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Calcified Cyst of Spermatic Cord: Case Reportgeorge
CALCIFIED CYST OF SPERMATIC CORD CASE REPORT GEORGE C. BURR From the Urological Service, Detroit Receiving Hospital Detroit, Michigan
Tumors of the cord are rare in comparison to those of the testicle; so much so that they are seldom described in textbooks or current literature. It is often necessary to differentiate them from encysted hydrocele, spermatocele or growths involving the tunica vaginalis, appendix testis, paradidymis or testicle itself. In 1909, Patel and Chalier (1), after a thorough search of the literature, found but 89 cases of solid tumor arising in the cord itself and called attention to the relative infrequency of malignancies in their group compared with those of the testicle. Lipoma was the most frequent, then in order came sarcoma, fi.brosarcoma, mixed tumors, plain fibroma and myoma in order of frequency, with but one case of carcinoma included in their report. Hinman and Gibson (2) were able to add 9 cases to the literature, including one of pure seminoma which was in no way connected with the testicle. In 1926, Rubaschow (3) was able to find 183 authentic cases of spermatic cord tumors and MacKenzie and Ratner (4) were able to raise the total to date, to 198 cases of cord tumors, included in which were 11 connective tissue cysts and 1 cavernoma. The case herein described was that of an adult male, colored, thirtyfive years of age. Past history, negative. There was no history of injury in the region of the external genitalia. Patient recalls the presence of a mass about the size of a large walnut for eight or ten years above the right testicle. He is not sure as to whether or not the mass has been there since childhood. It has been painless, and so far as he knows has not increased in size in several years. Examination revealed a mass of the size and shape just mentioned. The tumor was of stony hardness and was not painful. It was not connected to the tunica vaginalis, 259
260
GEORGE C. BURR
I! Iijllllllllljllli II Illjll II! II iljll lllillll 7
FIG. 1.
VIEW
OF
EXTERIOR
OF
al
91
10
.11
II Ill
BISECTED CALCIFIED GROWTH WITH SCALE IN INCHES
FIG. 2.
,
VIEW OF INTERIOR OF BISECTED GROWTH
CALCIFIED CYST OF SPERMATIC CORD
261
testicle, epididymis, in so far as could be learned from examination. The man's physical condition was otherwise normal. The blood chemistry, Wassermann and Kahn, blood counts and urinalysis were all negative. Operation was carried out January 28, 1932 and a tumor mass of stony hardness was removed without difficulty from the spermatic cord. No difficulty was encountered in preserving the blood supply to the testicle and epididymis. There was no communication or connection with the tunica vaginalis, epididymis or testicle and the origin was from the intercolumnar and cremasteric fascias. No communication or origin could be traced to a non-obliterated vaginal process. The wound was closed in the usual manner. An attempt was made to incise the tumor mass, but this could not be accomplished with the scalpel. The mass was then taken to the laboratory where it was divided by means of a saw. The divided mass showed a thick calcified exterior, containing a dark brown thick gelatinous material which gave a strongly positive benzidin test and microscopic examination showed the presence of cholesterin. The fibrous incrustation and secondary deposition of phosphate and carbonate of lime apparently had formed an unusually thick stonelike capsule sufficiently strong to limit the growth of the cyst beyond its confines.
1706 David Whitney Building, Detroit, Michigan REFERENCES (1) (2) (3) (4)
PATEL, M., AND CHALIER, A.: Rev. de Chir., 1909, xxxix and xl, 88. HINMAN, F., AND GrnsoN, T. E.: Arch. Surg., 1924, viii, 100. RuBASCHOw, A.: Zeitschr. f. Urol. Chir., 1926, xxi, 42. MAcKENzrE, D. W., AND RATNER, M.: Canad. Med. Assoc. Jour., 1932, xxvii, No. 5,477.
Tumors of the cord are rare in comparison to those of the testicle; so much so that they are seldom described in textbooks or current literature. It is often necessary to differentiate them from encysted hydrocele, spermatocele or growths involving the tunica vaginalis, appendix testis, paradidymis or testicle itself. In 1909, Patel and Chalier (1), after a thorough search of the literature, found but 89 cases of solid tumor arising in the cord itself and called attention to the relative infrequency of malignancies in their group compared with those of the testicle. Lipoma was the most frequent, then in order came sarcoma, fi.brosarcoma, mixed tumors, plain fibroma and myoma in order of frequency, with but one case of carcinoma included in their report. Hinman and Gibson (2) were able to add 9 cases to the literature, including one of pure seminoma which was in no way connected with the testicle. In 1926, Rubaschow (3) was able to find 183 authentic cases of spermatic cord tumors and MacKenzie and Ratner (4) were able to raise the total to date, to 198 cases of cord tumors, included in which were 11 connective tissue cysts and 1 cavernoma. The case herein described was that of an adult male, colored, thirtyfive years of age. Past history, negative. There was no history of injury in the region of the external genitalia. Patient recalls the presence of a mass about the size of a large walnut for eight or ten years above the right testicle. He is not sure as to whether or not the mass has been there since childhood. It has been painless, and so far as he knows has not increased in size in several years. Examination revealed a mass of the size and shape just mentioned. The tumor was of stony hardness and was not painful. It was not connected to the tunica vaginalis, 259
260
GEORGE C. BURR
I! Iijllllllllljllli II Illjll II! II iljll lllillll 7
FIG. 1.
VIEW
OF
EXTERIOR
OF
al
91
10
.11
II Ill
BISECTED CALCIFIED GROWTH WITH SCALE IN INCHES
FIG. 2.
,
VIEW OF INTERIOR OF BISECTED GROWTH
CALCIFIED CYST OF SPERMATIC CORD
261
testicle, epididymis, in so far as could be learned from examination. The man's physical condition was otherwise normal. The blood chemistry, Wassermann and Kahn, blood counts and urinalysis were all negative. Operation was carried out January 28, 1932 and a tumor mass of stony hardness was removed without difficulty from the spermatic cord. No difficulty was encountered in preserving the blood supply to the testicle and epididymis. There was no communication or connection with the tunica vaginalis, epididymis or testicle and the origin was from the intercolumnar and cremasteric fascias. No communication or origin could be traced to a non-obliterated vaginal process. The wound was closed in the usual manner. An attempt was made to incise the tumor mass, but this could not be accomplished with the scalpel. The mass was then taken to the laboratory where it was divided by means of a saw. The divided mass showed a thick calcified exterior, containing a dark brown thick gelatinous material which gave a strongly positive benzidin test and microscopic examination showed the presence of cholesterin. The fibrous incrustation and secondary deposition of phosphate and carbonate of lime apparently had formed an unusually thick stonelike capsule sufficiently strong to limit the growth of the cyst beyond its confines.
1706 David Whitney Building, Detroit, Michigan REFERENCES (1) (2) (3) (4)
PATEL, M., AND CHALIER, A.: Rev. de Chir., 1909, xxxix and xl, 88. HINMAN, F., AND GrnsoN, T. E.: Arch. Surg., 1924, viii, 100. RuBASCHOw, A.: Zeitschr. f. Urol. Chir., 1926, xxi, 42. MAcKENzrE, D. W., AND RATNER, M.: Canad. Med. Assoc. Jour., 1932, xxvii, No. 5,477.