An inguinal hernia with cryptorchidism with a Leydig cell tumor in an elderly man: A case report.
BACKGROUND
Cryptorchidism is common in children but is rare in the elderly. It often presents with a constellation of signs and symptoms similar to routine inguinal hernias. We present the case of an elderly man with cryptorchidism containing a Leydig cell tumor and provide clinical insights.


METHODS
An-84-year old man was admitted with an incarcerated right lower quadrant hernia. Both testes were absent on palpation of the scrotum. After reduction of the hernia, computed tomography scan revealed a round lesion in the hernia sac, which was suspected to be the ectopic testis. Laparoscopic exploration was performed in combination with an open anterior approach. The hernia orifice was the right internal inguinal ring, and the inguinal canal was obliterated by adhesions because the spermatic cord did not pass through it. The ectopic testis was resected with the hernia sac, and the hernia repaired with a KUGEL™ patch (Bard, USA).


CONCLUSIONS
Laparoscopic exploration was useful to delineate the anatomy of this unusual inguinal hernia. The open anterior approach was necessary to dissect the ectopic testis and the hernia sac. Pathological findings revealed tumor cells with clear cytoplasm in the resected testis, diagnosed as a Leydig cell tumor.


CONCLUSIONS
The combination of laparoscopic and anterior approaches facilitated the surgical treatment of an unusual inguinal hernia with cryptorchidism. The resected ectopic testis should undergo thorough histopathologic examination.
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki, Ibaraki, Japan. Electronic address: th-zuiki@jichi.ac.jp.
Toru
T
Zuiki
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki, Ibaraki, Japan.
Jun
J
Ohki
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki, Ibaraki, Japan; Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
Toshihide
T
Komatsubara
Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
Alan Kawarai
AK
Lefor
Department of Surgery, Yuki Hospital, Yuki 9629-1, Yuki, Ibaraki, Japan; Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, Japan.
Yuzo
Y
Miyahara
Department of Urology, Yuki Hospital, Yuki 9629-1, Yuki, Ibaraki, Japan.
Masanori
M
Ochi
Hirota Institute for Surgical Pathology, Idaimae 3-6-5, Shimotuke, Tochigi, Japan.
Norio
N
Hirota
Case report; Cryptorchidism; Elderly; Inguinal hernia; Laparoscopy; Leydig cell tumor