PMC4643473_01
Preoperative computed tomography.. (A) Arrowheads indicate focal increase in density of the subcutaneous fat with stranding along with the right spermatic cord.. (B) Arrowheads indicate that the right testis located in the subcutaneous region of the right groin.
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Contrast-enhanced computed tomography showed focal increase in the density of the subcutaneous fat with stranding along the right spermatic cord (Fig. 1A) corresponding to the location of the induration. The right testis was located in the subcutaneous region of the right groin (Fig. 1B).
Intraoperative photography.. (A) Each nerve is encircled by vessel tape. Blue, ilioinguinal nerve; red, iliohypogastric nerve; yellow, the genital branch of genitofemoral nerve. (B) Yellow arrowheads indicate meshoma circumferentially enveloping the spermatic cord with scar formation. Blue arrows indicate the right testis. It is completely atrophic and located at the subcutaneous tissue in the groin area.
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Three nerves were identified (Fig. 2A), and each nerve was encircled with vessel tape. The spermatic cord and the right testis were dissected from the surrounding tissue as far as the inferior epigastric vessels (Fig. 2B) and were then ligated and divided.
The macro- and microscopic appearances of surgical specimens.. (A) The macroscopic appearances of surgical specimens. Upper, the right spermatic cord and testis. The area enclosed by dotted line indicates meshoma that is completely integrated with the spermatic cord. Yellow arrowheads indicate the genital branch of genitofemoral nerve. White arrows indicate atrophic testis. Middle, iliohypogastric nerve; lower, ilioinguinal nerve.. (B) Microscopic appearance of the genital branch of genitofemoral nerve (magnification; x100). Fibrosis of the epineurium and foreign-body reaction around this nerve is observed, while endoneural damage is not evident within it.. (C) Microscopic appearance of iliohypogastric nerve (magnification; x100).. (D) Microscopic appearance of ilioinguinal nerve (magnification; x100).. (E) Microscopic appearance of the spermatic cord (magnification; x40). The area enclosed by dotted line indicates the vas deference. The area enclosed by solid line is represented as magnified photograph in Fig. 3 Figure 3F.. (F) Microscopic appearance of the spermatic cord (magnification; x100), indicating magnification of the area enclosed by the solid line in Figure 3E. The areas enclosed by dotted line indicate nerve bundles of the paravasal nerve fibers. There was no fibrotic reaction and inflammation around these nerves.
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Regarding the gross appearance of the resected specimens, the wrinkled mesh was integrated with the structures of the spermatic cord (Fig. 3A). Pathological examination revealed fibrotic proliferation of the epineurium, and a foreign-body reaction and fibrosis was observed around the genital branch of the genitofemoral nerve; however, endoneural damage was not evident within this nerve (Fig. 3B). Perineural inflammation was present around both the iliohypogastric (Fig. 3C) and ilioinguinal nerves (Fig. 3D), but it was relatively mild. There was no fibrotic reaction and inflammation around the paravasal nerves running along the vas deferens (Fig. 3E and F).