1
|
Pathak M, Suchiang B, Elhence P, Saxena R, Jadhav A, Rathod K, Sinha A. Testicular remnant "nubbin" and incidental ectopic adrenal cortical rests: A case series and systematic review. J Pediatr Urol 2020; 16:627-634. [PMID: 32741641 DOI: 10.1016/j.jpurol.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/04/2020] [Accepted: 07/10/2020] [Indexed: 11/15/2022]
Abstract
AIM To determine whether excising a testicular remnant or nubbin is necessary and perform a systematic review of the incidental ectopic adrenal cortical rest associated with undescended testis. MATERIAL AND METHODS A retrospective analysis of impalpable undescended testis was carried out between May 2016 and June 2019. The demographic data, intra-operative findings and histopathological diagnosis were analyzed. In conjunction with this, systematic search of PUBMED and EMBASE database was performed by using the search terms "undescended testis" AND "ectopic adrenal tissue". Data was collected for demographic characteristics, size and appearance of ectopic adrenal cortical rest and histopathology. Quantitative data has been presented as medians. Categorical variables have been presented as percentages. RESULT We encountered 43 cases of impalpable undescended testis, out of which, nubbins were identified in 9 cases. Incidence of EACT in nubbin and impalpable UDT was 2/9 (22.22%) and 2/43 (4.7%) respectively. None of the excised nubbin had germ cells. On Systematic review, EACT associated with UDT was seen in 90/2501 (3.6%), while its association with testicular nubbin has been reported only once before in a case report. CONCLUSION A testicular nubbin is a condition wherein no viable testicular tissue can be grossly identified in a case of impalpable testis. Even when germ cells are not found in the excised nubbin, the presence of ectopic adrenal cortical rest make them prone to later malignant transformation. Association of EACT with UDT has been consistently reported but there is scarcity of such documentation in association with testicular nubbin.
Collapse
Affiliation(s)
- Manish Pathak
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India.
| | - Biangchwadaka Suchiang
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Poonam Elhence
- Department of Pathology, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Rahul Saxena
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Avinash Jadhav
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Kirtikumar Rathod
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Arvind Sinha
- Department of Pediatric Surgery, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| |
Collapse
|
2
|
Yankelevich GR, Piraino J, Akanda S, Edwards DC, Gerges M, Snow ZA, McGreen B, Levy J, Ciocca V, Hagg MJ. Paraganglioma of the Spermatic Cord With Spinal Metastasis: A Case Report. Urology 2020; 143:e7-e11. [PMID: 32505620 DOI: 10.1016/j.urology.2020.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/25/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022]
Abstract
A 40-year-old male with presented to the clinic with the chief complaint of right inguinal pain radiating to his right testicle and right thigh with no history of trauma, fever, chills, dysuria, hematuria, or unprotected sexual activity. Physical exam revealed right testicular tenderness with no palpable abnormality of the bilateral testes or spermatic cords. Scrotal ultrasound was performed and was unremarkable for testicular or other intrascrotal pathology. Concurrently, chronic low back pain had prompted a lumbar CT to be performed, which was indeterminate, but subsequent lumbar MRI performed three months later revealed abnormal signals in the vertebral bodies of T12, L3, and L5, concerning for occult metastatic disease or multiple myeloma. PET-CT was performed revealing hypermetabolic lesions throughout the axial skeleton and, most notably, hypermetabolic lesions in the left inguinal and left upper scrotum. At this time, about 4 months after the original visit, physical exam revealed a palpable mobile mass in the left upper scrotum that was distinct from the left testicle, and another mass palpable near the left inguinal ring.
Collapse
Affiliation(s)
| | - Javier Piraino
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Shawon Akanda
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
| | | | - Michael Gerges
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA
| | - Zachary A Snow
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Brian McGreen
- Department of Urology, Main Line Health, Philadelphia, PA
| | - Jason Levy
- Department of Urology, Main Line Health, Philadelphia, PA
| | | | - Michael J Hagg
- Department of Urology, Main Line Health, Philadelphia, PA
| |
Collapse
|
3
|
Gontarz B, Hegde P, McFadden D. Paraganglioma of the spermatic cord: A case report and literature review. Int J Surg Case Rep 2019; 60:368-370. [PMID: 31288201 PMCID: PMC6614785 DOI: 10.1016/j.ijscr.2019.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022] Open
Abstract
A paraganglioma, or an extra-adrenal catecholamine-producing tumor, is a clinically significant neuroendocrine tumor with an incidence of 3–8 cases per million population. The majority of paragangliomas, 85–90%, occur in the adrenal glands and 98% are found in the abdomen. Unlike pheochromocytomas, where only 10% are malignant, paragangliomas carry a 40–50% malignancy rare, and their development is part of a hereditary syndrome in 30% of cases. The most common hereditary syndromes associated with paragangliomas are von Hipple-Lindau (VHL), multiple endocrine neoplasia 2 (MEN 2) and neurofibromatosis type 1 (NF1). Herein we describe and review the 13th paraganglioma documented arising from the spermatic cord.
Introduction Neuroendocrine tumors are a diverse and well-described entity with most arising from the gastrointestinal tract. A clinically significant example is the paraganglioma, or an extra-adrenal catecholamine-producing tumor. Presentation of case Herein we describe and review a paraganglioma arising from the spermatic cord in a 55 year old asymptomatic man. Discussion Paragangliomas are rare, with an incidence of 3–8 cases per million population. To date there are only 12 cases found in the literature. Conclusion In this article, we review our patient’s presentation, follow-up, and screening followed by a review of the literature of this fascinating tumor. Although rare, paraganglioma should be considered in the differential diagnosis of unusual groin masses. This work has been reported in line with the SCARE criteria (Agha et al., 2018).
Collapse
Affiliation(s)
- Brendan Gontarz
- Department of Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06032, United States.
| | - Poornima Hegde
- Department of Pathology and Laboratory Medicine, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06032, United States.
| | - David McFadden
- Department of Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT, 06032, United States.
| |
Collapse
|
4
|
Bachmeier C, Kuma L, Collins M, Sangla K. Succinate Dehydrogenase Subunit B Mutation Presenting with Spermatic Cord and Neck Paraganglioma. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2018-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
5
|
Zhao Y, Guo H, Zhao Y, Shi B. Secreting ectopic adrenal adenoma: A rare condition to be aware of. ANNALES D'ENDOCRINOLOGIE 2018. [PMID: 29525561 DOI: 10.1016/j.ando.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ectopic adrenal adenoma causing chronic Cushing's syndrome (CS) is a rare phenomenon. Diagnosis is usually made years after disease onset because of the insidious nature of the ectopic adrenal gland and because it overlaps with common symptoms, such as overweight and hypertension, in the general population (Kreitschmann-Andermahr et al., 2015). Here, we report the case of a 46-year-old male with a 15-year history of severe hypertension, facial plethora, and centripetal obesity. During treatment for herpes zoster, the patient presented with severe hypokalemia and flaccid paralysis, characteristic changes associated with CS. The serum cortisol level was elevated and baseline adrenocorticotrophic hormone (ACTH) was suppressed. After administration of the low-dose overnight dexamethasone suppression test, plasma cortisol was 38.9μg/dL. A contrast computed tomography (CT) scan revealed normal adrenal glands and significant tumor adjacent to the right renal hilum measuring ∼3.6×2.3cm. The tumor was removed through retroperitoneoscopy, and pathological examination confirmed adrenocortical adenoma and myelolipoma metaplasia. The serum potassium level gradually became normal after surgical removal of the mass. In the current report, we have reviewed the pertinent literature and highlighted the importance of considering ectopic adrenal adenoma in the differential diagnosis of chronic CS with nonspecific symptoms.
Collapse
Affiliation(s)
- Yang Zhao
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong, University School of Medicine, Xi'an, Shannxi 710061, PR China
| | - Hui Guo
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong, University School of Medicine, Xi'an, Shannxi 710061, PR China
| | - Ying Zhao
- Department of Pathology, The First Affiliated Hospital of Xi'an Jiaotong, University School of Medicine, Xi'an, Shannxi 710061, PR China
| | - Bingyin Shi
- Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong, University School of Medicine, Xi'an, Shannxi 710061, PR China.
| |
Collapse
|
6
|
Laparoscopic Finding of Ectopic Adrenocortical Tissue in a 2-Year-Old Boy with Vanishing Testis. European J Pediatr Surg Rep 2018; 6:e4-e6. [PMID: 29326864 PMCID: PMC5762196 DOI: 10.1055/s-0037-1612633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/02/2017] [Indexed: 11/11/2022] Open
Abstract
Ectopic adrenocortical tissue (EAT) along the spermatic cord is an unusual condition in children. The author reports on a 2-year-old boy with impalpable testis. On laparoscopy, EAT was detected along the hypotrophic spermatic vessels and excised. These remnants should be removed to prevent hormone production or malignant transformation.
Collapse
|
7
|
Kwon AY, Kang H, An HJ, Kim G, Kim TH, Heo JH, Lee HJ, Hong YK. Spermatic Cord Paraganglioma With Histologically Malignant Features. Urology 2016; 93:e7-8. [DOI: 10.1016/j.urology.2016.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 11/27/2022]
|
8
|
Müllhaupt G, Mordasini L, Gramann T, Ertel V, Schmid HP, Abt D. Ectopic Adrenocortical Tissue in the Spermatic Cord in a 44-Year-old Man. Urol Case Rep 2014; 2:169-70. [PMID: 26958477 PMCID: PMC4782098 DOI: 10.1016/j.eucr.2014.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/27/2014] [Indexed: 11/15/2022] Open
Abstract
We report on a 44-year-old man who underwent microsurgical inguinal repair for symptomatic varicocele. As an incidental finding during surgery, a yellowish tumor (9 × 5 × 4 mm) was found in the spermatic cord. Histologic examination revealed ectopic adrenocortical tissue. Ectopic adrenocortical tissue in the spermatic cord is known to appear in children and adolescents but is extremely rare in adults. Surgical removal of the tissue is recommended, although malignant transformation or functional hormonal disorders are very unlikely.
Collapse
Affiliation(s)
| | - Livio Mordasini
- Department of Urology, Cantonal Hospital, St. Gallen, Switzerland
| | - Tobias Gramann
- Department of Urology, Cantonal Hospital, St. Gallen, Switzerland
| | - Vera Ertel
- Department of Pathology, Cantonal Hospital, St. Gallen, Switzerland
| | | | - Dominik Abt
- Department of Urology, Cantonal Hospital, St. Gallen, Switzerland
| |
Collapse
|
9
|
Paragangliome du cordon spermatique. Prog Urol 2013; 23:486-8. [DOI: 10.1016/j.purol.2013.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 03/08/2013] [Accepted: 03/11/2013] [Indexed: 11/20/2022]
|
10
|
Alataki D, Triantafyllidis A, Gaal J, Rodiou C, Vouros J, Papathanasiou A, Papanicolaou A, Rombis V, de Krijger RR. A non-catecholamine-producing sympathetic paraganglioma of the spermatic cord: the importance of performing candidate gene mutation analysis. Virchows Arch 2010; 457:619-22. [PMID: 20842377 PMCID: PMC2974905 DOI: 10.1007/s00428-010-0966-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 08/13/2010] [Accepted: 08/18/2010] [Indexed: 12/03/2022]
Abstract
Background Catecholamine-producing tumours are called pheochromocytomas when they are located in the adrenal gland and sympathetic paragangliomas when they are located elsewhere in the abdomen. Rarely these tumours do not produce catecholamines and even more rarely they arise in the spermatic cord. Over the past decade, systematic mutation analysis of apparently sporadic cases of pheochromocytomas and paragangliomas has elucidated the frequent presence of germ line mutations in one of five candidate genes, including RET, VHL, SDHB, SDHC, and SDHD. Clinical history and methods We describe a 45-year-old man with a non catecholamine-producing paraganglioma of the spermatic cord. We performed SDHB immunohistochemistry and performed mutation analysis of the SDHB, SDHC, and SDHD genes. Results There was no staining of tumour cells with SDHB immunohistochemistry, indicative of an SDH mutation. Mutation analysis demonstrated a germ line SDHD mutation (p.Val147Met). Conclusions Systematic mutation analysis is required in paraganglioma patients for the detection of germ line mutations. This should be preceded by SDHB immunohistochemistry to limit the number of genes to be tested.
Collapse
Affiliation(s)
- Despoina Alataki
- Department of Pathology, Hippokration General Hospital of Thessaloniki, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Mendez R, Tellado MG, Somoza I, Liras J, Sanchez-Abuin A, Pais E, Vela D. Ectopic adrenal tissue in the spermatic cord in pediatric patients: surgical implications. Int Braz J Urol 2006; 32:202-7; discussion 207. [PMID: 16650300 DOI: 10.1590/s1677-55382006000200013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To study the incidence and relevance of ectopic adrenal tissue in pediatric patients who underwent groin surgical explorations. MATERIALS AND METHODS We studied 1120 patients with groin surgical explorations during a period of 8 consecutive years. Patients' clinical data and histological findings were analyzed. RESULTS We found ectopic adrenal tissue in 13 patients in 1120 groin surgical exploration (1.16%). Of the 13 cases, 5 were diagnosed as having undescended testes, 6 inguinal hernia and 2 communicating hydrocele. Median age at diagnosis was 5.6 years. Histological sections showed adrenal cortical tissue with no medulla present. CONCLUSION Based on the clinical implications of those adrenal rests it is mandatory the removal of this ectopic tissue whenever encountered during surgical interventions in the groin region in children.
Collapse
Affiliation(s)
- Roberto Mendez
- Pediatric Urology, Department of Pediatric Surgery, Children's Hospital Teresa Herrera, Complexo Hospitalario Juan Canalejo, A Coruna, Spain.
| | | | | | | | | | | | | |
Collapse
|
12
|
Sullivan JG, Gohel M, Kinder RB. Ectopic adrenocortical tissue found at groin exploration in children: incidence in relation to diagnosis, age and sex. BJU Int 2005; 95:407-10. [PMID: 15679804 DOI: 10.1111/j.1464-410x.2005.05310.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the incidence of ectopic adrenocortical tissue (EACT) in the groin in children, and examine the relationship between the incidence and the underlying diagnosis, age and sex. PATIENTS AND METHODS From computer records, all groin explorations between 1988 and 2002 in patients < or = 15 years old were identified. Cases of EACT were identified from computer histology records, and the incidence in different groups compared. RESULTS Of 935 groin explorations, EACT was identified in 25 (2.7%); there were no cases in girls. The incidence was 0.7% at inguinal herniotomy (IH), 4.1% at ligation of the patent processus vaginalis for communicating hydrocele (P = 0.03 vs IH), and 3.3% at exploration for undescended testes (P = 0.02 vs IH). In boys with undescended testes the incidence of EACT was similar in different age groups (0-7 years, 3.3%; 8-15 years 3.2%, P = 0.96). CONCLUSIONS The overall incidence of EACT at groin exploration was 2.7%, with none detected in girls. There was no evidence of involution of EACT with increasing age. The incidence of EACT varied with the underlying diagnosis, but the reason for this is unknown.
Collapse
Affiliation(s)
- Jonathan G Sullivan
- Department of Urology, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK.
| | | | | |
Collapse
|
13
|
Savaş C, Candir O, Bezir M, Cakmak M. Ectopic adrenocortical nodules along the spermatic cord of children. Int Urol Nephrol 2002; 32:681-5. [PMID: 11989564 DOI: 10.1023/a:1014429119226] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Nodules of ectopic adrenal cortex are found incidentally during inguinal operations. These rests have some clinical significance as they may undergo marked hyperplasia in conditions associated with excessive ACTH production, and occasionally may give rise to neoplasms. In the present study, it is aimed to evaluate the ectopic remnants of adrenal tissue encountered during the inguinal operations in children. PATIENTS AND METHODS Four hundred and fifty-two inguinal operations were performed on 397 children (325 male/72 female; mean age 2.7 years), during a period of 36 months. Nodules resembling ectopic adrenal tissue from eleven patients (2.7%) were removed and the histopathological examination was performed using hematoxylin-eosin staining. RESULTS Ectopic adrenal cortical tissues were found in eight male patients (2%), located within the distal end of the spermatic cord. Macroscopically, the nodules were round to oval in shape, 1 to 5 mm in diameter, and bright yellow to orange in colour. Microscopically, they had three layers of adrenal cortex surrounded by a fibrous capsule and none contained any medulla. Hyperplasia or neoplastic changes were not detected, and no fetal cortex was identified. CONCLUSIONS It is important for surgeons to be conscious of the possibility that a nodule along the spermatic cord may be the ectopic adrenal cortical tissue. As they are associated with hyperplasia and neoplastic change, removal of ectopic adrenal cortical tissue is warranted whenever it is encountered, but a routine search for them is not mandatory.
Collapse
Affiliation(s)
- C Savaş
- Süleyman Demirel University Medical School, Department of Pediatric Surgery, Turkey.
| | | | | | | |
Collapse
|
14
|
Weidman ER, Cendron M, Schned AR, Harris RD. Scrotal lymphangioma: an uncommon cause for a scrotal mass. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2002; 21:669-672. [PMID: 12054304 DOI: 10.7863/jum.2002.21.6.669] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Eric R Weidman
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03755, USA
| | | | | | | |
Collapse
|