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International Urology and Nephrology 35: 513–514, 2003.© 2004 Kluwer Academic Publishers. Printed in the Netherlands.
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Heterotopic ossification of the spermatic cord
Deniz Demirci1, Oguz Ekmekçioglu1, Mehmet Inci1 & Hülya Akgün2
Department of 1Urology and 2Pathology, School of Medicine, Erciyes University, Kayseri, Turkey
Abstract. Heterotopic ossification is the most frequent type of connective tissue metaplasia. We report a rare casewith bone formation in the spermatic cord.
Key words: Heterotopic, Ossification, Spermatic cord
Introduction
Heterotopic ossification is a true bone formation in anabnormal place. The etiology is unclear, but burns,muscle injuries, traumatic brain or spinal cord injuryare potential risk factors.
We report a case with rare form of heterotopicOssification.
Case report
A 56-year-old men presented with a one year (espe-cially last three month) history of pain and swelling ofright testicle with scrotal tenderness. The patient hadused various anti-inflammatory agents like diclofenacsodium and salicylats to pain management. Phys-ical examination revealed that a 10 cm long masswhich localized entirely in the spermatic cord region.The 2 cm width mass extended to the normal righttesticle. A cystic mass with 5 cm diameter was palp-ated in the caput epididymis localisation. Urinalysisand biochemical analysis of the serum were normal.A plain radiography of the pelvis during intravenouspyelography showed irregular multiple linear opaqueimages over the right ischium (Figure 1). Ultrasono-grapy (USG) showed the hyperechogen mass fromepididymis to internal inguinal ring and spermatocelein the caput epididymis. Magnetic resonance images(MRI) were similar to USG findings. Using inguinalincision, the very hard mass which totally surroundedthe spermatic cord between near the internal ring andtesticle was dissected. Whereas the mass totally fixedthe upper segment of the right testicle, it ended just
Figure 1. Irregular multiple linear opaque images over the rightischium.
below the internal ring. Frozen samples showed notumor tissue. Radical orchiectomy was performed byligation of the normal spermatic cord at the internalring level. Pathologic examination showed matureosseous tissue of the spermatic cord. (Figure 2).
Conclusions
Heteretopic ossification is the most frequent type ofconnective tissue metaplasia [1]. The heterotopic bonecontains all of the morphologic and biochemical char-acteristics of mature bone. The onset of the ossifica-tion in adults is between 4 to 12 weeks after traumawith a peak at 2 months and maturation of the ossi-fication completes 1 to 2 years. First clinical signs ofheterotopic ossification are pain, swelling, restrictedmobility of the affected organs. Although, there was
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Figure 2. Mature osseous tissue of the spermatic cord (HEx200).
a one year testicular pain history of our patient, wecould not detect any etiologic factors which triggeredto heterotopic ossification.
Radionucleide bone imaging which can identifyheterotopic ossification up to four weeks prior toradiography can be useful to detect heterotopic ossi-fication in early stage [2]. USG, computerized tomo-graphy and MRI are useful for planning to surgery.
We thought that the radio-opaque images on plainfilm of pelvis were positive late signs for mature ossi-fication of spermatic cord. We exactly diagnosed thisabnormality after pathologic examination. This typeof heterotopic ossification is extremely rare and wefound only one paper in the literature [3]. The treat-ment of the heterotopic ossification in early stage arenon-steroidal anti-inflammatory agents, radiotherapy.Surgical resection is an optimal treatment after matur-ation of the ossification.
References
1. Kluger MD, Kochs A, Holthausen H. Heterotopic ossification inchildhood and adolesence. J Child Neurol 2000; 15: 406–413.
2. Zagaja GP, Cromie WJ. Heterotopic bone formation in associ-ation with pelvic fracture and urethral disruption. J Urol 1999;161: 1950–1953.
3. Hara S, Shoji T, Uno H. A case of ossification of the spermaticcord. Hinyokika Kiyo 1965; 11: 989–992.
Address for correspondence: Assistant Prof. Dr. Deniz Demirci,Department of Urology, School of Medicine, Erciyes University,38039 Kayseri, TurkeyPhone: 0.90.352.4374937-20451; Fax: 0.90.352.4375288E-mail: [email protected]
