Paratesticular myxoid liposarcoma in a 23-year old Nigerian

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

Rare Tumors 2010; volume 2:e23 Paratesticular myxoid liposarcoma in a 23-year old Nigerian

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

Management of metastatic paratesticular tumour in a resource-poor setting

Paratesticular tumours are tumours that arise from the testicular tunics, spermatic cord, epididymis, or vestigial remnants. The tumours are rare and account for approximately 5% of intrascrotal neoplasms. About 75% of these tumours arise from the spermatic cord. Paratesticular tumours most commonly manifest as painless scrotal masses. Alternatively, the tumour may be incidentally noticed when a scrotal ultrasound scan is done for another intrascrotal pathology such as hydrocele, inguinoscrotal hernia, epididymo-orchitis, or suspected testicular tumour. We present a case of metastatic paratesticular tumour in a 21-year-old Nigerian male, who presented at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, in September 2018 at the age of 19 years with a painless right hemiscrotal mass. The patient was clinically evaluated with scrotal ultrasonography, testicular tumour markers, and liver function test. Biopsy specimen obtained was ignorantly discarded by the patient who was subsequently lost to follow-up. Histologic diagnosis of mesenchymal tumour (myxoid liposarcoma) was made two years after his initial presentation when he developed both inguinal and retroperitoneal lymph node metastasis at the age of 21 years. He was evaluated as clinical stage IV disease and then commenced on chemotherapy after baseline investigations. Our objective of presenting this report is to highlight the effect of delayed diagnosis in the management outcome, challenges in the provision of resources in low- and middle-income countries, and to emphasise the rarity of the tumour in our subregion

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways