Pathology of the pediatric regio inguinalis: mysteries of the hernia sac exposed

Mullerian Serous Cystadenoma Occurring in the Scrotum Post-Orchidopexy: A Rarely Reported Yet Distinctive Entity

Serous cystadenoma is a rare lesion in the para-testicular tissue, with even rarer reports of this entity occurring in the scrotum post-orchidopexy. We present such an occurrence, adding support for its existence as a distinct entity.

Skipping the cord during laparoscopic percutaneous internal ring suturing in children, is it reasonable?

BACKGROUND

As a minimally invasive procedure, laparoscopic inguinal hernia repair in children was introduced. Percutaneous internal ring suturing (PIRS) is a popular technique. The main concern is that the spermatic cord will be trapped and/or the vasculature of the testes will be damaged in boys. This can be avoided by performing a careful dissection or by skipping the peritoneum over the cord and/or the vessels. The aim of the study was to compare the incidence of recurrence or complication (e.g. hydrocele) in children with skipped peritoneum on the cord and/or vessels compared to those without skipped peritoneum during laparoscopic PIRS repair.

METHODS

The charts of children who underwent laparoscopic PIRS repair for inguinal hernia between 2017 and 2021 were analyzed. Complications and recurrence were assessed. The video recordings were viewed, and data on skipping (group 1) or not skipping (group 2) the peritoneum on vas deferens was recorded. The rates of recurrence and complications were compared between groups.

RESULTS

There were 101 boys with a total of 125 inguinal hernias in the study. There were 45 right-sided hernias, 32 had left-sided hernias, and 24 had bilateral hernias. According to the video investigation, there were 63 hernias in group 1 and 62 hernias in group 2. In each group, there were two recurrences (3% for both groups). There were no other postoperative complications.

CONCLUSIONS

To avoid spermatic cord or vessel damage, skipping the cord appears to be an acceptable path that does not appear to increase recurrence or complication rates while also ensuring the safety of spermatic structures.

Clinical and Economic Value of Routine Pathological Examination of Hernia Sacs and Scheduled Clinic Follow-Ups After Inguinal Hernia and Hydrocele Repair in a Canadian Tertiary Care Children's Hospital

BACKGROUND

The clinical and economical value of routine submission of hernia sacs for pathological examination and scheduled clinic follow-ups after inguinal hernia and hydrocele repair has been questioned. Herein, we assessed the institutional variability in these routine practices.

METHODS

We retrospectively reviewed patients who underwent unilateral or bilateral inguinal hernia and/or hydrocele repair, open or laparoscopically, at our institution from 2015 to 2018.

RESULTS

1181 patients were included (1074 inguinal hernias and 157 hydroceles). Of 531 specimens obtained from 446 (38%) patients, 515 (97%) were normal. 16 (3%) abnormal pathological findings included 7 with mesothelial hyperplasia, 5 with nonfunctional genital ductal remnants, 3 with ectopic adrenal cortical tissues, and 1 epidydimal structure which was not recognized at the time of surgery. 418 (35%) patients had scheduled clinic follow-ups 65 (IQR 46-94) days postoperatively. 44 (4%) patients with unexpected postoperative Emergency Department visits within 30 days of surgery were identified. Only one patient required inpatient treatment, and the rest did not require intervention or admission. The total direct cost of analyzing specimens during the study period was $30,798 CAD ($10,266/year). The average cost to detect a potentially significant finding was $1924.88/specimen and $2053.20/patient.

CONCLUSIONS

Routine pathological examination of hernia sacs and scheduled clinic follow-ups were associated with significant costs and predominantly nonsignificant findings. They should therefore be reserved for patients with a high clinical suspicion of injuries/abnormalities or risk factors for potential complications.

LEVEL OF EVIDENCE

This is a level III evidence study.

The utility of pathologic evaluation of adult hernia specimens

BACKGROUND

Pathological examination of hernia sac specimens adds additional steps and cost to a surgical procedure but has no proven benefit. Although well studied in pediatrics, there are limited data in the adult literature pertaining to this practice.

METHODS

This is a retrospective analysis from a single institution referral center over a 4-year period (2007 to 2011). All inguinal, incisional, ventral, and umbilical hernia repairs greater than 18 years of age were included.

RESULTS

A total of 1,216 inguinal (55.4%), incisional (11.4%), umbilical (21.5%), or ventral hernia (11.7%) repairs were included. In 246 cases (20.2%), hernia sac specimens were sent to pathology (open 96.7%; laparoscopic 3.3%). There were no cases in which management of the patient changed because of the final results.

CONCLUSION

The rarity of changes in diagnosis and treatment from routine pathologic examination of a hernia sac does not justify this practice and indicates that it may be omitted except in unique circumstances.

Meconium periorchitis: intrauterine diagnosis and neonatal outcome: case reports and review of the literature

Meconium periorchitis (MP) is a rare disorder caused by fetal meconium peritonitis with subsequent spillage of meconium into the scrotal sac. The condition is seldom diagnosed correctly during fetal life and the ultrasonographic diagnoses reported vary from no diagnosis to hematoma or hydrocele. It is usually diagnosed clinically during the first year of life when a scrotal mass is an incidental finding. Here, we describe two cases of MP that were diagnosed during routine intrauterine ultrasound examination for fetal growth assessment, and confirmed after birth. One infant underwent a surgical excision of the scrotal mass, confirming the histological diagnosis of meconium periorchitis. The other was managed conservatively. Neither had cystic fibrosis. Thus, we believe that a diagnosis of MP should be considered when prenatal ultrasonographic findings are suspicious for the problem. The awareness of the ultrasonographer and the neonatologist are important for immediate postnatal management, as congenital scrotal masses may have other etiologies.

Serous tumor of low malignant potential arising in inguinal endosalpingiosis: report of a case

A 46-year-old woman presented with a right inguinal mass. Imaging studies revealed no abnormalities of the pelvis (including the ovaries) or abdomen. The inguinal mass was composed predominantly of variably sized cysts lined by flat to low cuboidal cells resembling mesothelial cells and ciliated columnar tubal-type cells with a focal transition between the two cell types. Papillae, detached cell clusters with mild cytologic atypia, and psammoma bodies were also found, warranting a diagnosis of a serous borderline tumor. This appears to be the first report of a serous borderline tumor arising in inguinal endosalpingiosis and not associated with an ovarian serous tumor.