Albino Giuseppe, Nenna Rosanna, Inchingolo Cosimo Damiano, Marucco Ettore Cirillo
U.O. di Urologia, Ospedale "L. Bonomo" ASL BAT, Andria, Italy.
Arch Ital Urol Androl. 2010 Dec;82(4):287-90.
Hydrocele is a fluid collection between tunica vaginalis and testis. Approximately 10% of testicular cancers occurs with a reactive hydrocele.
A 64 year old male presented with a 30 year history of left hydrocele, progressively increasing. Physical examination demonstrated a left large hydrocele, transilluminable, not under pressure. Ultrasonography showed a "corpusculated hydrocele with vaginal hypertrophy jutting out near the head of the epididymis, perhaps caused by an inflammatory reaction [...]" As the patient showed only a minimal discomfort due to the groin swelling, without pain, surgical excision was planned without priority (Class C < 180 days).
The surgical exploration showed a paratesticular papillary neoplasm of 3 cm. Intraoperative pathologic examination of a frozen sample demonstrated a "borderline papillary cystadenoma". The Left orchifunicolectomy was performed. The definitive histological examination showed a "left paratesticular Papillary Serous Tumor of Low Malignant Potential (PSTLMP) with morfoimmunoistochemical features of Mullerian origin of neoplasm". Computed tomography (CT) was negative for lymph nodes and metastasis. In agreement with the oncologist we decide for atchful waiting.
Despite of rich personal experience of resections and eversions of the vaginal tunic, an urologist rarely observes a case of paratesticular cancer. A PubMed search found 28 citations between 1985 and 2010 with 42 reported cases of paratesticolar neoplasm, including 27 with malignancy features. Rhabdomyosarcoma is the most common, followed by mesothelioma, adenocarcinoma and neuroblastoma. This case report consists of a "borderline" neoplasm for which in the literature, after orchiectomy, it is reported no case of recurrence or metastasis (with a follow up of up to 18 years).
The banality of the disease never must underestimate the possibility of an undetected cancer.
鞘膜积液是指鞘膜腔内积聚的液体。约10%的睾丸癌伴有反应性鞘膜积液。
一名64岁男性，有30年左侧鞘膜积液病史，且积液逐渐增多。体格检查发现左侧有一个大的鞘膜积液，透光试验阳性，无压痛。超声检查显示“附睾头部附近有一个伴有鞘膜肥厚的颗粒状鞘膜积液，可能由炎症反应引起[...]”。由于患者仅因腹股沟肿胀感到轻微不适，无疼痛，计划进行手术切除，但不紧急（C级<180天）。
手术探查发现一个3厘米的睾丸旁乳头状肿瘤。术中冰冻切片病理检查显示为“交界性乳头状囊腺瘤”。遂行左侧睾丸精索切除术。最终组织学检查显示为“左侧睾丸旁低恶性潜能乳头状浆液性肿瘤（PSTLMP），具有苗勒氏源性肿瘤的形态免疫组化特征”。计算机断层扫描（CT）显示淋巴结及转移均为阴性。与肿瘤学家协商后，我们决定采取密切观察。
尽管泌尿外科医生在鞘膜切除和翻转方面经验丰富，但很少观察到睾丸旁癌病例。对PubMed的检索发现，1985年至2010年间有28篇相关文献，报道了42例睾丸旁肿瘤病例，其中27例具有恶性特征。横纹肌肉瘤最为常见，其次是间皮瘤、腺癌和神经母细胞瘤。本病例报告的是一种“交界性”肿瘤，文献报道睾丸切除术后无复发或转移病例（随访长达18年）。
对于这种常见疾病，绝不能低估未被发现的癌症的可能性。
