RESUMEN
A 10-year-old boy, who had a mild inguinal hernia in his left scrotum, was referred to our clinic because of redness of the scrotal skin and tenderness of the left scrotal contents. Scrotal echography showed a hypoechoic lesion around the normal testis and epididymis. Because torsion of either the testis or testicular appendage was suspected, the scrotum was opened and 1.5 mL of purulent fluid was observed in the tunica vaginalis with inflammatory tissue around the testis and epididymis. On the first postoperative day, a low grade fever and abdominal tenderness persisted, however, the abdomen was flat and soft. There was no marked tenderness over McBurney's point, but there was moderate tenderness over Lanz's point on deep palpation. Abdominal sonography and magnetic resonance imaging revealed abscess formation between the bladder and the sacrum. With a diagnosis of perforation of the appendix, a laparotomy was performed. The inguinal hernia sac could not be observed on inspection, and it was not possible to palpate the left side because of severe adhesion due to infection. Also, the neck of the right inguinal sac could not be seen. The appendix specimen was gangrenous. On the second postsurgical day, all symptoms and signs disappeared. We present this rare condition and discuss the difficulty in establishing a diagnosis.
Asunto(s)
Apendicitis/complicaciones , Enfermedades de los Genitales Masculinos/etiología , Escroto , Enfermedad Aguda , Apendicectomía , Apendicitis/diagnóstico , Apendicitis/cirugía , Niño , Diagnóstico Diferencial , Enfermedades de los Genitales Masculinos/diagnóstico , Hernia Inguinal/diagnóstico , Humanos , Masculino , Rotura Espontánea , SupuraciónRESUMEN
OBJECTIVE: In 6 patients, ranging in age from 26 to 71 years, we analyzed aspirated fluid and histologically studied cystic lesions located at the midline of the prostate. METHODS: Digital rectal examination, ultrasonography, magnetic resonance imaging, and aspiration of cystic fluid were performed to evaluate size, contents, and location of the cystic lesion. A 22-gauge needle was inserted into the cystic lesion perineally under ultrasound guidance. After extracting fluid for cytology and measurement of prostate-specific antigen (PSA) and prostatic acid phosphatase (PAP), a specimen from the prostate involving the cystic wall was collected. Hematoxylin-eosin staining and immunohistochemical staining for PSA were performed. RESULTS: All aspirated fluid specimens were yellowish and clear without any sperm or malignant cells. The PSA levels in the fluid ranged between 90 and 670 x 10(4) ng/ml, while the PAP levels were between 168 and 4,000 ng/ml. These levels of PSA and PAP were significantly higher as compared with those in the serum. The cystic wall was lined with cuboidal or columnar epithelium. Some epithelial cells from the cystic wall showed positive immunostaining for PSA. CONCLUSIONS: Not all cystic lesions located at the midline of the prostate are müllerian duct cysts, and there is a high probability that the lesion could be a cystadenoma or a simple cyst of the prostate.
Asunto(s)
Quistes/diagnóstico , Conductos Paramesonéfricos/patología , Enfermedades de la Próstata/diagnóstico , Fosfatasa Ácida/metabolismo , Adulto , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Biopsia con Aguja , Líquidos Corporales/citología , Líquidos Corporales/metabolismo , Quistes/tratamiento farmacológico , Quistes/metabolismo , Endosonografía , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Minociclina/administración & dosificación , Minociclina/uso terapéutico , Conductos Paramesonéfricos/diagnóstico por imagen , Conductos Paramesonéfricos/metabolismo , Próstata/diagnóstico por imagen , Próstata/metabolismo , Próstata/patología , Antígeno Prostático Específico/metabolismo , Enfermedades de la Próstata/tratamiento farmacológico , Enfermedades de la Próstata/metabolismo , Estudios RetrospectivosRESUMEN
We described a 39-year-old woman with systemic lupus erythematosus who developed 20 dermatofibromas accompanied by more than 30 eruptive benign keratoses while she was receiving systemic corticosteroid therapy. We are not aware of a previous case of multiple dermatofibromas accompanying multiply eruptive keratoses. The autoimmune disease or altered immunity, or both, may have played a role in the pathogenesis of these conditions.