Deciduoid Mesothelioma of Peritoneum Masquerading as Peritoneal Carcinomatosis.

Mesothelioma is an insidious neoplasm that develops from mesothelial cells. About 80 % of mesotheliomas originate in the pleural cavity. Other sites where it has been reported are the peritoneal cavity, tunica vaginalis, and the pericardium. A 45-year-old female presented with complaints of abdominal distention and pain for three months. Physical examination revealed signs of wasting of the appendicular and axial skeleton muscles, loss of subcutaneous fat, and hollowing of the eye sockets. There was pitting edema in the bilateral lower limbs. Per abdomen, examination revealed abdominal distension with umbilicus in the midline. On palpation, gross ascites was present, and no organomegaly, definitive mass, or lump was palpable. On percussion, the dull note was heard all over the abdomen, and fluid thrill was appreciated. The ascitic fluid examination revealed the presence of atypical cells. Omentectomy was done and sent for histopathological examination.The specimen of omentectomy was in multiple fragments and measured 17x16x3cm. Few of the fragments were nodular, soft to firm. On serial slicing, the cut section was gray-white with areas of necrosis. Microscopic examination showed sheets of malignant cells. These tumor cells were immunoreactive to EMA, Cytokeratin, Vimentin, Calretinin, WT-1, and D2-40 and immunonegative to Desmin (highlighting only the entrapped reactive mesothelial cells), Inhibin, BerEP4, TTF-1, CD 68, Napsin, ER, CEA, CDX2, PR, PAX-8, and SALL4. Ki 67 labelling index was 15%. The features were of Malignant Mesothelioma, Deciduoid variant. Deciduoid mesothelioma is a rare subtype with a poor prognosis. So, the mesothelioma should be distinguished from deciduosis.

Complex hypospadias reconstruction: Ulaan Baatar technique revisited

Background: Complex hypospadias repair is a challenging issue for the urologists. In Ulaan Baatar technique a distal neourethral tube along with glans is reconstructed in first stage with formation of a controlled fistula between neourethral tube and native urethra proximally. Later in second stage the fistula is closed by traditional technique. Therefore glans and distal urethral tube are not being manipulated during second stage repair and thus it has better cosmetic outcomes.Methods: We reviewed the records of 33 different patients with proximal hypospadias who had undergone Ulaan Baatar repair in last 3 years. 21 patients had multiple previous attempts of hypospadias repair and 12 were primary (naïve) cases with proximal hypospadias.Results: Mean follow up was 18.5 months after first stage and 12.4 months after the second stage. The mean age was 14.1years (ranged 8 to 22 years). Mean time between stage I and stage II was 8 months (range 6-9 months). None of the patients developed fistula, glans dehiscence, meatal stenosis or diverticula formation. All patients had satisfactory cosmetic appearance of glans, distal meatus and shaft.Conclusions: The Ulaan Baatar technique is very safe and effective technique with better cosmetic outcomes and least complication rates. Also the vascularized tunica vaginalis flaps may be used for construction of urethral lumen in complex hypospadias cases when local penile skin is deficient.

Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns

<b><i>Objective:</i></b> This study aimed to explore the clinical characteristics, treatment methods, and prognosis of neonatal pyocele of tunica vaginalis and to provide a reference for the clinical treatment. <b><i>Methods:</i></b> A total of 56 newborns with pyocele of tunica vaginalis were admitted to our hospital due to the scrotal emergency from January 2015 to January 2020. Our study retrospectively analyzed these 56 cases. Of the 56 cases, including 32 full-term infants and 24 premature infants, age ranged from 1 to 27 days. Initially, conservative treatment (intravenous antibiotic treatment) was applied to 42 cases, and surgery to 14 cases. Then, 7 underwent surgical exploration during the conservative treatment, and 2 cases with initial surgical treatment experienced orchiectomy because of complete necrosis. For 56 cases, the average follow-up time was 18 months. <b><i>Results:</i></b> The clinical recovery time of cases with conservative treatment ranged from 8 to 17 days, with an average of 11.02 ± 2.31 days. The clinical recovery time of cases with surgery ranged from 6 to 15 days, with an average of 9.28 ± 2.78 days. During the follow-up, for 56 cases, except for the 2 cases with orchiectomy, the testicular position and Doppler flow both went back to normal, of the 42 cases with initial conservative treatment, 1 case experienced testicular retardation, of the 14 cases with initial surgical treatment, 2 cases experienced testicular retardation, and hydrocele of 42 cases were self-healed. <b><i>Conclusions:</i></b> Neonatal pyocele of tunica vaginalis is mostly secondary to intra-abdominal infection. Color Doppler ultrasound is helpful for the diagnosis. The percutaneous aspiration is a way of collecting pathogenic bacteria during the conservative treatment. If the color Doppler suggests testicular involvement, surgical exploration should be performed.

Testis with no tunica vaginalis: A case report and literature review

This is a Letter to the Editor. Please download the PDF or view the article HTML.

Prognosis and Management of Communicating and Non-communicating Hydrocele

Hydrocele can be found as a collection of fluid within the testicular tunica vaginalis. According to the etiology and pathophysiology of the disease, it can be classified into primary and secondary. Furthermore, primary hydrocele might include the closed or non-communicating, the communicating type, the congenital and or neonatal type. Many management approaches have been proposed for both the communicating and non-communicating hydrocele with different post-operative and prognostic outcomes. In this literature review, we have discussed the current management approaches and prognosis of communicating and non-community hydrocele. Adequate diagnosis of the condition is the first step to achieve favorable management outcomes. Although the reported management outcomes are reported to be effective in the literature, the surgical approaches seem to be superior. However, many side effects might be associated with these operations. Estimates show that following varicocelectomy procedures, ipselateral (left) hemi-scrotal varicocele is the most common condition to occur, which might even develop following the procedure by several months and years (in some cases). Further investigations are still needed because the current evidence is largely based on case reports and small case series investigations. Therefore, larger studies are needed to help draw effective management protocols and enhance the outcomes and prognosis.

Mesothelioma

Malignant mesothelioma is a disease affecting serosal surfaces derived from the mesothelium comprising the pleura, peritoneum, pericardium, and tunica vaginalis testis [...]