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Liu Y, Zhang Z, Wang J, Wang S. Effects of radiotherapy on the survival of patients with malignant spermatic cord tumors: A retrospective cohort study. Cancer Med 2023; 12:5580-5589. [PMID: 36354142 PMCID: PMC10028065 DOI: 10.1002/cam4.5402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Malignant spermatic cord tumors (SCT) are rare and currently, there is no consensus regarding the role of radiotherapy in their treatment. This study evaluated the effect of radiotherapy on the overall survival (OS) of patients with malignant SCT based on the large-sample advantage of the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with malignant SCT recorded in the SEER database from 1975 to 2016 were included. All patients were divided into non-radiation and radiation groups, and propensity score matching (PSM) (1:1) was performed for baseline covariates between the two groups. The overall survival rate between the two groups of patients was analyzed using the Kaplan-Meier curve. The effects of radiotherapy on patient prognosis were analyzed using univariate and multivariate COX regression analyses. RESULTS In total, 389 patients with malignant SCT were included. There were 285 (73.26%) and 104 (26.74%) patients who either did or did not receive radiotherapy, respectively. Kaplan-Meier curves before and after PSM showed no significant differences in OS between the two groups. Similarly, multivariate COX regression models before and after PSM showed that radiotherapy was not an independent risk factor for OS in patients with malignant SCT. CONCLUSIONS Radiotherapy has no obvious advantage in improving the survival time of patients with malignant SCT.
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Affiliation(s)
- Yifu Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhicheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jinxiang Wang
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Siyuan Wang
- Department of Urology, Sichuan Cancer Hospital, Chengdu, China
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2
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Ahmed F, Aslam A, Tanveer Y, Jaffry S. Leiomyosarcoma of the spermatic cord: a rare paratesticular neoplasm case report. World J Surg Oncol 2022; 20:94. [PMID: 35337334 PMCID: PMC8957147 DOI: 10.1186/s12957-022-02539-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary soft tissue sarcomas contribute to only 2% of all malignancies arising from the male genitourinary tract. Leiomyosarcoma (LMS) is a malignant soft tissue neoplasm which originates from the mesenchyme and has a characteristic smooth muscle differentiation. Usually, it presents as a painless, firm, slow-growing unilateral scrotal mass. Investigations include imaging, tumor markers, and histopathology. CASE PRESENTATION A 65-year-old gentleman known diabetic and beta-thalassemic trait was referred to the Urology OPD at Letterkenny University Hospital. His presenting complaint was a left groin lump that appeared 1 year ago and was growing larger in size gradually. According to the patient, his lump was slightly painful (localized) initially that later became painless. He did not report any testicular trauma/infection or UTI. There was no significant history of malignancies running through his family. Clinical examination revealed a soft and lax abdomen, normal testes. There was a non-tender 2cm x 2cm well-circumscribed, mobile, firm to cystic irreducible left inguinoscrotal mass and appeared to be attached to the spermatic cord. Cough impulse was indiscernible. Ultrasound left groin showed 1.8 cm transverse x 1.4 cm AP x 1.9 cm sagittal) well-circumscribed ovoid nodular subcutaneous lesion present in the upper left inguinal area just lateral to the left pubic tubercle that appeared solid with heterogeneous internal echotexture and no internal calcification. Some internal vascularity is demonstrated with color Doppler assessment. CONCLUSION Because of its rareness, LMS represents a management conundrum. There is no standard protocol for treatment. We present a case and discuss the available evidence from the literature to date to help identify LMS of the spermatic cord that is highly unusual.
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Affiliation(s)
- Farah Ahmed
- Department of Urology, Letterkenny University Hospital, Letterkenny, Ireland.
| | - Asadullah Aslam
- Department of Urology, Letterkenny University Hospital, Letterkenny, Ireland
| | | | - Syed Jaffry
- Department of Urology, Galway University Hospital, Galway, Ireland
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3
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Safari Variani A, Saboori S, Shahsavari S, Yari S, Zaroushani V. Effect of Occupational Exposure to Radar Radiation on Cancer Risk: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2019; 20:3211-3219. [PMID: 31759343 PMCID: PMC7063007 DOI: 10.31557/apjcp.2019.20.11.3211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Microwave radiation is one of the most growing environmental workplace factors that exposes too many workers in the various workplaces. Regard to concerns about cancer incidence in these workers and lack of systematic or meta-analytic studies about this object, so, we conducted a meta-analysis to acquire an understanding of the association between cancer risk and occupational exposure to radar radiation. METHODS A systematic search was carried out on case-control, cohort and clinical control trial studies that published in the Cochrane Library, PubMed, ISI Web of Science, Scopus and Google scholar databases that accomplished from March 2017 to March 2018 and updated on 30 September, 2018 in English and Persian articles without time limit in publication date. Keywords were selected based on PICO principle and collected from MeSH database. After removal of duplicated studied, taking into inclusion and exclusion criteria, the process of screening was carried out and data were extracted after preparation of the full text of included articles. Article collection was completed by manually searching for a reference list of eligible studies. For quality assessment of included studies, Newcastle-Ottawa scale was used. RESULTS a total of 533 studies was found in the first step of literature search, only 6 were included with 53,008 sample size according to inclusion and exclusion criteria. Estimated pooled random effects size analysis showed no significant increasing effect of occupational exposure to radar radiation on mortality rate (MR=0.81, 95%CI: 0.78, 0.83) and relative risk (RR=0.87, 95%CI: 0.75, 0.99, P <0.0001) of cancer with a significant heterogeneity between the selected studies. CONCLUSIONS In conclusion, the results of this meta-analysis study have shown no significant increase in overall mortality ratio and cancer risk ratio from occupational exposure to the radar frequency of workers. But, these results are not conclusive. As regards to some limitation such as fewer numbers of included studies, lack of data about exposure characterizations and demographic characterizations in this meta-analysis, this result is not certain and conclusive. It is recommended to conduct future studies.
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Affiliation(s)
- Ali Safari Variani
- Department of Occupational Health Engineering, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Somayeh Saboori
- Department of nutrition, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Saeed Shahsavari
- Instructor of Biostatistics, Health Product Safety Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Yari
- Student Research Committee, Department of Faculty of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vida Zaroushani
- Department of Occupational Health Engineering, Faculty of Health, Qazvin University of Medical Sciences, Qazvin, Iran.,Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
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4
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Murray KS, Vertosick EA, Spaliviero M, Mashni JW, Sjoberg DD, Alektiar KM, Herr HW, Russo P, Coleman JA. Importance of wide re-resection in adult spermatic cord sarcomas: Report on oncologic outcomes at a single institution. J Surg Oncol 2018; 117:1464-1468. [PMID: 29473967 DOI: 10.1002/jso.25016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 01/17/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES We evaluated the effect of re-resection with wide margins (undertaken because initial resection performed elsewhere was incomplete) on survival in patients with spermatic cord sarcoma (SCS). METHODS After excluding those with metastatic disease and those not undergoing surgical intervention, the records of 72 consecutive patients treated for SCS between 1981 and 2011 at Memorial Sloan Kettering Cancer Center were reviewed. Recurrence-free survival (RFS) and cancer-specific survival were calculated using the Kaplan-Meier method for comparing between the 48 patients who underwent wide re-resection (WRR) within 5 months of diagnosis and the 24 who did not. The relationship of age, tumor size, tumor histology, adjuvant radiation, and wide re-resection with recurrence and death was assessed by univariate Cox regression. RESULTS WRR significantly improved RFS (hazard ratio [HR] 0.16, 95%CI 0.07-0.37; P < 0.0001), despite the fact that patients receiving WRR had higher-grade disease. Tumor-positive margins upon WRR were strongly associated with both disease recurrence (HR 5.56; 95%CI 1.14-27.11, P = 0.034) and death from cancer (HR 6.16, 95%CI 1.25-30.29; P = 0.025). CONCLUSIONS A WRR with negative margins is effective in the management of patients with SCS and leads to improved RFS.
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Affiliation(s)
- Katie S Murray
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Massimiliano Spaliviero
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Stony Brook Medicine, Stony Brook, New York
| | - Joseph W Mashni
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Banner MD Anderson Cancer Center Clinic, Gilbert, Arizona
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaled M Alektiar
- Brachytherapy Service, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Harry W Herr
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Weill Cornell Medical College, New York, New York
| | - Paul Russo
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Weill Cornell Medical College, New York, New York
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Urology, Weill Cornell Medical College, New York, New York
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5
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Balducci M, Di Rito A, Mantini G, Manfrida S, Chiesa S, Frascino V, D'Agostino GR, Valentini V, De Bari B. Role of Radiotherapy in the Treatment of Fibrosarcoma of the Spermatic Cord: A Case Report and Review of the Literature. TUMORI JOURNAL 2018; 97:36e-8e. [DOI: 10.1177/030089161109700624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Spermatic cord sarcomas are rare. The therapeutic approach is based only on case reports and small series. The standard treatment is radical orchiectomy with wide local resection, while the role of adjuvant therapies is not clear. We present a case of fibrosarcoma of the spermatic cord treated with surgery and adjuvant radiotherapy. A review of the literature about the role of adjuvant treatments is also discussed. Case Report A 59-year-old man presented a right testicular mass of about 4 × 3 cm in size. Biopsy showed a high-grade polymorphous sarcoma, consistent with a diagnosis of poorly differentiated fibromyosarcoma. He underwent a right radical inguinal orchiectomy and adjuvant radiotherapy (total dose: 5940 cGy). During treatment the patient developed a G3 skin toxicity (RTOG score) in the inguinal fold. After a follow-up of 57 months, he is alive and without evidence of local or distant recurrence. No late toxicity was noted. Conclusion The optimal adjuvant management of spermatic cord sarcoma is still uncertain. Looking at the literature, it seems that adjuvant radiotherapy can improve locoregional control and disease-free survival without additional late toxicity.
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Affiliation(s)
- Mario Balducci
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Alessia Di Rito
- Service de Radiothérapie, Centre Medical de Forcilles, Ferolles-Attilly, France
| | - Giovanna Mantini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Stefania Manfrida
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Silvia Chiesa
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Vincenzo Frascino
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | | | - Vincenzo Valentini
- Radiation Oncology Service, Bioimages and Radiological Science Department, Catholic University, Rome, Italy
| | - Berardino De Bari
- Service de Radiothérapie-Oncologie, Centre Hospitalier Lyon-Sud, Pierre Benite, France
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6
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Abstract
The paratesticular scrotal contents consist of the spermatic cord, epididymis, and fascia, which originate from the embryologic descent of the testis through the abdominal wall. Historically, the primary diagnostic modality has been high-resolution ultrasound. Magnetic resonance imaging (MRI) is an alternative imaging option. Both contrast MRI and diffusion weighted imaging can assist in differentiating between benign and malignant lesions. Unlike the testis which most disease processes are malignant, a wide spectrum of benign disease processes affects the paratesticular region either in isolation or as part of a contiguous disease process from adjacent organs. The familiarity with the epidemiology, pathogenesis, and imaging features can aid the radiologic diagnoses and guide appropriate clinical management. In this article, we review the ultrasound and MR characteristics of various paratesticular pathologies.
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7
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Verghese M, Hwang J. Specific Surgical Topics: A Multidisciplinary Management of Paratesticular Sarcomas in Adults. Sarcoma 2017. [DOI: 10.1007/978-3-319-43121-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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8
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Hugar LA, Quiroga-Garza GM, Davies BJ, Hrebinko RL, Tran T, Jacobs BL. Molecular Cytogenetics as a Diagnostic Aid for Primary Liposarcoma of the Spermatic Cord. Clin Genitourin Cancer 2016; 15:e83-e89. [PMID: 27666164 DOI: 10.1016/j.clgc.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Lee A Hugar
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ronald L Hrebinko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Thu Tran
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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9
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Zolotareva EV, Andreeva YY, Frank GA, Rodionov VI. [Liposarcoma of the spermatic cord]. Arkh Patol 2015; 77:41-50. [PMID: 26226781 DOI: 10.17116/patol201577341-50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper reviews the literature on primary paratesticular tumors. It describes the classification, brief characteristics of liposarcomas and the morphological pattern of the tumor with an immunohistochemical profile. A clinical case of differentiated liposarcoma of the spermatic cord with myxoid and rhabdomyoblastic differentiation is depicted in a 61-year-old man.
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Affiliation(s)
- E V Zolotareva
- Department of Pathologic Anatomy, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia
| | - Yu Yu Andreeva
- Department of Pathologic Anatomy, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia
| | - G A Frank
- Department of Pathologic Anatomy, Russian Medical Academy of Postgraduate Education, Ministry of Health of Russia
| | - V I Rodionov
- Medical Center on the Botkinsky, OOO 'MRT Azbuka Zdorovia' (Health Alphabet MRI), Moscow
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10
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Matias M, Carvalho M, Xavier L, Teixeira JA. Paratesticular sarcomas: two cases with different evolutions. BMJ Case Rep 2014; 2014:bcr-2014-205808. [PMID: 25145896 DOI: 10.1136/bcr-2014-205808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paratesticular sarcomas are rare and account for less than 1% of all adult sarcomas. Intrascrotal tumours can be testicular or paratesticular, paratesticular tumours being rarer (7-10%). Only 30% of paratesticular tumours are malignant and 90% of these are sarcomas. Histological subtypes include leiomyosarcoma, rhabdomyosarcoma, liposarcoma and undifferentiated high-grade pleomorphic sarcoma. Recurrence is frequent in this type of tumour and can occur years from initial diagnosis. These reports show two cases of paratesticular sarcoma with very distinct evolutions. The first case concerns a patient who presented with low-grade leiomyosarcoma with two local recurrences treated with surgery, and distance recurrence with cutaneous, subcutaneous, pulmonary and hepatic metastasis 30 years after surgery of the primary tumour. The second case reports of a patient who presented with high-grade myxoid liposarcoma with local and distance recurrence 3 years after surgery of the primary tumour, which progressed after chemotherapy; the patient died 7 months after diagnosis of recurrence.
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Affiliation(s)
- Margarida Matias
- Department of Medical Oncology, Hospital Garcia de Orta, Almada, Portugal
| | - Miguel Carvalho
- Department of Urology, Hospital Garcia de Orta, Almada, Portugal
| | - Luisa Xavier
- Department of Medical Oncology, Hospital Garcia de Orta, Almada, Portugal
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11
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High grade myofibroblastic sarcoma of paratesticular soft tissues. Case Rep Oncol Med 2014; 2014:768379. [PMID: 25177505 PMCID: PMC4142550 DOI: 10.1155/2014/768379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022] Open
Abstract
Tumors of the paratesticular region most often arise from the soft tissue surrounding the spermatic cord and the epididymis or from the soft tissue (dartos muscle) of the scrotal wall. Paratesticular tumors, despite their rarity, present a high incidence of malignancy (30%), and the therapeutic approach of choice is surgical resection with negative margin. The grade, the histology type, the presence of metastases during the diagnosis, the size of the tumor, the age of the patients, and the surgical margins are all important prognostic factors. We present a case report of a 86-year-old patient with a high grade paratesticular and scrotum sarcoma of soft tissues which was presented as a hard painful mass of the scrotum. The patient was subjected to high ligation of the spermatic cord and received no further treatment and 6 months after the operation no local or systematic recurrence was observed.
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12
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A rare case of paratesticular leiomyosarcoma. Case Rep Urol 2014; 2014:715395. [PMID: 24744951 PMCID: PMC3972873 DOI: 10.1155/2014/715395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 02/03/2014] [Indexed: 12/01/2022] Open
Abstract
Paratesticular leiomyosarcomas are rare and can lead to significant morbidity and mortality, if inadequately diagnosed or treated. We present a case of paratesticular leiomyosarcoma in an 88-year-old man presenting with a left scrotal mass with ultrasound revealing that the mass is extratesticular. Left radical orchidectomy was performed and pathological examination of the resected specimen confirmed the diagnoses of high grade leiomyosarcoma with surgical margins clear of tumour. The patient was free of metastatic disease on further imaging and has been disease-free for 18 months. A review of the literature regarding paratesticular leiomyosarcoma presentation, diagnosis, and treatment is also discussed.
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13
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Rodríguez D, Barrisford GW, Sanchez A, Preston MA, Kreydin EI, Olumi AF. Primary spermatic cord tumors: disease characteristics, prognostic factors, and treatment outcomes. Urol Oncol 2013; 32:52.e19-25. [PMID: 24239475 DOI: 10.1016/j.urolonc.2013.08.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Experience with management of spermatic cord tumors (SCTs) is uncommon. We utilized a large population-based cancer registry to characterize the demographic, pathological, treatment characteristics, and outcomes of SCTs. MATERIAL AND METHODS The Surveillance, Epidemiology, and End Results database (1973-2007) was queried. RESULTS From the database, 362 patients were identified with SCT. The annual incidence of SCT was 0.3 cases per million and did not change over time. The most common histologic types were liposarcoma (46%), leiomyosarcoma (20%), histiocytoma (13%), and rhabdomyosarcoma (9%). The median age of diagnosis for rhabdomyosarcomas was (26.3 y), whereas for other SCTs, it was (64.7 y) (P<0.001). On multivariate analysis, a worse outcome was observed with undifferentiated tumor grade, distant disease, positive lymph nodes, and leiomyosarcoma or histiocytoma cell histology. CONCLUSION We describe the largest cohort of SCT studied to date. Liposarcoma was most common, while leiomyosarcoma and histiocytoma histologic subtypes were observed to be the most aggressive. Multivariate analysis revealed that tumor grade, stage, histologic type, and lymph node involvement were independently predictive of prognosis.
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Affiliation(s)
- Dayron Rodríguez
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Glen W Barrisford
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Alejandro Sanchez
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Mark A Preston
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Evgeniy I Kreydin
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Aria F Olumi
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA.
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14
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Adult inguinoscrotal sarcomas: outcome analysis of 21 cases, systematic review of the literature and meta-analysis. World J Urol 2013; 32:445-51. [DOI: 10.1007/s00345-013-1124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022] Open
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15
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Abstract
Primary spermatic cord tumors are rare yet clinically significant urologic lesions that affect patients of all ages. They are the most common tumors of the paratesticular region and generally present as asymptomatic, slow growing, firm, palpable paratesticular masses. Although most of them are benign comprised primarily of lipomas, approximately 25% are potentially life-threatening malignant tumors. The most common reported malignant histological types include liposarcomas, leiomyosarcomas, rhabdomyosarcomas, malignant fibrous histiocytoma, and fibrosarcomas. Management of these malignant tumors has been difficult because of their rarity, therefore there is little consensus regarding optimal surgical and adjunctive treatment strategies. It is recommended that radiological techniques such as scrotal ultrasound (US), computed tomography, and magnetic resonance be used to evaluate these masses before surgery. The curative treatment of choice is radical orchiectomy with high cord ligation and wide excision of surrounding soft tissue structures within the inguinal canal. Patients with inadequately resected disease should undergo a reoperative procedure for wide inguinal re-resection. Retroperitoneal lymphadenectomy is recommended when there is preoperative evidence of retroperitoneal lymph node metastasis and as an adjuvant treatment for rhabdomyosarcomas since they have a higher propensity for lymphatic spread. Adjuvant treatments, such as radiotherapy and chemotherapy, have shown little efficacy, except in the management of patients with local recurrence or high-grade rhabdomyosarcomas. Long-term follow up is recommended given their high recurrence rates.
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16
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Abstract
Spermatic cord sarcomas (SCS) are very infrequent and sometimes misdiagnosed malignancies. Moreover, their optimal management remains undefined with ongoing controversy about the indications for adjuvant therapy. Histologically, liposarcomas are the most common type. Osteosarcoma is rarely observed in this location and combined tumours with this component have not been described. We present a case of SCS with mixed differentiation with both liposarcoma and osteosarcoma elements.
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17
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Ruiz Liso J, Pardo López M, Vaillo Vinagre A, Gutiérrez Martín A, Bermúdez Villaverde R, Ruiz García J. [Long-term paratesticular leiomyosarcoma. Conceptual and literature review]. Actas Urol Esp 2008; 32:727-36. [PMID: 18788490 DOI: 10.1016/s0210-4806(08)73922-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION To know the incidence and clinical and pathologic characteristics of the paratesticular leiomyosarcoma (LMS) with the contribution of a case of long evolution, studying the histopathologic criteria that must be valued for this type of tumours. MATERIAL AND METHODS A 73-year-old patient includes for study with scrotal tumour present left side for 30 months. Histopathologic and imunohistochemical study is realized. Of equal form there is realized a bibliographical search of this type of tumours and their different subtypes across Medline and of not index-linked search. RESULTS Our case is the second of greater evolution of international literature, first in greater of 60 years and one of those of smaller mitotic index (1 x 50 cga). Nevertheless, his atipia, tumorlike necrosis next to 50% of the injury and its pleomorphic properties, as well as his inmunophenotypic characterization corresponds with a well differentiated LMS, degree 1 (French Federation Cancer). We have found only 107 published cases of this type of sarcomas, of them 5 in our country, which gives to a profile of the low incidence of these tumours, that within sarcomas 1% do not reach. We included the clinical and pathologic profile of such. CONCLUSIONS The long evolution of a paratesticular tumour and the absence of metastasis does not exclude its malignancy. The low incident of the LMSs in this location, implies that a protocol of actuation validate for such does not exist. We considered of great importance, its creation on the part of urologist, oncologists, radiologists and pathologists like he took control of located in retroperitoneal cavity and deep soft tissues.
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18
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Enoch S, Wharton SM, Murray DS. Management of leiomyosarcomas of the spermatic cord: the role of reconstructive surgery. World J Surg Oncol 2005; 3:23. [PMID: 15860129 PMCID: PMC1097762 DOI: 10.1186/1477-7819-3-23] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2005] [Accepted: 04/28/2005] [Indexed: 01/09/2023] Open
Abstract
Background Leiomyosarcomas (LMS) of the spermatic cord are extremely rare. Radical inguinal orchiectomy and high ligation of the cord is the standard primary surgical procedure. The extent of surrounding soft tissue excision required and the precise role of adjuvant radiotherapy, however, remains unclear. In addition, recurrence is a commonly encountered problem which might necessitate further radical excision of adjacent soft tissues. Methods This article reviews the pathophysiology of spermatic cord leiomyosarcomas (LMS), and discusses the various reconstructive surgical options available to repair the inguinal region and the lower anterior abdominal wall after excision of the tumour and the adjacent soft tissues. Results There is paucity of literature on LMS of spermatic cord. The majority of paratesticular neoplasms are of mesenchymal origin and up to 30% of these are malignant. In adults, approximately 10% of spermatic cord sarcomas are LMS. Approximately 50% of these tumours recur loco-regionally following definitive surgery; however, the incidence decreases if resection is followed by adjuvant radiotherapy. Conclusion It is therefore important to achieve negative histological margins during the primary surgical procedure, even if adjuvant radiotherapy is instituted. If extensive resection is required, either during the primary procedure or following recurrence, reconstructive surgery may become necessary. This article reviews the pathophysiology of spermatic cord LMS, the reasons for recurrence, and discusses the management options including the role of reconstructive surgery.
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Affiliation(s)
- Stuart Enoch
- West Midlands Regional Centre for Plastic and Reconstructive Surgery, Selly Oak Hospital, University Hospital of Birmingham, – B29 6JD, UK
- Wound Healing Research Unit, University Department of Surgery, University of Cardiff/University Hospital of Wales, Cardiff, – CF14 4UJ, UK
| | - Simon M Wharton
- West Midlands Regional Centre for Plastic and Reconstructive Surgery, Selly Oak Hospital, University Hospital of Birmingham, – B29 6JD, UK
| | - Douglas S Murray
- West Midlands Regional Centre for Plastic and Reconstructive Surgery, Selly Oak Hospital, University Hospital of Birmingham, – B29 6JD, UK
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Liberti M, Perugia G, Masala D, Teodonio S, Di Viccaro D, Iaboni L. Myxoid Liposarcoma of the Spermatic Cord. Urologia 2005. [DOI: 10.1177/039156030507200144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The myxoid liposarcoma, a rare form of spermatic cord liposarcoma, is a neoplasia of adult men which arise from adipose tissue, with a slow and subdolous growth, showing good prognosis and low incidence of local or distant recurrence. The case came at our attention is the sixteenth described in literature. Orchifunicolectomy is the gold standard therapy, although in some cases in which this kind of surgery is not radical, adjuvant inguinal or retroperithoneal and pelvic nodes radiotherapy should be taken in consideration.
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Affiliation(s)
- M. Liberti
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - G. Perugia
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - D. Masala
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - S. Teodonio
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - D. Di Viccaro
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
| | - L. Iaboni
- Dipartimento di Urologia “U. Bracci”, Università degli Studi di Roma “La Sapienza”, Roma
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20
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Mack LA, Temple WJ, DeHaas WG, Schachar N, Morris DG, Kurien E. Groin soft tissue tumors?a challenge for local control and reconstruction: A prospective cohort analysis. J Surg Oncol 2004; 86:147-51. [PMID: 15170653 DOI: 10.1002/jso.20058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Groin soft tissue tumors are associated with high local recurrence rates of 16-48% and postoperative complications in 40-68%. Neoadjuvant chemoradiation and aggressive reconstructive techniques were utilized to improve local control and complication rates in this challenging area. METHODS Nine patients in this prospective series were treated with neoadjuvant chemoradiation (30 mg IV doxorubicin x 3d followed by 300 cGy/d x 10d) followed by surgery and two patients received radiation (5,000 cGy with tissue spacer) followed by surgery for tumors with a pelvic/retroperitoneal component. Surgery included resection plus reconstruction of the abdominal wall, myocutaneous flaps for large defects, and vascular reconstruction as necessary. RESULTS The 11 consecutive patients presented with Stage I (30%), II (40%), or III (30%) disease. Four patients (36%) were operated on for possible incarcerated hernia prior to referral and two (18%) presented with recurrent tumors. Pathology included 10 sarcomas and 1 desmoid tumor; tumor grade was low (30%), moderate (40%), or high (30%). Local control (mean follow-up 55 months; minimum follow-up 36 months) and limb salvage rate was 100%. Minor wound complications not requiring re-operation occurred in three patients, lymphedema in two, and there were no postoperative hernias. CONCLUSIONS Preoperative therapy provides excellent local control of groin soft tissue tumors. Current surgical techniques allow extensive resection with limb salvage, dependable primary wound healing and long-term integrity of the abdominal wall.
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Affiliation(s)
- L A Mack
- Department of Surgery/Oncology, University of Calgary, Calgary, Alberta, Canada
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21
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Coleman J, Brennan MF, Alektiar K, Russo P. Adult spermatic cord sarcomas: management and results. Ann Surg Oncol 2003; 10:669-75. [PMID: 12839852 DOI: 10.1245/aso.2003.11.014] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND We present a 20-year surgical experience with spermatic cord sarcoma, describe prognostic features, and evaluate the results of surgical and adjunctive treatments. METHODS Forty-seven patients were identified from an institutional database. Disease-free survival was calculated, and prognostic factors such as tumor grade, size, extent of operation, and adjuvant therapy were analyzed. RESULTS The median patient age was 58 years (range, 16-83 years), and the median follow-up was 51 months (range,.5-226 months). The most common tumor types included liposarcoma (51%), leiomyosarcoma (19%), embryonal rhabdomyosarcoma (13%), and malignant fibrous histiocytoma (11%). Twenty-nine (62%) patients had high-grade tumors, 21 (45%) were treated with adjuvant radiation, and 9 (19%) received chemotherapy. The overall 5- and 10-year disease-specific survival was 75% and 55%, respectively. No specific prognostic factors were identified for recurrence or disease-free survival. In 21 patients who underwent reoperative wide resection after a prior incomplete resection, a trend toward improved disease-free survival was noted (P <.059). Of these, six (29%) had residual viable sarcoma. We could not demonstrate a therapeutic effect of adjuvant radiation or chemotherapy. CONCLUSIONS We demonstrated that aggressive surgical strategies, including reoperative wide resection, significantly decrease local recurrence and may improve disease free-survival in select patients with spermatic cord sarcoma.
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Affiliation(s)
- Jonathan Coleman
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Affiliation(s)
- B Khoubehi
- Department of Urology, Wexham Park Hospital, London, UK.
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23
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Girotto JA, Shaikh AY, Freeswick PD, Todd LB, Harmon JW. Diverticulitis presenting as a strangulated inguinal hernia. Dig Surg 2002; 19:67-70. [PMID: 11961361 DOI: 10.1159/000052011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIM Inguinal hernia is a common diagnosis for patients presenting with a painful groin mass; other potentially dangerous diagnoses may mimic a groin hernia. We present 3 unusual cases of diverticulitis with perforation. The resulting abscess presented clinically as an atypical strangulated inguinal hernia. METHODS/RESULTS From July 1, 1999, to June 30, 2000, 344 patients were admitted to the Johns Hopkins Bayview Medical Center with the diagnosis of diverticulitis. Of these patients, 44 (12.8%) required surgical intervention. We report here 3 cases in that academic year of diverticulitis complicated by perforation and abscess formation that presented as atypical strangulated inguinal hernias. In addition to being rare and difficult to diagnose, such cases illustrate that a tender inguinal mass may not represent a hernia. CONCLUSIONS The diagnosis of strangulated inguinal hernias remains primarily one of clinical suspicion. Radiologic and laboratory studies should augment, not replace, one's clinical diagnosis. In addition, the differential diagnosis of inguinal masses is discussed.
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Affiliation(s)
- John A Girotto
- Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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24
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Urdiales-Viedma M, Fernández-Rodríguez A, Martos-Padilla S, Pichardo Pichardo S. [Malignant fibrohistiocytoma of the spermatic cord]. Actas Urol Esp 2002; 26:581-4. [PMID: 12448177 DOI: 10.1016/s0210-4806(02)72832-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A malignant fibrous histiocytoma (MFH) of the spermatic cord is presented and a review of the literature has been performed. The patient here presented survived for eight years and is probably cured of his tumour. In general, MFHs of the spermatic cord have a good prognosis, even when they attain a big size. They have a worse evolution when satellite nodules are present. Although more experience is needed. It is our feeling, that a spermatic MFH smaller than 8 cm, without any satellite nodule and less than 25% nuclei positive to MIB-1 (cell proliferation marker), may have a conservative therapy, including only tumorectomy.
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Affiliation(s)
- M Urdiales-Viedma
- Sección de Anatomía Patológica, Hospital San Juan de la Cruz, Ubeda, Jaén
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Ballo MT, Zagars GK, Pisters PW, Feig BW, Patel SR, von Eschenbach AC. Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol 2001; 166:1306-10. [PMID: 11547063 DOI: 10.1016/s0022-5347(05)65758-8] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE We evaluate the outcome, clarify the patterns of failure and suggest treatment strategies for sarcoma in the spermatic cord. MATERIALS AND METHODS Between 1956 and 1998, 32 patients with spermatic cord sarcoma were treated at M. D. Anderson Cancer Center. A retrospective review of disease outcome, patterns of relapse and patient survival was performed. RESULTS Histological subtypes of sarcoma were malignant fibrous histiocytoma in 12 patients, leiomyosarcoma in 6, liposarcoma in 8 and other subtypes in 6. All except 2 patients underwent radical orchiectomy with or without additional resection to achieve negative margins. Margins were microscopically negative in 29 cases and positive in 3. There were 3 patients who received adjuvant radiation to the surgical site. With a median followup of 9 years the 10 and 15-year actuarial local control, distant metastasis-free and overall survival rates were 72% and 61%, 85% and 85%, and 63% and 52%, respectively. The major pattern of failure was local recurrence that occurred in 8 of the 12 patients in whom disease relapsed and was the sole site of relapse in 7. Pelvic nodes had relapsed in 2 patients and para-aortic nodes in 1. Hematogenous metastases had developed in 4 patients. Of the 7 cases of disease that recurred locally only 3 were salvaged. No relapse occurred in the 3 patients treated with combined surgery and radiation. CONCLUSIONS Spermatic cord sarcoma has a high propensity for local recurrence after surgery. Nodal relapse is less frequent than commonly believed. Because of the relatively high local failure rate seen in surgery alone and durable local control noted in 3 patients treated with surgery plus radiotherapy, combined modality treatment should be considered in those with spermatic cord sarcoma who are believed to be at high risk for local failure.
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Affiliation(s)
- M T Ballo
- Department of Radiation Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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Zografos G, Papadimitriou C, Kouerinis I, Messaris E, Petraki K, Androulakis G. An adult patient with a mixed germ cell tumor of the spermatic cord. Urology 2000; 55:436. [PMID: 10754174 DOI: 10.1016/s0090-4295(99)00545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tumors of the spermatic cord are very rare, and approximately one half of all primary spermatic cord tumors are malignant. We report the presentation and treatment of an adult (36-year-old) patient with a mixed germ cell tumor that originated in the spermatic cord. No similar cases of mixed tumors of the spermatic cord in adults have been reported.
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Affiliation(s)
- G Zografos
- First Department of Propaedeutic Surgery, University of Athens, Hippocration Hospital, Athens, Greece
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