Dataset Information

Inflammatory pseudotumor of the tunica albuginea and the tunica vaginalis: Case-report.

ABSTRACT: Inflammatory pseudo tumor of the tunica is rare and typically presents as long standing, painless scrotal mass. A 23-year-old man had palpable, multiple, hard scrotal masses for 3 months. Laboratory investigations were normal (including LDH, AFP, HCG). Radical inguinal orchiectomy done. Macroscopically the testis and epididymis were normal, with multiple gray nodules surrounding the testis and epididymis, attached to the tunica albuginea and vaginalis, had smooth surface, partly whorled cut surface. Histologically, the nodules were well circumscribed, consisting of fibrous tissue, with infiltration by plasma cells and mononuclear inflammatory cells, giving the diagnosis of plasma cell granulomas.

SUBMITTER: Sadeeq KJ

PROVIDER: S-EPMC6604162 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Inflammatory pseudotumor of the tunica albuginea and the tunica vaginalis: Case-report.

Sadeeq Kamiran J KJ Yaqo Rafil T RT Mohammed Ayad Ahmad AA

Urology case reports 20190626

Inflammatory pseudo tumor of the tunica is rare and typically presents as long standing, painless scrotal mass. A 23-year-old man had palpable, multiple, hard scrotal masses for 3 months. Laboratory investigations were normal (including LDH, AFP, HCG). Radical inguinal orchiectomy done. Macroscopically the testis and epididymis were normal, with multiple gray nodules surrounding the testis and epididymis, attached to the tunica albuginea and vaginalis, had smooth surface, partly whorled cut surf ...[more]

PMID: 31304094

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Project description:INTRODUCTION:In testicular torsion, ischemia time from pain onset impacts testicular salvage. A tunica albuginea fasciotomy to relieve compartment pressure followed by a tunica vaginalis flap (TVF) may enhance salvage. OBJECTIVE:To define the optimal window of ischemia time during which TVF may be most beneficial to avoid orchiectomy. STUDY DESIGN:A retrospective cohort study of males presenting with testicular torsion at a single tertiary-care institution from January, 2003 to March, 2017. Ischemia time was defined as duration of pain from onset to surgery. Because TVF would be an option to orchiectomy, and it was found that ischemia time was longer in testicles that underwent orchiectomy, matching was performed. Cases of torsion treated with TVF were matched 1:1 with cases treated with orchiectomy on age at surgery, and ischemia time. Outcomes included postoperative viability, defined as palpable testicular tissue with normal consistency, and atrophy, defined as palpable decrease in size relative to contralateral testicle. Sensitivity analyses were performed restricting to the subgroups with postoperative ultrasound, >6 months' follow-up, and additionally matching for degrees of twist. RESULTS:A total of 182 patients met eligibility criteria, of whom 49, 36, and 97 underwent orchiectomy, TVF, and septopexy alone, respectively. Median follow-up was 2.7 months; 26% of patients had postoperative ultrasound (61% of TVF group). In the orchiectomy, TVF, and septopexy groups, respectively, median ischemia times were 51, 11, and 8 h, postoperative viability rates were 0, 86, and 95%, and postoperative atrophy rates were 0, 68, and 24%. After matching, 32 patients with TVF were matched to 32 patients who underwent orchiectomy. In the TVF group, postoperative viability occurred in 95% (19/20) vs 67% (8/12) of patients with ischemia times ?24 and >24 h, respectively. Atrophy occurred in 67% (12/18) vs 83% (10/12) of these same respective patients. Sensitivity analysis by ultrasound and longer follow-up found similar viability results, although atrophy rates were higher. Additional matching for degrees of twist showed lower viability and higher atrophy rates for increasing ischemia times. DISCUSSION:Patients who presented with testicular torsion with ischemia times ?24 h and who were being considered for orchiectomy may have benefitted most from TVF, albeit at high risk of atrophy. However, for ischemia times >24 h, TVF may still have preserved testicular viability in two-thirds of cases. A limitation was short follow-up. CONCLUSION:A TVF was a valid alternative to orchiectomy for torsed testicles, albeit with high testicular atrophy rates.

Dataset Information

Inflammatory pseudotumor of the tunica albuginea and the tunica vaginalis: Case-report.

Publications

Inflammatory pseudotumor of the tunica albuginea and the tunica vaginalis: Case-report.

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