Cases reported "Genital Neoplasms, Male"

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1/14. Aggressive angiomyxoma of the scrotum.

    Aggressive angiomyxoma is a rare and nonmetastasizing soft tissue tumor of the pelvis and perineum and occurs almost exclusively in adult females. It infiltrates locally and has a high risk of local recurrence. Recommended treatment of the symptomatic patient is wide excision with tumor-free margins and close postoperative monitoring. Herein, a case of aggressive angiomyxoma in an adult male is described, which arose in the scrotum over 12 months. The tumor showed an intermediate signal on T1-weighted MRI images. Contrast-enhanced T1-weighted images showed good enhancement. Wide excision of the tumor was performed. The surgical specimen measured 7 x 5 x 5 cm in size and weighed 80 g. The tumor's surface was smooth and had a gelatinous cut surface. Grossly, it was encapsulated with a pleura-like membrane and had a finger-like projection. Microscopically, sections showed many walled vessels of various sizes, collagen fibrils, a loose myxoid background. and spindle stroma cells. MRI and CT showed the angiomatous and myxomatous nature of the tumor wall. To the authors' knowledge, this is the first report to describe MRI findings in scrotal angiomyxoma.
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2/14. Aggressive angiomyxoma of childhood: two unusual cases developed in the scrotum.

    Aggressive angiomyxoma (AAM) is a locally invasive soft tissue tumor and is predominantly found in the female pelvis and perineum. The incidence of AAM in adult and adolescent males is low, and is very rare in male children. However, two cases of AAM occurred in the scrotum of 8-year-old and 1-year-old boys. Grossly, both tumors were ill-delineated nodules showing myxoid homogenous and lobulated cut surface. The scrotum of case 2 was replaced by the exuberant mass, making a polypoid appearance. On microscopic examination, both had hypocellular myxoid stroma, spindle and stellate stromal cells, and blood vessels of various calibers. Both lesions typically showed infiltrating borders and penetrated into skin adnexa and Dartos' muscle fibers. AAM should be considered in the differential diagnosis of a scrotal mass found in childhood.
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3/14. Aggressive angiomyxoma. A report of four cases occurring in men.

    Aggressive angiomyxoma is a distinctive, locally aggressive but nonmetastasizing soft tissue tumor of the pelvic soft tissues and perineum. This rare tumor occurs almost exclusively in adult women. We report four cases occurring in adult men, one each located in the scrotum, inguinal region, spermatic cord, and pelvis. The tumors were infiltrative, and were composed of fibromyxoid matrix sparsely populated by bland-looking spindled and stellate cells with delicate cytoplasmic processes. There were haphazardly scattered small and large blood vessels, some of which exhibited hypertrophy or hyalinization of the wall. Immunohistochemically, the stromal cells stained consistently for vimentin and variably for muscle-specific actin, but not alpha-smooth muscle actin, desmin, and S-100 protein. None of the four tumors recurred in follow-up times from 11 months to 6 years, although two previously reported cases in men recurred. This uncommon tumor occurring around the genital region in men merits wider recognition because of its potential for recurrence. It should be distinguished from benign tumors with low risk of recurrence on one hand, and from malignant myxoid tumors with metastatic potential on the other.
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4/14. Aggressive angiomyxoma in a child with chronic renal failure.

    Aggressive angiomyxoma (AAM) is a rare and nonmetastasizing soft-tissue tumor predominantly found in the female pelvis and perineum. It has a high risk of local recurrence. We report the unusual case of a 15-year-old boy with an AAM presenting as a slowly enlarging scrotal mass. The patient had had chronic renal failure since 1997 and had needed hemodialysis for the previous 11 months. He presented with a 12-month history of a nontender soft mass in the right scrotum. Ultrasound examination revealed a solid mass in the scrotum. After surgical resection, pathological analysis disclosed spindle-shaped neoplastic cells widely separated by a myxoid stroma rich in collagen fibers and prominent irregularly shaped blood vessels; the histological examination confirmed an AAM.
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5/14. carcinosarcoma of the spermatic cord.

    The first case of carcinosarcoma in the spermatic cord is reported in a 40-year-old man. The tumor was a 2.5 X 2 cm pseudoencapsulated formation located in the connective tissue of the spermatic cord among the blood vessels. light microscopy examination of the neoplasm revealed two different histological patterns: epithelial and sarcomatous. Mitoses and atypias were infrequent in both types of areas. The epithelial cells formed papillary and gland-like structures stained with PAS, Hale and mucicarmine stains, and showed positive reaction for immunohistochemical demonstration of both keratin and epithelial membrane antigen. The lumen content of the gland-like structures reacted positively for the carcinoembryonic antigen. Electron microscopy revealed that the epithelial cells were joined by junctional complexes and displayed numerous short microvilli. The sarcomatous areas consisted of spindle cells embedded in a ground substance that occasionally presented myxoid changes. mast cells and focal calcifications were seen. Sarcomatous cells showed positive reaction for vimentin but not for the other histochemical and immunohistochemical techniques mentioned above. The ultrastructure of sarcomatous cells was similar to that of epithelial cells except for the occurrence of small desmosomes instead of junctional complexes. The differential diagnosis with adenomatoid tumor and malignant mixed mesothelioma is discussed.
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6/14. Giant neurilemoma: unusual scrotal mass.

    General physical examination of the male at whatever age is incomplete unless the scrotum and its contents are assessed. Since the scrotum consists of skin, fibrous connective tissue, smooth muscle, vessels, nerves, and a lining of simple squamous epithelium, a variety of tumors may arise in it. Scrotal tumors, however, are infrequent. Rare tumors are solitary neurilemomas. The English literature does not describe a giant neurilemoma of the scrotum.
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7/14. When to use the Chevassu maneuver during exploration of intrascrotal masses.

    As many as 50 per cent of explorations for intrascrotal masses result in orchiectomy for benign disease. The most common diagnoses are hydrocele, epididymitis and benign testicular tumors. Many of these diagnoses could be made before orchiectomy if the tunica vaginalis and, occasionally, the tunica albuginea were opened, and the lesion biopsied. However, violation of the testicular tunics traditionally has been considered taboo because of the dangers of tumor seeding. In 1906 Chevassu suggested inguinal exploration and occlusion of the testicular vessels before biopsy of suspicious lesions. We have added scrotal hypothermia, double ligation of the gubernaculum before its division and irrigation with distilled water to provide a procedure that adheres to the principles of good cancer surgery. Its use during inguinal explorations for suspicious intrascrotal masses in 5 patients led to a benign diagnosis and preservation of the testis in 3 instances without subsequent testicular atrophy. Its judicious use can decrease the incidence of orchiectomy for benign disease.
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8/14. leiomyosarcoma of the dartos muscle.

    Smooth muscle is seen in the skin in three locations, the arrectores pilorum muscles, the wall of vessels and the specialized muscles in genital skin (the dartos, vulvar, and mamillary muscles of the scrotum, labia majora, and the breast, respectively). We report a case of a leiomyosarcoma of the dartos muscle in a 57-year-old man. The histological features of this tumor are similar to the previously reported cases of leiomyosarcomas of the skin thought to originate in arrectores pilorum muscles and the wall of vessels.
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9/14. Aggressive angiomyxoma in males. A report of four cases.

    Aggressive angiomyxoma (AAM) is a rare, locally infiltrative but nonmetastasizing tumor of the pelvic and perineal soft tissues that occurs almost exclusively in adult females. The authors describe four cases of AAM in adult males that arose in the scrotum. There was some histologic variation among the tumors. One case was focally hypercellular around the blood vessels, two were more densely cellular throughout, and one had cystic degeneration. Three of the tumors were widely infiltrative, and one of the four tumors recurred locally. The clinicopathologic features of these cases are similar to those of AAM occurring in females. In either sex, AAM should be distinguished from benign myxoid tumors with a low risk of local recurrence and fully malignant myxoid tumors with distant metastatic potential.
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10/14. Aggressive angiomyxoma occurring in the scrotum: report of a case.

    The authors recently treated a case of aggressive angiomyxoma occurring in the left scrotum. A 61-year-old Japanese man was diagnosed as having an inguinal irreducible hernia that descended to the bottom of the scrotum preoperatively. However, during the operation a large tumor was found between the spermatic fascia and the skin pressing the testis upward. The tumor measured 20 x 15 x 15 cm, was yellowish with a smooth surface encapsulated by a membrane similar to the pleura, and the cut surface was gelatinous. The histological findings indicated that the tumor had thick-walled vessels which had prominently increased in size, delicately waved collagen fibers, and stromal cells in a myxoid background. The patient has remained recurrence-free as of 11 months after surgery.
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