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中华疝和腹壁外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 571 -574. doi: 10.3877/cma.j.issn.1674-392X.2021.06.007

临床论著

腹股沟疝合并精索恶性肿瘤的临床及影像学诊断
万超1, 苏姗1, 申英末2, 唐华1,()   
  1. 1. 100043 北京,首都医科大学附属北京朝阳医院超声科
    2. 100043 北京,首都医科大学附属北京朝阳医院疝和腹壁外科
  • 收稿日期:2020-01-28 出版日期:2021-12-20
  • 通信作者: 唐华

Clinical and imaging diagnosis of inguinal hernia with spermatic cord malignant tumor

Chao Wan1, Shan Su1, Yingmo Shen2, Hua Tang1,()   

  1. 1. Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
    2. Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
  • Received:2020-01-28 Published:2021-12-20
  • Corresponding author: Hua Tang
引用本文:

万超, 苏姗, 申英末, 唐华. 腹股沟疝合并精索恶性肿瘤的临床及影像学诊断[J]. 中华疝和腹壁外科杂志(电子版), 2021, 15(06): 571-574.

Chao Wan, Shan Su, Yingmo Shen, Hua Tang. Clinical and imaging diagnosis of inguinal hernia with spermatic cord malignant tumor[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(06): 571-574.

目的

探讨腹股沟疝合并精索恶性肿瘤临床和影像学特征。

方法

回顾性分析2000年8月至2019年8月首都医科大学附属北京朝阳医院收治的腹股沟疝合并精索恶性肿瘤19例患者的临床、影像学与病理资料,结合相关文献复习及对其临床诊治进行讨论。

结果

患者均以单侧腹股沟疝合并精索肿物收入院,行患侧精索肿物广泛性切除术。术后病理诊断分别为:精索高分化脂肪肉瘤8例,精索去分化脂肪肉瘤7例,精索平滑肌肉瘤4例。病理回报恶性肿瘤后患者转泌尿外科进一步接受根治性睾丸切除术。除1例患者术后随访1年后复发行放疗外,余18例患者随访至今均无复发。

结论

精索恶性肿瘤是一种少见的疾病,影像学及实验室检查多无特异性。术前诊断困难,推荐的治疗方法为根治性睾丸切除术及局部肿瘤广泛性切除术。

Objective

To explore the clinical and imaging features of inguinal hernia with malignant tumor of spermatic cord.

Methods

The clinical, imaging and pathological data of 19 cases of inguinal hernia with malignant tumor of spermatic cord in Beijing Chaoyang Hospital, Capital Medical University from August 2000 to August 2019 were analyzed retrospectively. The related literatures were reviewed and clinical diagnosis and treatment were discussed.

Results

All patients were admitted to the hospital with unilateral inguinal hernia with spermatic cord tumors, and underwent extensive resection of the tumor. The postoperative pathological diagnosis was: 8 well-differentiated liposarcoma of the spermatic cord (well differentiated liposarcoma, WDLS), 7 dedifferentiated liposarcoma of the spermatic cord (dedifferentiated liposarcoma, DDLS), 4 leiomyosarcoma of the spermatic cord (leiomyosarcoma, LMS). After pathology reporting of malignant tumor, all patients were transferred to the urological department for further radical orchiectomy. Except for 1 patient who accepted radiotherapy due to recurrence one year after the operation, no recurrence was found in the remaining 18 patients during follow-up.

Conclusion

Malignant tumor of spermatic cord is a rare disease with nonspecific imaging and laboratory examination. Preoperative diagnosis is difficult. The recommended treatment for this disease is radical orchiectomy and extensive resection of local tumor.

图1 左侧阴囊内探及8.7 cm×6.5 cm×4.9 cm实性高回声团,回声欠均,形态规则,边界清,未见明显血流信号,加压探头大小未见明显变化,团块与左侧睾丸边界清
图2 该患者双侧睾丸大小、形态未见明显异常。
[1]
Cheng YC, Chou YH, Chiou HJ, et al. Liposarcoma of the spermatic cord: a report of two cases and a review of the literature[J]. J Med Ultrasound, 2004, 12(4): 125-130.
[2]
Demirci U, Buyukberber S, Cakir A, et al. Synchronous testicular liposarcoma and prostate adenocarcinoma: a case report[J]. Cases J, 2010, 3(1): 27.
[3]
Chintamani , Tandon M, Khandelwal R, et al. Liposarcoma of the spermatic cord: a diagnostic dilemma[J]. JRSM Short Rep, 2010, 1(6): 49.
[4]
Gregorio MD, D'Hondt L, Lorge F, et al. Liposarcoma of the spermatic cord: an infrequent pathology[J]. Case Rep Oncol, 2017, 10(1): 136-142.
[5]
Fagundes MA, Zietman AL, Althausen AF, et al. The management of spermatic cord sarcoma[J]. Cancer, 1996, 77(9): 1873-1876.
[6]
Kryvenko ON, Rosenberg AE, Merce J, et al. Dedifferentiated liposarcoma of the spermatic cord: a series of 42 cases[J]. Am J Surg Pathol, 2015, 39(9): 1219-1225.
[7]
Ushida H, Johnin K, Koizumi S, et al. Liposarcoma of the spermatic cord in the left scrotum and inguinal region: a case report[J]. Hinyokika Kiyo, 2000, 46(5): 349-351.
[8]
Malizia M, Brunocilla E, Bertaccini A, et al. Liposarcoma of the spermatic cord: description of two cases and review of the literature[J]. Arch Ital Urol Androl, 2005, 77(2): 115-117.
[9]
Kyratzi I, Lolis E, Antypa E, et al. Imaging features of a huge spermatic cord leiomyosarcoma: review of the literature[J]. World J Radiol, 2011, 3(4): 114-119.
[10]
Yamamichi G, Nakata W, Yamamoto A, et al. Liposarcoma of the spermatic cord associated with scrotum lipoma: A case report and review of the literature[J]. Urol Case Rep, 2018, 17(C): 114-116.
[11]
S Aslam S, Dow-Mu K, Husband JE. The role of imaging in the diagnosis, staging, and management of testicular cancer[J]. AJR Am J Roentgenol, 2008, 191(2): 387-395.
[12]
Dogra VS, Gottlieb RH, Oka M, et al. Sonography of the scrotum.[J]. Invest Radiol, 1983, 18(2): 112-121.
[13]
Benson CB, Doubilet PM, Richie JP. Sonography of the male genital tract[J]. AJR Am J Roentgenol, 1989, 153(4): 705-713.
[14]
Voyvoda N, Voyvoda B, Çamurdan O. The role of imaging in testicular cancer diagnosis, staging and follow-up[J]. Ueroonkoloji Buelteni, 2017, 16(2): 51-56.
[15]
Flohr TG, Schaller S, Stierstorfer K, et al. Multi-detector row CT systems and image-reconstruction techniques[J]. Radiol, 2005, 235(3): 756-773.
[16]
Thurnher S, Hricak H, Carroll PR, et al. Imaging the testis: comparison between MR imaging and US[J]. Radiology, 1988, 167(3): 631-636.
[17]
Schultz-Lampel D, Bogaert G, Thüroff JW, et al. MRI for evaluation of scrotal pathology[J]. Urol Res, 1991, 19(5): 289-292.
[18]
Johnson JO, Mattrey RF, Phillipson J. Differentiation of seminomatous from nonseminomatous testicular tumors with MR imaging[J]. AJR Am J Roentgenol, 1990, 154(3): 539-543.
[19]
Tsili AC, Constantine T, Xenofon G, et al. MRI in the histologic characterization of testicular neoplasms[J]. AJR Am J Roentgenol, 2007, 189(6): 331-337.
[20]
Pilotti S, Torre G, Della , Mezzelani A, et al. The expression of MDM2/CDK4 gene product in the differential diagnosis of well differentiated liposarcoma and large deep-seated lipoma[J]. Br J Cancer, 2000, 82(7): 1271-1275.
[21]
Saâda-Bouzid E, Burel-Vandenbos F, Ranchère-Vince D, et al. Prognostic value of HMGA2, CDK4, and JUN amplification in well-differentiated and dedifferentiated liposarcomas[J]. Mod Pathol, 2015, 28(11): 1404-1414.
[22]
Ware PL, Snow AN, Maya G, et al. MDM2 copy numbers in well-differentiated and dedifferentiated liposarcoma: characterizing progression to high-grade tumors[J]. Am J Clin Pathol, 2014, 141(3): 334-341.
[23]
Crago AM, Socci ND, Penelope DC, et al. Copy number losses define subgroups of dedifferentiated liposarcoma with poor prognosis and genomic instability[J]. Clin Cancer Res, 2012, 18(5): 1334-1340.
[24]
Coindre JM, Mariani O, Chibon F, et al. Most malignant fibrous histiocytomas developed in the retroperitoneum are dedifferentiated liposarcomas: a review of 25 cases initially diagnosed as malignant fibrous histiocytoma[J]. Mod Pathol, 2003, 16(3): 256-262.
[25]
Antoine I, Laurence B, Elisabet G, et al. Clinical and biological significance of CDK4 amplification in well-differentiated and dedifferentiated liposarcomas[J]. Clin Cancer Res, 2009, 15(18): 5696-5703.
[26]
Seung Eun L, Jin KY, Jeong KM, et al. High level of CDK4 amplification is a poor prognostic factor in well-differentiated and dedifferentiated liposarcoma[J]. Histol Histopathol, 2013, 29(1): 127-138.
[27]
Pilotti S, Torre G, Della , Lavarino C, et al. Distinct mdm2/p53 expression patterns in liposarcoma subgroups: implications for different pathogenetic mechanisms[J]. J Pathol, 2015, 181(1): 14-24.
[28]
Mariani O, Brennetot C, Coindre JM, et al. Oncogene amplification and overexpression block adipocytic differentiation in highly aggressive sarcomas[J]. Cancer Cell, 2007, 11(4): 361-374.
[29]
Snyder EL, Sandstrom DJ, Kenneth L, et al. c-Jun amplification and overexpression are oncogenic in liposarcoma but not always sufficient to inhibit the adipocytic differentiation programme[J]. J Pathol, 2010, 218(3): 292-300.
[30]
Volm M, Koomägi R. Relevance of proliferative and pro-apoptotic factors in non-small-cell lung cancer for patient survival[J]. Br J Cancer, 2000, 82(10): 1747-1754.
[31]
Dong Y, Sui L, Sugimoto K, et al. Cyclin D1-CDK4 complex, a possible critical factor for cell proliferation and prognosis in laryngeal squamous cell carcinomas[J]. Int J Cancer, 2015, 95(4): 209-215.
[32]
Ronald S, Kirsten S, Peter S, et al. Amplification pattern of 12q13-q15 genes(MDM2, CDK4, GLI) in urinary bladder cancer[J]. Oncogene, 2002, 21(16): 2476-2483.
[33]
Zhao P, Hu YC, Talbot IC. Expressing patterns of p16 and CDK4 correlated to prognosis in colorectal carcinoma[J]. World J Gastroenterol, 2003, 9(10): 2202-2206.
[34]
Ghazizadeh M, Jin E, Shimizu H, et al. Role of cdk4, p16INK4, and Rb expression in the prognosis of bronchioloalveolar carcinomas[J]. Respiration, 2005, 72(1): 68-73.
[35]
Castro IPD, Cárcer GD, Montoya G, et al. Emerging cancer therapeutic opportunities by inhibiting mitotic kinases[J]. Curr Opin Pharmacol, 2008, 8(4): 375-383.
[36]
Cormio G, Loizzi V, Carriero C, et al. Conservative management of uterine leiomyosarcoma: report of a failure[J]. Eur J Gynaecol Oncol, 2009, 30(2): 206-207.
[37]
Bozzini G, Albersen M, Romero OJ, et al. Feasibility and safety of conservative surgery for the treatment of spermatic cord leiomyosarcoma[J]. Int J Surg, 2015, 24(Pt A): 81-84.
[38]
Kinjo M, Hokamura K, Tanaka K, et al. Leiomyosarcoma of the spermatic cord. a case report and a brief review of literature[J]. Acta Pathol Jpn, 2010, 36(6): 929-934.
[39]
谢乾坤,叶军锋,柴文刚, 等. 增生性精索炎伴坏死误诊为腹股沟斜疝嵌顿一例[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(1): 68-69.
[40]
Coleman J, Brennan MF, Alektiar K, et al. Adult spermatic cord sarcomas: management and results[J]. Ann Surg Oncol, 2003, 10(6): 669-675.
[41]
Soipi S, Vucic M, Ulamec M, et al. Leiomyosarcoma of the spermatic cord with scalp metastasis: case report and literature review[J]. Coll Antropol, 2014, 38(2): 763-766.
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