title: Inguinal polypropylene plug: a cause of unusual testicular tumor pelvic metastasis.
abstract: We report the case of a patient who had undergone polypropylene plug placement 3 years before and referred to our institution with testicular tumor. CT scan demonstrated an enlargement of pelvic lymph nodes on the tumor side while retroperitoneal nodes were normal. Orchifunicolectomy was performed and histopathological examination showed a mixed germ cell tumor involving the tunica vaginalis, rete testis, epididymis and spermatic cord. After surgery the patient was addressed to adjuvant chemotherapy according to PEB scheme. Clinical re-staging showed a decrease of the pelvic bulk disease whereas retroperitoneal nodes were still normal and tumor markers were negative. Left external, internal and common iliac lymphadenectomy as well as left modified template nervesparing retroperitoneal lymph node dissection was performed. Intraoperatively the node bulk was firmly adherent to the external iliac artery and extended until the common iliac bifurcation. In the deeper part of this enlarged and firm lymphatic chain the polypropylene plug placed at the time of hernioplasty was found. Behind the plug all retroperitoneal nodes appeared normal and resulted negative on histopathologic examination. The patient had an unusual metastatization, probably due to the plug.
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy. angelica_grasso@yahoo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Grasso
authors.forename: Salvatore
authors.initials: S
authors.lastname: Blanco
authors.forename: Angelica Anna Chiara
authors.initials: AA
authors.lastname: Grasso
authors.forename: Luca
authors.initials: L
authors.lastname: Nespoli
mesh_terms: D000328:Adult; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation*; D006801:Humans; D008297:Male; D009373:Neoplasms, Germ Cell and Embryonal / Q000556:secondary*; D010386:Pelvic Neoplasms / Q000556:secondary*; D011126:Polypropylenes / Q000009:adverse effects*; D013736:Testicular Neoplasms / Q000209:etiology* / Q000473:pathology* / Q000556:secondary
chemical_list: D011126:Polypropylenes