背景:脂肪肉瘤约占软组织肉瘤的9.8-16%,四肢和腹膜后是主要发生部位。虽然腹股沟区的脂肪肉瘤并不常见,很少报道病例起源于腹膜后,并通过腹股沟管伸入阴囊。这里,我们介绍了一例腹膜后脂肪肉瘤,在使用网片塞进行疝修补术后,从左腹股沟管脱出进入阴囊。
方法:一名55岁男性患者因疑似复发性腹股沟疝接受了CT扫描,这显示了一个相当大的脂肪密集的肿瘤由左肾挤压通过左腹股沟管周围的阴囊。一年前,该患者在另一家医院接受了左侧腹股沟疝的网塞修复术,并在疝修补术后发现同侧腹股沟肿胀。病人被转诊到我们医院。肿瘤切除完成,合并切除可能受累的器官:左侧结肠,左肾,和左肾上腺.此外,通过手术切除腹股沟管后壁完成肿瘤的完整切除,网塞,肿瘤延伸到阴囊.鉴于腹股沟管后壁和前壁的撕裂状态几乎完全缺失,采用缝线闭合外部闭孔腱鞘炎。此外,使用无张力切口技术闭合腹股沟韧带.随后仅放置一个网格。切除肿瘤47×30×15cm,体重7.5kg。手术切除后,腹膜后脂肪肉瘤诊断成立.手术切除后2年零6个月,未观察到脂肪肉瘤或腹股沟疝的复发。
结论:在这种情况下,先前的腹股沟疝必须是腹膜后脂肪肉瘤的脱垂。因此,建议进行术前检查,应该包括CT扫描,因为疝气中脂肪团的存在可能表明腹膜后脂肪肉瘤的存在。即使无法进行术前诊断,如果腹膜后脂肪肉瘤可以在再次手术时完全切除,则可以预期长期预后。
BACKGROUND: Liposarcomas represent ~9.8-16% of soft tissue sarcomas, with the extremities and retroperitoneum being the primary sites of occurrence. While liposarcoma in the inguinal region is uncommon, few reported cases originate from the retroperitoneum and protrude into the scrotum through the inguinal canal. Here, we present a
case of a
retroperitoneal liposarcoma with prolapse from the left inguinal canal into the scrotum following hernia repair with a mesh plug.
METHODS: A 55-year-old male patient underwent a CT scan for a suspected recurrent inguinal hernia, which revealed a sizeable adipose-dense tumor by the left kidney extruded through the left inguinal canal surrounding the scrotum. The patient had undergone mesh plug repair for a left inguinal hernia at another hospital one year ago and noticed ipsilateral inguinal swelling after the hernia repair. The patient was referred to our hospital. The tumor resection was completed with combined resection of potentially involved organs: left side colon, left kidney, and left adrenal gland. Also, complete excision of the tumor was accomplished through surgical resection of the posterior wall of the inguinal canal, the mesh plug, and the tumor extending into the scrotum. Given the nearly complete absence of the inguinal canal\'s posterior wall and the anterior wall\'s torn state, sutures were employed to close the external obturator tenosynovitis. Additionally, the inguinal ligament was closed using a tension-free incision technique. Only a mesh was subsequently placed. The resected tumor measured 47 × 30 × 15 cm and 7.5 kg in weight. After surgical resection, a
retroperitoneal liposarcoma diagnosis was established. After 2 years and 6 months following the surgical resection, no recurrence has been observed for either liposarcoma or inguinal hernia.
CONCLUSIONS: The previous inguinal hernia in this
case must be a prolapse of
retroperitoneal liposarcoma. Thus, it is recommended to conduct a preoperative examination, which should include a CT scan, since the presence of a fatty mass within the hernia may indicate the presence of a
retroperitoneal liposarcoma. Even if a preoperative diagnosis cannot be made, a long-term prognosis can be expected if the
retroperitoneal liposarcoma can be completely resected at reoperation.