Roslyn J J, Stabile B E, Rangenath C
Am Surg. 1980 Jun;46(6):358-62.
Three cases of malignant tumors associated with hernial sacs are presented. One case of a primary liposarcoma of the spermatic cord illustrates the necessity of examining all excised specimens microscopically. The two cases of metastic disease from colonic and rectal primaries support the observation that the most frequent primary site for neoplastic disease within hernial sacs in the large bowel. Neoplasm within a hernial sac should be suspected in patients with previously diagnosed intraperitoneal malignancy who present with a new hernia, and in elderly patients who develop incarceration of a chronic, previously reducible hernia. Local phenomena such as intraperitoneal seeding by gravity are probably most important in explaining the unusual finding of metastatic tumor foci within hernial sacs. Suggestions for increasing diagnostic yield include biopsy and frozen-section examination of suspect specimens and, in cases in which tumor is confirmed, thorough intraperitoneal digital palpation and laparoscopy. The hernial sac offers a unique opportunity for peritoneal biopsy that should not be overlooked.
本文报告了3例与疝囊相关的恶性肿瘤。1例精索原发性脂肪肉瘤病例表明，对所有切除标本进行显微镜检查是必要的。2例来自结肠和直肠原发灶的转移病例支持了这样的观察结果，即疝囊内肿瘤性疾病最常见的原发部位是大肠。对于先前诊断为腹腔内恶性肿瘤且出现新疝的患者，以及慢性、先前可复性疝发生嵌顿的老年患者，应怀疑疝囊内存在肿瘤。重力导致的腹腔播散等局部现象可能是解释疝囊内转移瘤灶这一不寻常发现的最重要原因。提高诊断率的建议包括对可疑标本进行活检和冰冻切片检查，以及在确诊肿瘤的病例中进行彻底的腹腔内指诊和腹腔镜检查。疝囊为腹膜活检提供了一个不应被忽视的独特机会。
