作者：Fouad Hajji, M.D. Abdellatif Janane, M.D. 单位：Mohammed V Military Teaching Hospital, Rabat, Morocco
A 22-year-old man with a history of uncorrected left cryptorchidism presented after 7 days of left groin pain. A genitourinary examination was performed, which revealed that his left inguinal region was swollen because of a palpable, tender mass that was 5 cm in greatest dimension. No testicle was palpable in the ipsilateral hemiscrotum (Panel A). An ultrasound examination of the inguinal area revealed a heterogeneous testicle, with no blood flow on Doppler examination. Surgical exploration confirmed torsion of the undescended testis (Panel B). Torsion of a cryptorchid testicle is an uncommon condition but is reported to occur more frequently than torsion of a normally descended testis. In a patient presenting with pain and uncorrected cryptorchidism, a testicular tumor must also be considered in the differential diagnosis. In this patient, final pathological examination revealed a diffusely ischemic, necrotic testicle with no malignant tumor.
一个22岁的男子，既往有左侧隐睾，但是未接受外科治疗。7天前患者出现左侧腹股沟的疼痛就诊。入院后患者接受了泌尿生殖系统的检查，结果显示左侧腹股沟区有一个5 厘米大小的质地偏硬的肿块，同时同侧睾丸缺失（图 A）。腹股沟区的超声检查发现肿物为变形的的睾丸，多普勒超声检查无血流灌注。手术探查证实 (图 B) 为隐睾睾丸扭转。隐睾睾丸扭转的是一个少见的情况，但报告称这种情况要比自然的睾丸扭转发生率较高。未纠正的隐睾患者如果是出现了疼痛，还必须考虑睾丸肿瘤的存在。这个病人，最后病理检查发现睾丸坏死，但是没有恶性肿瘤的情况。
作者：Claudio Guedes Salgado, M.D. Josafa Goncalves Barreto, M.D. 单位：Universidade Federal do Para, Martuba, Brazil
A 57-year-old man presented with a 7-year history of diffuse skin infiltration associated with sensory loss in his left hand. His face had multiple nodular lesions that coalesced into plaques, especially on the forehead, ears, nose, and lips (Panel A). He had weakness in the muscles on the left side of his face and loss of eyebrow hair and eyelashes. The ulnar and tibial posterior nerves were enlarged. A skin smear stained according to the Ziehl–Neelsen method revealed acid-fast bacilli in clumps. Screening for IgM antibodies to phenolic glycolipid I, which is specific for Mycobacterium leprae, was performed with the use of enzyme-linked immunosorbent assay. The highly positive results were consistent with a diagnosis of lepromatous leprosy. This anergic form of leprosy is characterized by an inefficient immune response. Nerve damage is slow to occur and is related to high levels of infection of the nerves. The patient underwent multidrug therapy, with the addition of prednisone, for 5 months. After 9 months of multidrug treatment, the skin infiltration and weakness in the left eyelid had diminished (Panel B). The treatment period for standard multibacillary leprosy is 12 months, but anergic polar forms, as occurred in this patient, usually require 24 months of treatment before cure.
A 59-year-old man presented with a weeping mole on his back that had been growing for 8 years. On examination, a 10-cm ulcerated lesion was found on his lower back, and multiple subcutaneous areas of swelling were found in both inguinal regions. The raised areas on both sides were firm, fixed, and matted together, and they measured approximately 5 cm each (Panel A, arrows). Examination of a biopsy specimen from the lesion on the patient's back revealed stage T4 melanoma. Computed tomographic imaging showed a single pulmonary metastasis and multiple inguinal lymphatic metastases (Panel B, arrows). Inguinal lymph nodes are a common site of metastasis for malignant tumors located in the lower extremities, pelvis, and back. Enlarged lymph nodes are not always visible but should be palpable. This patient died 3 months after presentation, despite chemotherapy.