Ipsilateral Spermatic Cord Research Articles

Renal cell carcinoma metastases to the spermatic cord: review of the literature and case presentation

We present a case of clear cell renal cell carcinoma with metachronous metastasis to the ipsilateral spermatic cord. We also review the literature of the rare instance of renal cell carcinoma metastasising to the spermatic cord.

Rare case of paratesticular solitary fibrous tumour (lipomatous

A 26-year-old male presented with an asymptomatic 6-cm leftparatesticular mass. Ultrasound and magnetic resonance imagingconfirmed this mass as extratesticular, likely a tumour arisingfrom the left spermatic cord. The mass demonstrated marked avidenhancement on post-contrast images, suggestive of a spermaticcord sarcoma. A left inguinal exploration was performed and grossexamination of the mass revealed a well-circumscribed tumourwith a discrete capsule separating it from the ipsilateral spermaticcord. The mass was resected without performing an orchiectomyand histology demonstrated a solitary fibrous tumour (lipomatoushemangiopericytoma), with minimal proliferative activity and negativemargins. The occurrence of a paratesticular solitary fibroustumour is exceedingly rare, with only a handful of case reports.We review the literature regarding this rare entity and discuss itsdiagnosis and management.

Initial Results for Combined Orchiectomy and Prosthesis Exchange for Unsalvageable Testicular Torsion in Adolescents: Description of Intravaginal Prosthesis Placement at Orchiectomy

Historically the placement of testicular prosthesis during orchiectomy for torsion is delayed despite reports of safe prosthesis placement during mastectomy and orchiectomy for cancer as well as the removal of infected penile prostheses. We describe our experience with intravaginal testicular prosthesis at orchiectomy in adolescents with torsion. Consecutive pubertal patients undergoing exploration for torsion from 2010 to 2011 were offered orchiectomy with staged prosthesis or combined orchiectomy and prosthesis exchange for nonsalvageable testis. Through a midline scrotal incision the ipsilateral tunica vaginalis was opened, testis detorsed and contralateral orchiopexy performed. When verified as unviable, the ipsilateral spermatic cord was suture ligated within the tunica vaginalis and preplaced sutures secured the saline filled prosthesis in the tunica vaginalis. Patients were discharged home on the day of surgery with 5 days of oral antibiotics and narcotics. Demographic, surgical and postoperative measures were prospectively recorded. Of 19 patients 6 had testes deemed salvageable at surgery with a median time to presentation of 6 hours (range 4 to 48) vs 96 (range 14 to 168, p = 0.002) in the 13 patients with nonsalvageable torsion. Of these patients 12 (median age 15 years, range 12 to 16) elected combined orchiectomy and prosthesis exchange. With a median followup of 4.8 months (range 1.5 to 16) there were no infectious complications or extrusions. Eleven (91.7%) patients had a symmetric appearing scrotum with the prosthesis located in a mid to dependent scrotal position. We demonstrate the feasibility of intravaginal prosthesis placement for immediate scrotal reconstruction in adolescents with nonsalvageable testicular torsion. Advantages of combined orchiectomy and prosthesis exchange include orthotopic prosthetic position, extra tunica vaginalis barrier layer and avoidance of a second anesthetic.

Rare case of paratesticular solitary fibrous tumour (lipomatous hemangiopericytoma)

A 26-year-old male presented with an asymptomatic 6-cm left paratesticular mass. Ultrasound and magnetic resonance imaging confirmed this mass as extratesticular, likely a tumour arising from the left spermatic cord. The mass demonstrated marked avid enhancement on post-contrast images, suggestive of a spermatic cord sarcoma. A left inguinal exploration was performed and gross examination of the mass revealed a well-circumscribed tumour with a discrete capsule separating it from the ipsilateral spermatic cord. The mass was resected without performing an orchiectomy and histology demonstrated a solitary fibrous tumour (lipomatous hemangiopericytoma), with minimal proliferative activity and negative margins. The occurrence of a paratesticular solitary fibrous tumour is exceedingly rare, with only a handful of case reports. We review the literature regarding this rare entity and discuss its diagnosis and management.

Paratesticular Metastasis From Wilms Tumor

Testicular or paratesticular metastasis from Wilms tumor (WT) is extremely rare. We report a 5-year-old boy with WT of right kidney presented with metastasis to the ipsilateral spermatic cord. The patient underwent a high inguinal right orchiectomy. Histopathological examination revealed infiltration of WT to spermatic cord but the testis and epididymis were not involved. The patient received the standard chemotherapy regimen but the response to treatment was poor with 2 tumor recurrences within the follow-up period. Among the mechanisms of metastasis to scrotal region, retrograde venous and the patent processus vaginalis seem to be more common and also preventable.

Surgery Plus Targeted Therapy for Renal Cell Carcinoma With Isolated Spermatic Cord Metastasis

We present a case of renal cell carcinoma with metastasis to the ipsilateral spermatic cord. We report the clinical presentation and management of this case and review the scientific literature of this unusual case presentation.

Retroperitoneal lymph node mapping with intratesticular injected patent blue dye in rats

Objectives Endolymphatic injection of several dyes have been previously studied to identify retroperitoneal lymphatic structure in animals and humans with malignant diseases. However, there have been no studies, to our knowledge, that demonstrate the utility of injecting patent blue dye into the testicular parenchyma to detect retroperitoneal lymphoid structure. The aim of this experimental study was to investigate whether intratesticular patent blue dye injection is feasible and is an accurate method for retroperitoneal lymph node mapping in rats. Materials and Methods Twenty male albino Wistar rats were included in the study and divided over two equal groups. The first group underwent patent blue violet (PBV) injection into the spermatic funiculus, while the second group underwent PBV injection into the testicular parenchyma. After the injection, the color changes in the retroperitoneal lymphatic structures and the urinary bladder were anticipated. The time interval between the injection and the staining of lymphatic structures and urinary bladder was measured for each intervention. Blue stained retroperitoneal nodal tissues were dissected and removed. These nodal tissues were examined histologically. Results After PBV injection, intense staining of the ipsilateral spermatic cord lymphatics was seen and anticipated color changes in the retroperitoneal lymphatic structures and urinary bladder were evaluated visually. Both application routes of dye resulted in the same distribution of retroperitoneal lymph nodes in the same time frame. All retroperitoneal nodular tissues removed were noted histologically to be lymph nodes and were found to be consistent with the ipsilateral lumbar lymph and the ipsilateral suprarenal lymph nodes according to the staining order in both groups. No toxic effects were observed histologically. There were no statistically significant differences in the time intervals between the two groups. Conclusions We demonstrated that both funicular and intratesticular injections of patent blue dye are feasible and accurate methods for retroperitoneal lymph node mapping in rats. This shows that intralymphatic dye injection is not absolutely necessary to detect retroperitoneal lymphatic structures and may have applications beyond testis cancer.

TESTICULAR ISCHEMIA FOLLOWING OPEN PROSTATECTOMY

Testicular ischemia is a known complication of inguinal herniorrhaphy and varicocelectomy. We report a case of acute testicular ischemia following simple retropubic prostatectomy. CASE REPORT A 49-year-old male underwent open retropubic prostatectomy for benign prostatic hyperplasia (BPH) and urinary retention, without complications. A 22Fr Foley catheter was placed intraoperatively. The patient had painless scrotal edema on postoperative day 1 and was treated with a scrotal support. On postoperative day 4 he complained of sudden onset left testicular pain. On physical examination the left hemiscrotum was erythematous with an enlarged and tender left testicle and thickening of the ipsilateral spermatic cord to the level of the external inguinal ring. Cremasteric reflexes were absent bilaterally. Laboratory evaluation showed leukocytosis and no evidence of bacteriuria. Color Doppler ultrasound demonstrated a heterogeneous left testicle devoid of flow to the left epididymis and testicle. Emergency scrotal exploration revealed an enlarged swollen left testicle and thickened spermatic cord. On opening the tunica vaginalis the testis appeared cyanotic and mottled with an indurated epididymis (see figure). The testicle and epididymis were in the normal axis without evidence of testicular torsion. Immediately after the tunica vaginalis was opened the testicle and epididymis became pink, suggesting reperfusion. Intraoperative Doppler showed a strong signal in the left distal spermatic cord. Brisk bleeding was identified following a small incision through the tunica albuginea, confirming good blood flow to the testis. The scrotum was closed in the standard fashion with a Penrose drain left indwelling. DISCUSSION Simple retropubic prostatectomy for BPH offers advantages over the less invasive modalities, including a lower re-treatment rate and more complete removal of the prostatic adenoma under direct visualization. Complications include bleeding requiring a blood transfusion, sepsis, urinary incontinence and retrograde ejaculation, with cardiovascular complications such as pulmonary emboli, myocardial infarctions, cerebrovascular accidents and deep vein thrombi occurring less than 1% of the time. 1 Iatrogenic testicular ischemia and infarction have been reported after inguinal herniorrhaphies and varicocelectomies. 2 Although scrotal edema and ecchymosis may be common after retropubic prostatectomy, acute scrotal pain secondary to ischemia is unusual. Doppler ultrasound is an effective noninvasive test with a sensitivity and specificity of 100% and 97%, respectively, in diagnosing testicular ischemia. 3 Testicular torsion and torsion-detorsion are the most likely culprits leading to an ischemic testis. However, this clinical scenario does not meet the usual presentation. The brisk restoration of pink color along with the presence of a strong Doppler signal after opening the tunica vaginalis in the absence of a twisted cord and in the setting of an already edematous scrotum makes a compelling argument for a scrotal compartmental syndrome. Scrotal compartmental syndrome causing testicular ischemia has yet to be reported in the literature as a complication of this procedure. Although compression and vasospasm of the testicular artery may occur intraoperatively from retraction, such findings would be an unusual presentation 4 days postoperatively. We report a unique phenomenon of resolution of testicular ischemia after opening the tunica vaginalis, suggestive of a scrotal compartmental syndrome presenting with negative flow to the unilateral testis and temporary ischemia following open prostatectomy for BPH.

Paracolic recurrence of stage I seminoma

Paracolic recurrence of testicular germ cell tumors is rare and is usually related to incomplete excision of the ipsilateral spermatic cord. We describe a paracolic recurrence outside of the standard radiation field of a low-stage pure seminoma that was managed by chemotherapy and surgical excision, rendering the patient disease free with short-term follow-up.

PARACOLIC RECURRENCE: THE IMPORTANCE OF WIDE EXCISION OF THE SPERMATIC CORD AT RETROPERITONEAL LYMPH NODE DISSECTION

Four patients who underwent retroperitoneal lymph node dissection elsewhere and subsequently had radiographic evidence of expanding ipsilateral paracolic recurrence were referred to our institution for treatment. We evaluated ipsilateral spermatic cord metastatic involvement at retroperitoneal lymph node dissection and identified the possible etiology of these unusual recurrences. Between January 1988 and February 1998, 34 of 685 patients who underwent a total of 702 retroperitoneal lymph node dissections had metastatic disease in the spermatic cord specimen. Variables examined in this group of patients included other disease sites, lymphovascular invasion in the primary tumor, histopathological findings of the primary tumor and retroperitoneal disease, clinical and pathological stage, disease side and the specific site of anatomical involvement of metastatic disease within the spermatic cord specimen, that is spermatic vessels and/or surrounding lymphatic tissue. Of these 34 positive spermatic cord specimens 18 were in primary retroperitoneal lymph node dissections and 16 were in post-chemotherapy specimens. Histopathological evaluation in 25 (74%) and 9 (26%) of the 34 primary tumors showed a mixed germ cell pattern and pure embryonal carcinoma, respectively. Similarly 9 of the 34 retroperitoneal lymph node specimens (26%) showed pure embryonal cell carcinoma and the remainder showed mixed histopathological findings. Disease was clinical stage I in 13 cases (38%) and lymphovascular invasion was absent in the primary tumor in 11 (32%). Despite disease in the spermatic cord specimen there was none at the primary landing zone in 2 patients (6%), including 1 in whom the spermatic cord was the only disease site. In 12 positive spermatic cord specimens (35%) disease was identified in the surrounding perivascular and lymphatic tissue without gonadal vessel involvement. Metastatic disease in the spermatic vessels and/or surrounding lymphatic tissue represents a possible site of recurrence when incompletely excised. The lack of lymphovascular invasion in the primary tumor does not preclude metastatic disease in the spermatic cord specimen. Complete and wide excision of the spermatic cord and surrounding lymphatic tissues at retroperitoneal lymph node dissection is necessary and may prevent paracolic recurrence.

Noradrenaline and nitrite-nitrate concentrations in the contralateral testes during ipsilateral spermatic cord torsion in the presence or absence of a testis and epididymis.

To determine the changes occurring during ipsilateral spermatic cord torsion either in the presence or absence of the ipsilateral testis and epididymis, by evaluating noradrenaline and nitrite-nitrate concentrations in the contralateral testes. Forty male albino rats were allocated randomly to one of four equal groups undergoing: group 1, a sham operation; group 2, ipsilateral spermatic cord torsion; group 3, epididymo-orchidectomy only; and group 4, spermatic cord torsion after epididymo-orchidectomy. The contralateral testes were harvested after 24 h and the noradrenaline and nitrite-nitrate contents determined. The levels in each group were compared using the Kruskal-Wallis and Mann-Whitney U-tests. The noradrenaline content of testes from group 2 was significantly lower than in those of groups 1 and 3, but there were no significant differences in content between groups 1 and 3, 1 and 4, and 2 and 4. The content in group 4 was significantly less than that in group 3. There were no significant differences in nitrite-nitrate contents among any of the groups. Spermatic cord torsion for 24 h, either in the presence or absence of a testis and epididymis, significantly decreased the noradrenaline content in the contralateral testis. This finding supports the suggestion that the sympathetic system is activated by exposure to noradrenaline in the contralateral testis during ipsilateral spermatic cord torsion, with no dependency on the presence of a testis and epididymis. As the nitrite-nitrate concentrations were unaffected, nitric oxide seems to have no role in contralateral testicular deterioration.

DNA Flow Cytometry Reveals Depressed Spermatogenetic Activity in the Contralateral Testis within 24 h of Ipsilateral Spermatic Cord Torsion Independently of the Presence of the Testis and Epididymis

An experimental study was planned to evaluate if contralateral testicular deterioration following ipsilateral torsion requires the presence of a twisted ipsilateral testis and/or epididymis. Five groups, each containing 6 rats, were established. The groups underwent sham operation, epididymo-orchiectomy, testicular torsion, torsion following subepididymal orchiectomy and torsion following epididymo-orchiectomy. After 24 h, the contralateral testes were harvested and the percentage of haploid cells was determined by DNA flow cytometry. Ipsilateral torsion, in the presence and absence of testis and epididymis, significantly decreased the number of haploid cells compared to sham and epididymo-orchiectomy procedures. Torsion of only the ipsilateral spermatic cord and adjacent vasculature seemed to suffice to damage the contralateral testis. Since the presence of the ipsilateral testis and epididymis is not mandatory for this acquired damage, which occurs within 24 h, a role for a preexisting congenital defect and autoimmunity seems unlikely.

Spermatic cord metastasis from ureteral carcinoma

A case of ureteral transitional cell carcinoma metastasizing to ipsilateral spermatic cord is reported.

Unilateral torsion of spermatic cord in men: Effect on Leydig cell

In our previous studies, we reported that short-term unilateral spermatic cord torsion had no adverse effect on the germ cells and the Sertoli cell in the contralateral testis of men. As an extension of our earlier investigations on the testicular pathophysiology in humans after unilateral spermatic cord torsion, the present study was undertaken to assess the Leydig cell function employing both fine structural and morphometric analysis in patients with short-term spermatic cord torsion. Bilateral testicular biopsy samples obtained from 4 men (15–19 years) with short-term unilateral torsion of the spermatic cord and from a control group of 6 men (15–40 years) were used innthe present investigation. No appreciable difference in the Leydig morphology was noted between the biopsy samples from control and the contralateral testes. This was substantiated by morphometric analysis. The present study clearly indicates that patients with unilateral torsion of the spermatic cord may not essentially have bilateral testicular abnormalities, as suggested by the previous investigators. This report, thus lends further support to our earlier contention that alteration in microcirculation is quite likely the earliest and possibly the most significant contributor to the contralateral testicular damage in man after ipsilateral spermatic cord torsion.