67歳男, 腫瘤の形成はなく, 精管に沿って発生した精索平滑筋腫の1例.精索に発生した平滑筋腫でこのような特異な形態を呈した症例は文献上報告がなく, 本症例が最初の報告であるWe report an unusual case of a leiomyoma of the spermatic cord. The tumor did not present as a mass but presented as a hard structure along the spermatic cord. To our knowledge, this is the first case report of a leiomyoma of the spermatic cord with such an unusual appearance

ASAO, Takeshi

MURAYAMA, Tetsuo

SAKAI, Naoki

YAMADA, Tetsuo

Kyoto University Research Information Repository

Title Leiomyoma of the spermatic cord extending along the vasdeferensAuthor(s)SAKAI, Naoki; YAMADA, Tetsuo; MURAYAMA, Tetsuo;ASAO, TakeshiCitation泌尿器科紀要 (1998), 44(2): 121-123Issue Date1998-02URL http://hdl.handle.net/2433/116119RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityActa Urol.  Jpn.  44: 121-123, 1998 121LEIOMYOMA OF THE SPERMATIC CORD EXTENDING ALONG THE VAS DEFERENSNaoki  SAKAI, Tetsuo YAMADA and Tetsuo MURAYAMAFrom the Department of Urology, Sagamihara N tional HospitalTakeshi ASAOFrom the Department of Pathology, Sagamihara N tional Hospital   We report an unusual case of a leiomyoma of the spermatic ord. The tumor did not present as a mass but presented as a hard structure along the spermatic ord. To our knowledge, this is the first case report of a leiomyoma of the spermatic ord with such an unusual appearance.                                            (Acta Urol. Jpn. 44: 121-123,1998)Key  words: Leiomyoma, Spermatic ord, vas Deferens         INTRODUCTION  Leiomyoma is a benign neoplasm that generally presents as a mass. Leiomyoma of the spermatic cord is an extremely uncommon neoplasm. Only a few cases have been reported in the  literature  1-6) All of them have been reported to present as a mass in the spermatic cord. We report an unusual case of a leiomyoma of the spermatic cord presenting as a hard spermatic cord. To our knowledge, this is the first case report of such a tumor.           CASE REPORT  A-67-year-old man presented with left scrotal pain and a 1-year history of a thick and hard linear  structure  ; he did not notice any enlargement in the left inguinal region. The medical history was unremarkable. A physical examination revealed that it was approximately 1 cm in diameter,                                                                  •                                               •              40. Fig. 1. Macroscopic appearance of the resected        specimen.  Upper  ; vas deferens.  Center  ; tail of the epididymis with        surrounding fat. Lower  left  ; head and       body of the epididymis.extending along the left spermatic cord. Laboratory studies including urinalysis were negative. High-resolution inguinal sonography showed an isoechoic, thick spermatic cord but did not show the  -whorled-appearance'; typical of leiomyomas developing in other sites. We considered inflammatory disorders, such as tuberculosis. In order to identify the linear structure, an operation was performed through a left                                                    • .. .. . . ...: ,.., ;,. .,            0,—i .'-')Vir: '.24.!'''',:,:.4.•;:''''''SeAi.... ...'..:,:'                                              qq..,:,:i..,,.,..r„.?.....',:..•,',?,...'•-..                                       --t...:%••,..::::::4;;;:,.....t.:,:,,.                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F '.,. ..!‘ .1?'1`Q, 1 1.: . „-A F'..' ; :V'4 "'..,'.. , .-.,. ki:'/,...',..,.,.',..•7:,4.r.Z:',.•:'471r/kk.,,1....:2...A'.sf,'            ''1',:,•^....„'•,..,  s ..,. , ,, .,, ,,,,,.Y                        ,i..,.. '...y..--,-=-::-'•';,:z..-,,,,..^,,,,Z.4,:,,,km,.--..--,,,,"*..,-.4..,...,..;1:::,:,_,:-.:-_,,,,....:,...,.,,* i                        ..-..; .- ,-.)!_                                  ,4., a.7-!-.-,,,,.'N.t--,.''..,,,, ...b,..'...:::.......;,...•A‘,.....:;''. ,,,,,I.U..„0. ..7 4. ,:_,s ..-TIA-0...:,•:.,..,     i,„-t,;.,:,,....-;--..,:::t.... , ..*7z...,.",:;.-'.--!.'--7:4r.!",.°31:770.::'... -'4'..-V7.,t                         ...1;„11,#1.!,s;.7.,.;:;,..,--..,,,,.*%.,..., .44. ,..,..7.;.....:., • '" ,.."4•4„C>. ..'!'.'....  A,"  ''....i,,Li".7'.l'o,:te..1:'.:,..,-"'- W'I',1'Y It;k.4.,'-•—-     ..,..• BFig. 2. Microscopic findings of the leiomyoma       of the spermatic cord. (A) :  Left  ; vas        deferens.  Right  ; spermatic vessels.       HE stain. Original magnification X       3.3. (B) : Interlacing bundles of        smooth muscle cells are seen. HE       stain. Original  magnification  X 25.122 Acta Urol. Jpn.  Vol.  44, No. 2, 1998inguinal incision. An intraoperative examination revealed that the vas deferens was thick and hard from the junction with the epididymis, extending beyond the internal inguinal ring. As the vas was easily dissected from the spermatic ord and the testis appeared to be normal, it was resected up to the portion at the internal inguinal ring, with the epididymis (Fig. 1). Macroscopically, the surgical specimen showed a white cut surface of a markedly thick vas deferens. A pathological examination revealed that the vas deferens itself was normal but appeared to be somewhat constricted (Fig. 2A). The vas deferens and neighboring blood vessels were surrounded by irregularly proliferated smooth muscular tissues appearing to be occasionally transitional to the muscular layer of the blood vessels (Fig. 2B). The lumen of the epididymis was dilated, especially in the tail (not shown). No mitosis was seen in the lesion. These findings were patholo-gically identical with those of leiomyoma, although the lesion did not form a mass. Histological diagnosis was vascular leiomyoma of the spermatic cord.            DISCUSSION  Tumors arising from the spermatic cord are uncommon. Approximately 70% of the spermatic cord tumors are benign, while 30% are  malignant°. Lipomas are the most common tumors in this area, followed by mixed mesodermal tumors, and  fibromas° In contrast, leiomyoma of the spermatic cord is an extremely rare tumor with a few cases having been  reported1-61 They usually develop in patients between 40 and 60 years of  age1-6) The consistency is between that of a lipoma and a  fibroma6). However, surgical excision and histolo-gical examination is required to diagnose the benign nature of the tumor.  Clinically, most spermatic ord tumors appear as a discrete nodular mass. Leiomyoma in other areas generally presents as a mass. Leiomyomas of the spermatic cord also present as a painless  mass'-6) However, in this case the neoplasm did not presentas a mass but extended along the vas deferens. To our knowledge, this is the first reported case of a leiomyoma of a spermatic cord with such an unusual appearance.  Leiomyoma is a benign neoplasm that could arise from any organ containing smooth muscle  cells°. Leiomyoma of the spermatic cord could originate from the smooth muscle of the cremaster, blood vessels of the cord, and the vas  deferensi) In this case, a microscopic examination revealed that the proliferated smooth muscle tissues were transitional to the vessel walls. Therefore, we consider that the neoplasm developed from the blood vessels in the spermatic cord.  In this case, the epididymal lumen was dilated, especially in the epididymal tail. Histologically, the proliferated tissues compressed the vas deferens. Therefore, it is possible that the obstruction of the vas deferens resulted in the dilation of the epididymal lumen.  In conclusion, it should be noted that, although the exact mechanism remains unclear, leiomyoma can extend along the vas deferens without forming a mass.           REFERENCES 1) Belis JA, Post GJ, Rochman SC, et  al.  : Genito-   urinary leiomyomas. Urology 18: 424-429, 1979 2) Dougall AJ and Wilson  RR  : Leiomyoma of the vas    deferens. Br J Urol  41: 348-350, 1969 3) Sarma DP and Weilbaecher  TG  : Leiomyoma of the    spermatic ord. J Surg Oncol 28: 318-320, 1985 4) Kawashima K, Matsuo Y, Shimizu N, et  al.  : A case    of leiomyoma of the spermatic ord. Acta  UrolJap    34: 1479-1481, 1988 5) Elmer EB, Levine R and Nolan  J  : Leiomyoma of    spermatic cord with unusual features. Urology   33: 236-237, 1989 6) Taylor AM, Wijesuriya LI, Wong R, et  al.  :   Leiomyoma of the spermatic ord. Br J Urol  75:   101-102, 1995  Received onAugust 11, 1997)              Accepted onNovember 13,1997) SAKAI, et  al.  : Leiomyoma, Spermatic cord 123和文抄録精管に沿って発生 した精索平滑筋腫の1例国立相模原病院泌尿器科(医 長:村 山鉄郎)酒 井 直樹,山 田 哲 夫,村 山 鉄郎国立相模原病院検査科(医 長:浅尾武士)浅 尾 武 士腫瘤の形成はなく,精管に沿って発生 した精索平滑筋腫の1例 を報告する.精索に発生した平滑筋腫でこのような特異な形態を呈 した症例 は文献上報告がなく,本 症例が最初の報告 である.(泌尿紀要44:121-123,1998)

精管に沿って発生した精索平滑筋腫の1例

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精管に沿って発生した精索平滑筋腫の1例

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