Paratesticular liposarcomas are rare tumors and are usually seen in patients in middle age or older. Optimal treatment is radical orchidectomy. Radiotherapy or chemotherapy is added for advanced disease or recurrences. These practice guidelines often vary from the experience in developing countries.We present a 23-year old man who presented with paratesticular myxoid liposarcoma, after transscrotal orchidectomy for ‘testicular tumor’ without histology. He was subsequently managed by neoadjuvant chemotherapy and complete tumor excision.A case of paratesticular myxoid liposarcoma in a young man is highlighted. Also noted is the fact that complete extirpation at primary surgery reduces the risk of local recurrence. The practice of transscrotal orchidectomy and non-submission of surgical specimens is highlighted and condemned.
Renal angiomyolipomas (RAML) are uncommon benign renal tumours that are associated with a tendency to rupture resulting in sometimes-torrential retroperitoneal hemorrhage as the Wunderlich syndrome or as severe potentially exsanguinating hematuria. When hemorrhage from RAML occurs in pregnancy it presents a unique challenge requiring timely and appropriately adapted intervention with the goal of preventing fatality, preserving renal function as well as preventing fetal loss if possible. We report the management of severe bleeding from RAML in pregnancy and highlight the need to adopt a management strategy that suits the practice environment and offers the patient standard and enduring care.
This was a case of a 42year-old nulipara female who presented to a private specialist hospital in Enugu because of unusual but gradual abdominal distension. Her ultrasound diagnosis was of extensive intramural and subserosal myoma. Abdominal swelling was initially noticed around the lower abdomen but progressively increased in size involving the upper abdomen, that she later found it diffi cult to wear her regular clothes and move around easily. There was associated constipation, but no nausea, vomiting or loss of appetite was reported. There was weight loss but no yellowish discoloration of eyes or urinary symptoms. There were no associated leg swelling, menstrual disorders, abnormal vaginal discharge or fever. The abdomen was grossly distended with masses arising from the pelvis that was about similar size of a 46-weeks pregnant woman. The masses were fi rm, nodular, mobile and non-tender with irregular outlines. There was no demonstrable ascites. Figure 1 below shows the patient's grossly distended abdomen before the surgery. An abdominopelvic ultrasound was performed and reported multiple, large uterine masses of varying sizes and shapes. These masses had
Giant intrascrotal recurrent seminomas are rare in the surgical literature, probably due to widespread information about self-detection. A recent European study has reported a reduction in the primary tumour size at presentation. These findings are at variance with the situation in sub-Saharan Africa. We present a 32-year-old patient who presented with an 8-month history of progressive, painless left hemiscrotal swelling, no lower urinary tract symptoms and no evidence of metastatic disease. The patient had undergone a left inguinal orchidectomy 2 years prior to the onset of the current swelling, on account of a suspected testicular tumour. Histology was, however, returned as 'sections of testis showing haemorrhagic necrosis with areas of fibrosis. No malignancy seen. Diagnosis consistent with long standing torsion'. The patient had excision of the mass via an inguinoscrotal incision, with primary wound closure and drainage, and had good post-operative recovery. Histopathology subsequently reported seminoma. We discuss a rare case of giant intrascrotal recurrent seminoma in a young African patient and comment on the surprising absence of metastatic symptoms and the management in the absence of new imaging techniques. We emphasize the value of extirpation in such cases and the need for thorough sectioning of histopathological specimens. We also note that seminoma should be considered in the differential diagnosis of scrotal swelling even in the absence of the testes (after orchidectomy).
Tumoral calcinosis is a rare disorder that presents with ectopic calcifications deposited at different periarticular soft tissue regions of the body- mostly hips, elbows and shoulders. It results from a relative deficiency of, or resistance to, the phosphate-regulating hormone - Fibroblast Growth Factor 23 (FGF23), due to gene mutations, causing hyperphosphatemia. We describe this condition in a 13 year old, Nigerian boy who presented with a 7 year history of multiple body swellings of firm to hard consistency. Laboratory investigations showed hyperphosphatemia with normal serum calcium, vitamin D and parathyroid hormone levels. Radiological and histological findings were consistent with tumoral calcinosis. Having had two previous surgeries to remove the lesions, he was now commenced on low phosphate diet and phosphate binders. It is important to differentiate tumoral calcinosis from other causes of pathological calcification using clinical and laboratory findings especially in environments where molecular genetic testing is not readily available.
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