 J male (B6-M), IL18 deficient male (IL18-M), C57BL/6 J female (B6-F), IL18 deficient female (IL18-M). Body weight statistically significantly increased in IL18-M at 9 months (p < 0.05). Glucose tolerance occurred in IL18-M at 6 and 9 months. Total cholesterol and HDL cholesterol were statistically significantly increased in IL18-F compared with B6-F at 9 and 12 months, respectively (p < 0.05). Also, total cholesterol of IL18-M was statistically significantly increased compared with B6-F and IL18-F at 9 months (p < 0.05). The perirenal and inguinal fat masses were statistically significantly increased in IL18-M at 9 months (p < 0.05). In addition, the size of white adipocytes was increased in IL18-M at 9 months. In single-housed condition, onset of obesity and glucose tolerance were delayed by 3 months in IL18-M. Taken together, these results suggest that housing condition is a very important factor for weight gain and onset of glucose tolerance in IL18 deficient male mouse.

Multimodal treatment approach in a case of feline ventral abdominal angiosarcoma

A 14-year-old male neutered domestic shorthair cat presented for a recurrent angiosarcoma. Previously, the mass was incompletely resected twice at the referring practice with subsequent dehiscence and recurrence. The lesion...