#inguinal mass

[jcsmicasereports]

Myxoid liposarcoma of the spermatic cord: A rare entity by Emmanuel E. Sadava in Journal of Clinical Case Reports Medical Images and Health Sciences

Abstract

An 81-year-old man consulted at our hospital for evaluation of a long-established left inguinal mass. The patient denied experiencing pain, food intolerance, constipation or urinary tract symptoms in the past. A physical examination revealed a 15x10cm painless mass in the left inguinal region, distinct from the testicle, with no palpable changes during Valsalva´s maneuver. Magnetic resonance imaging (MRI) showed a 79mm heterogeneous lesion of the spermatic cord which projected itself through the inguinal canal into the scrotal sac, displacing the testis inferiorly. Laboratory testings were negative for testicular tumor markers such as α fetoprotein and human chorionic gonadotropin-β. A surgical resection of the inguinal tumor with an “en-bloc” inguinal orchiectomy was performed. The inguinal floor was repaired with a modified Bassini technique without the use of a mesh. The histopathological report confirmed findings were consistent with a myoxid liposarcoma. No further treatment was indicated and the patient continued follow-up with bi-annual MRIs. 18 months later, the patient continues with no signs of recurrence.

Key words: liposarcoma, liposarcoma of the spermatic chord, abdominal wall surgery, inguinal mass.

Introduction

Sarcomas constitute a heterogeneous group of rare solid tumors of mesenchymal cell origin. Collectively they account for approximately 1% of all adult malignancies with an annual incidence of 2.5 cases per million population[1]. In adults, the most common soft tissue sarcomas are liposarcomas. Overall, they account for approximately 17% of all soft tissue sarcomas. Most cases arise from de novo, therefore, the development from a preexisting benign lipoma is rare. Liposarcomas usually appear as a slowly enlarging, painless mass in a middle-aged person with a slightly higher incidence in men.

These tumors are classified in three main biologic forms: 1) well-differentiated liposarcoma; 2) myxoid and/or round cell; and 3) pleomorphic. The latter being a rare high-grade with a high recurrence rate and poor prognosis. The well-differentiated and myxoid types have favorable prognoses. However these tumors locally recur after incomplete excision[2].

The anatomic site of the primary disease represents an important prognostic factor, influencing treatment and outcome. Extremities (43%), the trunk (10%), visceral (19%), retroperitoneum (15%), or head and neck (9%) are the most common primary sites. Scrotal location is relatively rare, accounting for 3.6% of all liposarcomas. The origin of intra scrotal liposarcomas include the spermatic cord (76%), testicular tunic (20%), and the epididymis (4%).

Case Report

An 81-year-old man with a medical history of follicular cutaneous lymphoma and an open left hemi-colectomy for colon cancer consulted at our hospital for evaluation of a long-established left inguinal mass. The patient denied experiencing pain, food intolerance, constipation or urinary tract symptoms in the past. A physical examination revealed a 15x10cm painless mass in the left inguinal region, distinct from the testicle, with no palpable changes during Valsalva´s maneuver. Magnetic resonance imaging (MRI) showed a 79mm heterogeneous lesion of the spermatic cord which projected itself through the inguinal canal into the scrotal sac, displacing the testis inferiorly. Laboratory testings were negative for testicular tumor markers such as α fetoprotein and human chorionic gonadotropin-β. Ultrasound-guided biopsies of the mass were requested and their histopathology analysis revealed myxoid stroma with fusocelular proliferation.

A radical resection was suggested but, a week prior to the surgical procedure, the patient was diagnosed with COVID infection during which he intercurred with myocardial infarction and ischemic stroke. He underwent a double coronary angioplasty with drug-eluted stents and required anticoagulation and antiplatelet therapy posteriorly. The case was discussed at a multidisciplinary meeting and a conservative management of the inguinal tumor was decided. The patient was reassessed 12 month later with a new MRI, which showed the inguinal mass increased in size (99mm) compared to the previous study, and a computed tomography (CT) with no evidence of metastatic disease. A surgical resection of the inguinal tumor with an “en-bloc” inguinal orchiectomywas performed. The inguinal floor was repaired with a modified Bassini technique without the use of a mesh. The patient had an uneventful recovery and was discharged from the hospital on postoperative day two.

The histopathological report confirmed a 130x120x120mm low-grade fibro myxoid neoplasm. The surgical margins were negative. Immunohistochemistry showed strong reactivity for S100 and vimentin, whereas SOX10, desmin, CD34 and estrogen receptors were negative. These findings were consistent with a myoxid liposarcoma. No further treatment was indicated and the patient continued follow-up with bi-annual MRIs. 18 months later, the patient continues with no signs of recurrence.

Discussion

Liposarcomas invade through local extension and rarely invade through the lymphatic route, making regional lymph node dissection lose its value and having no impact on survival. Nevertheless, high-grade subtypes are associated with high rates of recurrence and hematogenous spread; lungs, liver and peritoneum being the most common sites of metastasis.  Surgical resection (with appropriate negative margins: >1cm) is the standard primary treatment in most patients with stromal cell sarcomas. Complete tumor resection is the primary prognostic factor for local recurrence, and liposarcomas are not the exception. Performing an “en-bloc” resection involving a high orchiectomy (including the surrounding tissue) is important to obtain negative margins [1].

Local recurrence rates for sarcomas, including liposarcomas of the spermatic cord, have been reported to be as high as 30-50%. Because of this, and despite the patient’s disease-free status, long term follow-up remains a crucial step in the detection of recurrences that might still be potentially curable. Current controversy arises on the use of adjuvant chemotherapy or radiotherapy. Being a rare and infrequent entity makes it hard for a single institution to accumulate enough cases to perform prospective randomized controlled trials. Extrapolated data from retrospective analyses support the use of adjuvant radiation on selected high-risk situations (tumor recurrence, high-grade tumors or residual disease). Concerning the role of chemotherapy, the use of adjuvant chemotherapy remains controversial and there is no definitive role in the management of localized liposarcomas[3].

In conclusion, myxoid liposarcomas of the spermatic cord are infrequent entities. As most soft tissue sarcomas, they have an indolent course and should be considered as a differential diagnosis of inguinal masses with no palpable changes during Valsalva´s maneuver. Complete surgical resection with high-orchidectomy “en-bloc” is encouraged.

[jcrmhscasereports]

Myxoid liposarcoma of the spermatic cord: A rare entity by Emmanuel E. Sadava in Journal of Clinical Case Reports Medical Images and Health Sciences 

ABSTRACT

An 81-year-old man consulted at our hospital for evaluation of a long-established left inguinal mass. The patient denied experiencing pain, food intolerance, constipation or urinary tract symptoms in the past. A physical examination revealed a 15x10cm painless mass in the left inguinal region, distinct from the testicle, with no palpable changes during Valsalva´s maneuver. Magnetic resonance imaging (MRI) showed a 79mm heterogeneous lesion of the spermatic cord which projected itself through the inguinal canal into the scrotal sac, displacing the testis inferiorly. Laboratory testings were negative for testicular tumor markers such as α fetoprotein and human chorionic gonadotropin-β. A surgical resection of the inguinal tumor with an “en-bloc” inguinal orchiectomy was performed. The inguinal floor was repaired with a modified Bassini technique without the use of a mesh. The histopathological report confirmed findings were consistent with a myoxid liposarcoma. No further treatment was indicated and the patient continued follow-up with bi-annual MRIs. 18 months later, the patient continues with no signs of recurrence.

Key words: liposarcoma, liposarcoma of the spermatic chord, abdominal wall surgery, inguinal mass.

INTRODUCTION

Sarcomas constitute a heterogeneous group of rare solid tumors of mesenchymal cell origin. Collectively they account for approximately 1% of all adult malignancies with an annual incidence of 2.5 cases per million population[1]. In adults, the most common soft tissue sarcomas are liposarcomas. Overall, they account for approximately 17% of all soft tissue sarcomas. Most cases arise from de novo, therefore, the development from a preexisting benign lipoma is rare. Liposarcomas usually appear as a slowly enlarging, painless mass in a middle-aged person with a slightly higher incidence in men.

These tumors are classified in three main biologic forms: 1) well-differentiated liposarcoma; 2) myxoid and/or round cell; and 3) pleomorphic. The latter being a rare high-grade with a high recurrence rate and poor prognosis. The well-differentiated and myxoid types have favorable prognoses. However these tumors locally recur after incomplete excision[2].

The anatomic site of the primary disease represents an important prognostic factor, influencing treatment and outcome. Extremities (43%), the trunk (10%), visceral (19%), retroperitoneum (15%), or head and neck (9%) are the most common primary sites. Scrotal location is relatively rare, accounting for 3.6% of all liposarcomas. The origin of intra scrotal liposarcomas include the spermatic cord (76%), testicular tunic (20%), and the epididymis (4%).

CASE REPORT

An 81-year-old man with a medical history of follicular cutaneous lymphoma and an open left hemi-colectomy for colon cancer consulted at our hospital for evaluation of a long-established left inguinal mass. The patient denied experiencing pain, food intolerance, constipation or urinary tract symptoms in the past. A physical examination revealed a 15x10cm painless mass in the left inguinal region, distinct from the testicle, with no palpable changes during Valsalva´s maneuver. Magnetic resonance imaging (MRI) showed a 79mm heterogeneous lesion of the spermatic cord which projected itself through the inguinal canal into the scrotal sac, displacing the testis inferiorly (Figure 1). Laboratory testings were negative for testicular tumor markers such as α fetoprotein and human chorionic gonadotropin-β. Ultrasound-guided biopsies of the mass were requested and their histopathology analysis revealed myxoid stroma with fusocelular proliferation.

A radical resection was suggested but, a week prior to the surgical procedure, the patient was diagnosed with COVID infection during which he intercurred with myocardial infarction and ischemic stroke. He underwent a double coronary angioplasty with drug-eluted stents and required anticoagulation and antiplatelet therapy posteriorly. The case was discussed at a multidisciplinary meeting and a conservative management of the inguinal tumor was decided. The patient was reassessed 12 month later with a new MRI, which showed the inguinal mass increased in size (99mm) compared to the previous study, and a computed tomography (CT) with no evidence of metastatic disease. A surgical resection of the inguinal tumor with an “en-bloc” inguinal orchiectomy (Figure 2) was performed. The inguinal floor was repaired with a modified Bassini technique without the use of a mesh. The patient had an uneventful recovery and was discharged from the hospital on postoperative day two.

The histopathological report confirmed a 130x120x120mm low-grade fibro myxoid neoplasm (Figure 3). The surgical margins were negative. Immunohistochemistry showed strong reactivity for S100 and vimentin, whereas SOX10, desmin, CD34 and estrogen receptors were negative. These findings were consistent with a myoxid liposarcoma. No further treatment was indicated and the patient continued follow-up with bi-annual MRIs. 18 months later, the patient continues with no signs of recurrence.

Figure 1: Pelvis MRI T2 axial and coronal images illustrating a left inguinal canal soft tissue density measuring 78 x 68mm.

Figure 2: A Intraoperative image of the liposarcoma. Left inguinal surgical approach with the spermatic cord lesion and left testicle in vivo. B: Intraoperative image of left inguinal mass (a) excision with radical orchiectomy (o).

Figure 3: A Hematoxylin and eosin staining: fusocelular and myxoid infiltrative neoplastic proliferation, made up of ovoid cells and finely granular chromatin. Scarce elongated cytoplasm arranged in fascicles accompanied by elongated, thin, curvilinear blood vessels with zones of perivascular cellular condensation. B: Immunohistochemistry positive for S-100.

DISCUSSION

Liposarcomas invade through local extension and rarely invade through the lymphatic route, making regional lymph node dissection lose its value and having no impact on survival. Nevertheless, high-grade subtypes are associated with high rates of recurrence and hematogenous spread; lungs, liver and peritoneum being the most common sites of metastasis.  Surgical resection (with appropriate negative margins: >1cm) is the standard primary treatment in most patients with stromal cell sarcomas. Complete tumor resection is the primary prognostic factor for local recurrence, and liposarcomas are not the exception. Performing an “en-bloc” resection involving a high orchiectomy (including the surrounding tissue) is important to obtain negative margins [1].

Local recurrence rates for sarcomas, including liposarcomas of the spermatic cord, have been reported to be as high as 30-50%. Because of this, and despite the patient’s disease-free status, long term follow-up remains a crucial step in the detection of recurrences that might still be potentially curable. Current controversy arises on the use of adjuvant chemotherapy or radiotherapy. Being a rare and infrequent entity makes it hard for a single institution to accumulate enough cases to perform prospective randomized controlled trials. Extrapolated data from retrospective analyses support the use of adjuvant radiation on selected high-risk situations (tumor recurrence, high-grade tumors or residual disease). Concerning the role of chemotherapy, the use of adjuvant chemotherapy remains controversial and there is no definitive role in the management of localized liposarcomas[3].

In conclusion, myxoid liposarcomas of the spermatic cord are infrequent entities. As most soft tissue sarcomas, they have an indolent course and should be considered as a differential diagnosis of inguinal masses with no palpable changes during Valsalva´s maneuver. Complete surgical resection with high-orchidectomy “en-bloc” is encouraged.

For more information: https://jmedcasereportsimages.org/about-us/

For more submission : https://jmedcasereportsimages.org/

[thecatspasta]

Bc I need a full list of the limb adjacent Arthur Lester blogs I am making one that will be updated as I discover more

If you find this post as a reblog pls check to og post before suggesting a blog. Ctrl f is your friend. Ok lets go

Arthur Lesters:

Right arm (og)

Left arm (sequel)

Criminal mind

Paternal instinct

Dead daughter

Receding hairline

Left pinky

Evicted maggots

Ribcage

Cunt (me :))

Clitoris

Tits

Top surgery scars

Hippocampus

Gut

Mental state

Partner

Liver

Whimpering

Will to live

TKiller cells

Scar tissue

Piano

Slutty waist

Small intestine

Irises

Throat

Intestines

Coccyx

Prostate

Trachea

Thighs

Eyes

Canine teeth

Nose

Leg hair

Prefrontal cortex

Dick

Balls

Femur

Gallbladder

Bones

Blood

Metatarsals

Right footsie

Left nostril

Eyeballs

Ass

Perineum

Left kidney

Nipples

Left shoulder

Amygdala

Left knee

Graymatter

Frontal lobe

New pinkie

Entire body

Right ear

Mouth

Canine teeth

Ovarian cyst

Wooden pinkie

Uvula

Veins

Endocrine system

Facial hair

Left foot

Moral compass

Carpal tunnel

Becracked spine

Skull

Missing ear piece

Cock

Broken bones

Middle c key

Injuries

Better half

Appendix

Neck scar

Matted hair

Tummy

Eyebrows

Inguinal masses

Mustache

Knees

Ass hair

Maggot

Nose

Uterus

DID

Better Half

Vocal Cords

Skin

Endometriosis

Others:

Darkthur lesters lost arm

Faroes music box

Faroes Lesters bathwater

Faroes lungs

The butchers hat

Larsons shattered eyeballs

Johns left foot

Johns right foot

Johns eldritch eyes

Fausts sharp femur

Mr fausts femur

Yellows top left tentacle

Yellows tentacock

Oscars hammer

Father Oscars left arm

Kaynes bare grippers

Kaynes canines

Parkers closeted corpse

[little-the-rat]

Fighting for my life not to join the Arthur Lester body part thing

I wanna be his inguinal masses (which may turn out to be testes)

[arthur-lesters-small-intestine]

Tagged by: @arthur-lesters-intestines (woagh thank you :0)

Rules: answer the questions and tag 9 (rules say 9 but feel free to tag however many or few you want) people you want to get to know better or catch up with

Favourite colour: the iridescent black of birds feathers that shines different colours in the light. Or the green of forests

Last song:

- listened to: it should’ve been me - riproducer

- sung: if we’re talking casually then also it should’ve been me because I sing along to all my music. But if we’re talking actual proper warm-up-first-and-actually-put-in-effort singing then it’s one of my original songs that I haven’t finished yet :}

- song you want to hear as you die: sleep by Eric whitacre because we sang it at my graduation ceremony and it brings me memories of all my friends and the good times I had singing in a choir. Or chiisaki mono from the pokemon jirachi movie because it encompasses all the good bits of my childhood

Currently reading: I have like, 6 fanfics on the go rn. Also the venom comics

Currently watching: Alex rider s3

Currently craving: brownies. Can we get Arthur to eat one please

Coffee or tea: not to be stereotypically British, but tea all the way.

A hobby you would like to try: opera singing

A discipline you’ll be following during the Olympics: I have no interest in sports, so none of them

Any AUs you have: none of existing media. Plenty of original stories though

Tags: Im just going to tag all the mutuals I have on this blog. Which isn’t a lot (no pressure to participate :})

@the-algid @faroes-music-box @arthur-lesters-inguinal-masses @morbid248 @arthur-lesters-mouth @arthur-lesters-endocrine-system @arthur-lesters-receding-hairline

[arthur-lesters-intestines]

Tagged by: @nonbinarytoast @arthur-lesters-coccyx hey bby 😘

Rules: answer plus tag 9 people you want to get to know better and/or catch up with

Favorite color: orple. Like. Any purple. Pink and orange are great too 👍

Last song: Last listened too: Beautiful People (stay high) - The Black Keys, Last sung: Give The Mule What He Wants - Queens of The Stone Age, What i want to hear as I die: Sail - AWOLNATION (specifically played at my funeral because it would be the funniest fucking thing to me and the people need to laugh.)

Currently reading: Honestly? Fanfic. A REAL answer: Amulet Book 3: The Cloud Searchers (I believe in Lugar supremacy. SURE HE TRIED TO MURDER CHILDREN BUT HE IS JUST A SWEET OLD MAN. HE DID NOTHING WRONG)

Currently watching: nothing. But I am going to watch, ELECTRIC DREAMS BABYYY

Currently craving: NUTRIENTS (back in character for this one 👈👈)

Coffee or tea: both. Both is good.

Any hobby you would like to try: Crocheting. Those wobbles look neat. I'd like to cop me some of the Minecraft ones.

Any discipline you'll follow during the Olympics: naaahh. But if I were, probably snowboarding or any of the ski stuff.

Any AU you're plotting for: more likely to not pursue due to just not having time, but I have thought about one where Kayne partially follows up on his deal, he gives Faroe back, but John is still entwined with Arthur. They have Faroe for a while (shes 14 or 15 at this point) Things go well till Kayne comes back to fuck up things in good ole Kayne fashion and makes Faroe question Arthur's strange habits, it boils down to the point she questions if he even is her real father. Arthur has to fess up and tell her the truth about everything. (There's a lot more I can add to this, but this is becoming longer than this should be. Maybe I'll make a separate post explaining more if people are interested.)

No pressure tags: @arthur-lesters-small-intestine @faroes-music-box @morbid248 @aroacecowboy @izzythedemigod @arthur-lesters-inguinal-masses @arthur-lesters-receding-hairline @platypus-with-interests @buried-in-the-archives

[arthur-lesters-throat]

This is the only tma image in my galery honestly idk what to do anymore I fear I'm always gonna be a hater 😔😔😔

I'm not gonna tag all of you my dear limbs but feel free to join

@arthur-lesters-uterus @arthur-lesters-eyebrows @arthur-lesters-evicted-maggots @arthur-lesters-amygdala @arthur-lesters-blood @arthur-lesters-bones @arthur-lesters-ass-hair @arthur-lesters-tits @arthur-lesters-uvula @faroes-lungs @faroes-bathtub @faroes-music-box @father-oscars-left-arm @oscars-hammer @parkers-closeted-corpse @arthur-lesters-teeth @arthur-lesters-scarred-throat @arthur-lesters-prefrontal-cortex @arthur-lesters-coccyx @arthur-lesters-dead-daughter @arthur-lesters-emotional-baggage @arthur-lesters-femur @arthur-lesters-facial-hair @arthur-lesters-frontal-lobe @arthur-lesters-gender @arthur-lesters-hippocampus @arthur-lesters-intestines @arthur-lesters-inguinal-masses @arthur-lesters-metatarsals

Found this on Twitter, so I thought, why not posting it here and doing a tag game 😊

Ok, I’ll go first

If he is the reason, I’d go to prison gladly 🥰❤️‍🔥

Tagging: @killerqueen-ofwillowgreen @nic-214 @milkyway-ashes @dr-radiation @whitequeen-ofwillowgreen @sunsetdaydreamer @therockywhorerpictureshow @delicatelyfantasticninja and everyone 😊

Sorry if I forgot to tag some of you!

[doughnutbooboo]

星辰大海，终有一别

This tribute is dedicated to May.

Four weeks have passed since May's passing from adenocarcinoma on August 16th at 5:25 PM. The challenge of crafting a suitable tribute has been formidable, with each iteration deemed inadequate. The limitations of language in conveying May's remarkable strength and courage have become apparent. The conventional expressions of condolence have only served to intensify the sense of loss.

Instead of writing how great of a dog May was (which she was. She is the best dog on earth), and how much we love her (which we do. I’ll continue to love her until the end of my life), I will write how she died.

May's symptoms commenced in the beginning of April, characterized by swelling and lameness in her rear left paw. Diagnostic investigations, including X-ray and biopsy, yielded inconclusive results. They showed no sign of bacterial and fungal infection, no sign of cancer. She was prescribed Metacam, which brought the swelling down immediately. By the end of April, the swelling was completely gone and she was using her leg as normal. We thought it was a twisted muscle or tendon and decided to go to China as planned.

The swelling and lameness came back around May 15th. A subsequent biopsy during revealed similar findings, prompting referral to Toronto Veterinary Emergency Hospital for further evaluation. May had her consultation on June 4th and three possibilities were laid in front of us: a foreign object trapped in her leg which caused all the swelling and tenderness, a rare parasite infection, or cancer. A CT scan, followed by an explosive surgery, were performed on her the next day. When the surgeon cut open her leg, she saw perivascular lesions with multi-cystic appearance along the muscle membranes. The oncologist was called over for a consultation. The lesions did not appear to be cancerous to him. Without the presence of any foreign object, they suspected she had a rare parasite infection. Multiple samples from the lesions were taken for further testing.

We got a phone call from the surgeon on June 10th and received the most devastating news. Every single sample she took, including the inguinal lymph node, came back to be adenocarcinoma. If this was not dreadful enough, we were told in most cases, the leg is a metastasized secondary site. The primary tumor is most likely somewhere in the abdomen. This is a stage 4 adenocarcinoma with very poor prognosis.

We were given an option to try an oral chemotherapy drug for one month. This drug has the potential to slow down the progression of the carcinoma, with a small likelihood of shrinking the tumors. By the end of the one month trial, we all vitnessed the further progression of the swelling and lameness, to a degree that she completely stopped using that leg. And she was clearly in pain. During her follow-up appointment with the oncologist, we found out her weight dropped from 36.7 kg to 33 kg in one month. We were suggested to do an ultrasound of her abdomen and a X-ray of her chest. Now looking back, those tests were meant to confirm she had cancer metastasized all over her body, in order to justify euthanasia.

Against all odds, her tests came back clear! No mass was found on the X-ray and the ultrasound. The leg was confirmed to be where the primary tumor was. Amputation of that limb would be a valid treatment, potentially a cure! Both the oncologist and the surgeon thought it was the “devastating case A”, but it turned out to be the “optimistic case B”. On July 18th, May had her rear left limb amputated.

The universe fucked us real hard! One week after the amputation, I noticed redness and swelling along her incision line. We brought her in for a recheck and it was believed to be a start of an infection. With the antibiotics prescribed to her, the “infection” got significantly worse in the next five days. When we brought her in for the oncologist follow-up, we were delivered the most dreadful news once again. The histopathology report found that the adenocarcinoma had metastasized to the left popliteal lymph node, the left inguinal lymph node, and to the skin around the inguinal lymph node. The metastasized area of the skin is extensive, covering her skin near her vagina, her anus, and above her tail. It was not some infection. It was the recurrence of cancer. It was neither “case A”, nor “case B”. It was the insidious “case C” no one has seen it coming.

From July the 31st, the day of the oncologist follow-up of the amputation, to August 16th, the day we euthanized her, the cancer was growing on her skin like a wild fire. There was visible difference every single day. I watched it grow, ulcerate, grow, could no longer maintain the growth rate, and die. The death of the cancer tissue developed into necrosis, which gave out a foul smell, the smell of rotting. May started to constantly lick after her oozing and stains. Leia joined very shortly after. Constantly cleaning after one’s own necrosis stains is not a dignified way to live.

We brought May in on August 14th, knowing in our heart we were in the end game, with the slightest hope that maybe some other chemotherapy protocol could prolong her lifespan. She was seen by another oncologist (hers was on vacation at the time), the surgeon who did the amputation, and the anesthesiologist. They were quite certain that May was reaching her tipping point. They were all shocked at how fast this carcinoma was progressing. I asked them to give her drugs that would make her comfortable for three more days. We didn’t care her kidney or liver might fail at that point. The anesthesiologist gave her a shot of fentanyl and a dose of slow releasing ketamine. With the other pain meds she has already been on, she was on five types of pain medications at the end of her life. We brought her to her vet for euthanasia on August 16th at 4:30 pm. May passed away at 5:25 pm.

Four weeks have passed and I found how fascinating my memory plays tricks on me. Those memories of tiny little details of May started to blur. Her very own unique smell, how she sighs when she’s satisfied, how she sighs when she’s tired and ready to sleep, the sound she makes when she was panting in different ways, the warning bark she gives out when she’s guarding, the happy bark when she’s saying hello, the angry bark before she starts a fight, the sound she makes when she comes upstairs, the sound she makes when she comes upstairs with three legs.

At the same time, some images will stay with me for the rest of my life.

I’ll always remember how she managed to walk up and down the stairs, went to the backyard to shit eight times per night when she was on the chemo drug. She never had a single accident in the house to the last moment of her life, whether was with that cancer leg gave her constant pain, or was with three legs right after her amputation on the same day. She didn’t even poop or urinate herself after she was euthanized. She lived a dignified life.

I’ll always remember the day we picked her up from her amputation surgery. She was spinning in circles with three legs, totally lossing herself with so much joy, just like how she losses her mind and forgets to breathe when we pick her up from the kennel or daycare every single time! July 18th is one of the happiest days in my life! I had so much hope that she was cured from the amputation.

I’ll always remember how her eyes shot wide open that very second she died. I’ll never forget how her body was slowly lossing the temperature and softness one hour after she passed, and that’s when we said the final farewell. Our ten years of life together came to an end. We will never see each other again.

I’m not gonna tell you that I think of her every minute or hour of my life since she passed away. Because I don’t and that’s only gonna drive me insane. I’m not gonna tell you that life will never be the same because life has been surprisingly the same.

People die everyday second of everyday. Animals die everyday. May’s death is like a drop of water into the ocean. It has been an honour and true happiness to spend ten years of my life with May, a brilliant, loyal, ridiculously strong and brave German shepherd, such a wonderful being that as an atheist, the creation of May is a mystery to me.

星辰大海，终有一别。

我会用我的余生来想念你。

[strapskinkstories]

Open letter, from a closed DM

OOoo hey bud, sorry I've kinda neglected you and the whole gay scene, my male side is *severely damaged* I need to get my orchiectomy so I can actually have my sexual function go back to normal, having all these testicular pains is *preventing me from sexual function*

get ready for this bullshit, I had my orchie scheduled for this last friday, instead I got a fuck you letter from a catholic hospital saying that they refuse to do a *sterilization* procedure, BRO I HAVE A TRACH AND LIKE A DOZEN GENETIC DISEASES, YOU THINK IM GONNA EVER HAVE KIDS!? YOULL HAVE TO RAPE ME AND THEN I END YOU

If a woman were to tie me down and then by force have sex with me I'll put a full magazine into their body and ensure they are done living

1. I do not want to have kids

2. I do not want to subject another single God borne God created SOUL to this shit hole world, while the LGBTQIA+ world is almost like a paradise within the earth a safe haven, it's surrounded by a proverbial sewer, that is America, European international and internal affairs along with all the other geopolitical BS we deal with. Then theres the shitty environment. We need an unbreakable world, a literal damn heavens specifically for the LGBTQIA+

3.I have so many medical conditions and even a high cancer risk, every time fucking humans multiply the mutations in the genome get worse because DUH! Just like COVID19 and other viruses, humans are in effect parasitic on the earth especially with reckless 'breeding practices' resulting in mass genomic mutations and higher cancer risk, believe it or not but in the damn Bible and in other books of history people could live to be several hundred years old, credited to the extremely new and pure earth atmosphere and zero emissions and full ozone layer. Humanity totally fucked the earth going with fossil fuels, we could have left the fucking oil in the ground and went with electricity but nobody wanted to listen to Nikola Tesla

4. I have chronic testicular pain that cannot be conservatively treated, so the only resolution is a full radical orchiectomy with removal of the contents of the inguinal canal. Scrotal approach is acceptable provided the surgeon possesses ability to terminate spermatic cords and arterial complexes leading from the genitofemoral branch at the inguinal canal exit point.

Soooo ummm sorry.. bit awkward that I just unloaded that on you but THERES THE LONG STORY.

Sorry it sounds UBER religious but hey if a fucking CATHOLIC HOSPITAL is gonna be UBER RELIGIOUS and fuck me over then I'll show the WHOLE FUCKING WORLD why #LoyolaMedicine should be allowing Orchiectomies and trans care to happen in its so called "Holy Hospital" Any place of true holiness would acknowledge that the system used for vessel enclosure, to seal a soul to a body is imperfect as it sorts thousands of souls per second during births. Sometimes a female soul ends up in a male body and this is well known by neuroscience and psychology confirmed by deep theological study as well as independent spirit explorations. Any hospital of holiness would be working as fast as possible to allow as many transitions to occur within a high throughput transitional care facility that should have surgical throughput of at least 60 cases per day and a psych services / presurgical clearance unit throughput of a minimum of 240 cases per day.

Such a trans center would be able to handle 13,000 MtF or FtM transitions within it's operating rooms, you'd think "bullshit, it can't run 24 hours" I say "fuck you, I can make it run 24 hours and people can come in and go sleep in an operating room while we do transition work"

I'm a *REAL CHRISTIAN*

Real Christians don't go around controlling other people for profit nor do they go using fear tactics for the churches purposes, and fucks sake they do not worship guns, though if you rape me or any woman you will find yourself dead or near it. Rape is not a joke on either side of the aisle *NOBODY SHOULD BE FORCED INTO SEX*

People have a *RIGHT TO THEIR GENDER AS ENCODED ON THEIR SOUL*

Discovery and decoding of a "gender key" is typically something that can happen in childhood but for some it can happen much later and trigger flashes back to childhood thereby revealing the childhood key.

Ok, so I'm probably seeing like half of my audience freaking the fuck out right now, at least a quarter of my audience is shitting bricks and saying WHAT THE FUCK, SINCE WHEN WAS STRAPS TRANS!?

Y'all might have seen some brief inklings here and there on Twitter but I haven't sat down to type and reveal the actual encoding.

When I was in earliest childhood I absolutely hated anything touching my genitals (sensory rejection, the genital organs shouldn't be there)

Later childhood, I didn't have any fitness level, ran a higher heart rate awake (females run higher heart rates with a higher ejection fraction than men typically) and I always gravitated toward female hobbies, arts and music although with a slight male twist of going digital and machine art with music mixing for a school radio station.

I often got into my moms medicine cabinet to steal makeup and also would get her clothing. Had a massive collection of barbies, a small collection of hot wheels and made a weird mashup between the two but the barbie collection got the most use

By the age of 14 I had the neuromuscular disease confirmed to be triggered by Cymbalta (I'm one of the reasons the antidepressants now all have a black box warning not to use them in children and young adults, they can be extremely neurotoxic in rare events) I also was run for many genetic tests and imaging tests, I have BREAST TISSUE on the left side of my chest. Someone do a damn gender chromosome check and a full endocrine blood on me, and look for hidden ovaries, I think I've been producing estrogen since day one. I'm probably a strange white unicorn.

Wait a minute... White Unicorn...

The white unicorn represents magic, divine female energy, and a balance between female and male energy. Explains why I am double gendered but more female leaning.

The white unicorn is considered a messenger of angels and reminds us to reconnect with our inner child and pursue activities that bring joy. Explains why I'm always working with music art or writing because I want to see other people enjoying my work

In dreams, the appearance of a white unicorn signifies purity of heart and can serve as a powerful guide. It may also indicate the need for more magic in life or the potential loss of something. This Unicorn came to me as a signal to write more, and also to reveal my true self to the world

White unicorns, according to Celtic astrology, are born between July 8th and August 4th. They are natural healers and nurturers, possess creativity, and are selective about who they spend their time with. I'm a Late Unicorn with a August 8th birthdate, but I was technically born prematurely and if I was four days earlier I would have been "on time" for Unicorn Arrival but not safe for the earth, so delayed four days for final preparations. I'm a heavily creative person, I am highly picky about who I spend time with but when I do select my people they form a very strong bond, I am one who always works with medicine and healing and have even returned to doing energy work after finding people who need it and who accept the world of spirit energy healing (I mostly do it to mitigate pain and reduce muscle tightness for people)

So this is why I have not been doing a whole lot on Tumblr, or Twitter or anywhere. I've been dealing with an internal spiritual battle, saving my female side from being destroyed and balancing things to find out that my male side is the destroyer, the one that will eventually kill me, the female side is what I need to keep. On top of the spirit battle which has now come to closure, the male side is dying slowly but has been successfully terminated. Now I need to get the physical battle done and get rid of the painful testicles that should have never existed in the first place.

Sooo yeah... Now you all know what's actually going on. We return to normal programming uhh... Whenever I finish my next story.

(If you read this far then you're a bud, thanks for reading, mash the like and let me know you're still around)

[tremendouspersonarbiter]

Best Laparoscopic Surgeon in Hyderabad - Dr. N.S. Babu

Looking For Laparoscopic Surgery in Hyderabad? or a Laparoscopic surgeon in Secunderabad? Dr. N Subrahmaneswara Babu is a renowned Surgical Gastroenterologist and Laparoscopic Surgeon in Hyderabad with +15 years of experience in the field of surgeries. He has a special interest in Laparoscopic surgeries. Laparoscopic surgery has operations within the abdominal or pelvic cavities. Laparoscopic cholecystectomy and Laparoscopic appendicectomy are the most generally performed surgeries. Dr. N Subrahmaneswara Babu is the best Laparoscopic surgeon in Hyderabad for such surgeries with his vast experience.

What Is Laparoscopic Surgery?

Laparoscopic surgery is also known as keyhole surgery. This is an advanced method of surgery. It allows the surgeon to access the pelvis and abdomen without making large incisions. In laparoscopic surgery, the Surgeon makes several little incisions that measure around 0.5-1.2cm. Then the surgeon inserts a narrow tool with a small camera and light at the end, called the laparoscope, through the small incision into your body.

When Is Laparoscopy Surgery Recommended?

Dr. N Subrahmaneswara Babu is an expert in Laparoscopic Surgery in Hyderabad. He suggests laparoscopic surgery to diagnose and treat the following conditions:

Pelvic pain or mass formation

Abnormal accumulation of fluid in the pelvic region

Inability to conceive

Tubal pregnancy

Ovarian cyst or tumor

Scarring from pelvic infection

What are the benefits of laparoscopic surgery?

Dr. N Subrahmaneswara Babu is a highly-qualified and experienced laparoscopic surgeon in Hyderabad. He always explains the advantages of laparoscopic surgery to his patients to make informed decisions. The benefits of laparoscopic surgery are as follows:

Less pain

Very small scars

Lower Blood Loss

Less tissue cutting

Reduced Risk of Infections

Quick healing as the scar is small

Stay for fewer days in the hospital

Types of Laparoscopic Surgery:

Dr. N Subrahmaneswara Babu is an outstanding laparoscopic surgeon in Hyderabad. His forte is advanced laparoscopic gastrointestinal surgery. Here are the laparoscopic surgeries provided by Dr. N Subrahmaneswara Babu:

Colorectal surgery: Colorectal surgery treats problems in the intestines. Colorectal surgery is used to describe different surgical procedures to treat diseases of the lower gut. It can be used to treat conditions like piles, colon and rectal cancer, hemorrhoids, anal fistula, congenital disabilities, diverticulitis surgery, and stoma creation & revision

Upper GI surgery: Upper gastrointestinal surgery is performed to treat pathologies of either the upper gastrointestinal tract, gall bladder, pancreas, liver, etc. It can be used to treat conditions like gastroesophageal reflux disease (GERD), diaphragmatic hernia repair, duodenal perforation repair, stomach cancer, etc.

Bariatric surgery: Bariatric surgery is a type of surgery used for weight loss. These surgeries make changes to your digestive system to support you lose weight. Sleeve gastrectomy, Roux-en-Y gastric bypass, and Mini gastric bypass are the types of Bariatric surgery

HPB Surgery: HPB surgeries include the treatment of benign and malignant diseases of the liver, gallbladder, pancreas, and bile ducts. It involves CBD Exploration, Open HPB Cancer Surgeries, Subtotal Cystogastrostomy, Cystogastrostomy

Laparoscopic inguinal hernia repair: Dr. N Subrahmaneswara Babu also specializes in TEP – Total extraperitoneal pre-peritoneal repair and TAPP – Transabdominal pre-peritoneal repair.

Why Dr. N S. Babu is the best Laparoscopic surgeon in Hyderabad?

He has more than 15 years of experience as a Laparoscopic surgeon.

He provides his patients with excellent treatment and considerate and acute care, assuring their quick recovery.

Dr. N S. Babu values communication and takes the time to explain medical conditions and treatments to his patients to understand their health concerns.

Dr. N S. Babu will provide you with a friendly and honest opinion regarding your suitability for surgery, putting your safety and well-being as the priority.

How to book an appointment for laparoscopic surgery With Dr. NS Babu?

You can fill out the patient form on our website www.hillsgastrocare.com. Once your appointment form is submitted, a team of medical coordinators will reach out to you at the earliest and fix an appointment with the laparoscopic specialist Dr. N.S. Babu according to your schedule. or You can also directly connect with our medical coordinators through the contact number 09490808080. The medical coordinator will listen to your query and connect you with the laparoscopic doctor near your area and book an appointment consecutively.

[lovingdreammick]

Comprehensive understanding Granuloma Inguinale

Granuloma Inguinale, also known as Donovanosis, is a chronic bacterial infection caused by the bacterium Klebsiella granulomatis (formerly known as Calymmatobacterium granulomatis). It primarily affects the genital and inguinal regions, leading to the development of painless, beefy-red, nodular lesions. Granuloma Inguinale is more commonly found in tropical and subtropical regions but can occur in other areas.

Key Points about Granuloma Inguinale:

Causes:

Granuloma Inguinale is caused by the bacterium Klebsiella granulomatis.

Transmission typically occurs through sexual contact, including vaginal, anal, or oral sex.

Incubation Period:

The incubation period, or the time between exposure to the bacteria and the development of symptoms, can be relatively long, ranging from weeks to months.

Clinical Presentation:

Genital Lesions: Granuloma Inguinale is characterized by painless, beefy-red, nodular lesions or ulcers on the genital, inguinal, or anal areas.

Granulomatous Tissue: Over time, the lesions can progress to form granulomatous tissue, which may bleed easily.

Complications:

If left untreated, the infection can lead to extensive tissue damage and the formation of genital masses.

Secondary bacterial infections may occur, contributing to complications.

Diagnosis:

Diagnosis is typically made through clinical examination of the characteristic lesions and laboratory testing of tissue samples or swabs.

Polymerase chain reaction (PCR) tests may be used for confirmation.

Treatment:

Antibiotics, such as doxycycline or azithromycin, are commonly prescribed to treat Granuloma Inguinale.

The duration of treatment may be extended to prevent relapse.

Prevention:

Safe sex practices, including the use of condoms, can reduce the risk of sexually transmitted infections.

Early diagnosis and treatment are essential for preventing complications and reducing the spread of the infection.

[nursingscience]

Lymphatic System

4. Lymph Nodes

Lymph nodes are small bean-shaped structures that are usually less than 2.5 cm in length. They are widely distributed throughout the body along the lymphatic pathways where they filter the lymph before it is returned to the blood. Lymph nodes are not present in the central nervous system. There are three superficial regions on each side of the body where lymph nodes tend to cluster. These areas are the inguinal nodes in the groin, the axillary nodes in the armpit, and the cervical nodes in the neck.

The typical lymph node is surrounded by a connective tissue capsule and divided into compartments called lymph nodules.

The lymph nodules are dense masses of lymphocytes and macrophages and are separated by spaces called lymph sinuses. The afferent lymphatics enter the node at different parts of its periphery, which carry lymph into the node; entering the node on the convex side. The lymph moves through the lymph sinuses and enters an efferent lymphatic vessel, which, located at an indented region called the hilum, carries the lymph away from the node.

[teachingrounds]

Q. What are the indications for differences of sex development (DSD) evaluation?

A. Indications for DSD evaluation: - abnormal phallus (unusually large/small) - typical phallus (+/- hypospadias) + bilateral nonpalpable gonads - virilized female, including asymmetrical genitalia such as a scrotal or inguinal mass - discordance between karyotype and genitalia - family history of DSD - delayed or absent puberty - certain syndromes (e.g. Klinefelter, Turner).

[lupine-publishers-juns]

Lupine Publishers | A Rare Case of Penile Schwannomatosis Presenting with Painful Nocturnal Penile Tumescence

Abstract

Background: Penile schwannoma is a rare tumor. They commonly present as an asymptomatic, painless and slow growing mass. Other presentations include sexual dysfunction, most commonly dyspareunia, followed by erectile dysfunction, abnormal penile curvature or pain with ejaculation. Case presentation: A 26-year-old male presented atypically with painful nocturnal penile tumescence, along with multiple nodules over the dorsal penis. Excision of multiple penile tumors under general anaesthesia was performed and histopathologic examination revealed benign schwannoma. Conclusion: Our hypothesis is that the schwannoma lies along the axis of the dorsal penile nerve, and compression of this nerve occurs during his erection causing pain. However, there are limited presentations of painful erections in penile schwannomas, and we hope that future studies can help confirm this theory.

Keywords: Penile; schwannoma; painful tumescence; sexual dysfunction

Background

Schwannomas are a form of peripheral nerve tumors made up of neoplastic Schwann cells that typically occur as solitary, encapsulated masses. They can occur throughout the body, but more commonly arise on the head, neck, or flexor surfaces of limbs [1,2]. The tumors are sporadically associated with genetic syndromes such as schwannomatosis and neurofibromatosis or may be the result of therapeutic irradiation [3]. Schwannomas have a low annual incidence of 0.6 per 100,000 people [4]. These are rare and only 27 cases have been reported in literature since it was first described in 1968 [5]. Penile schwannomas are typically asymptomatic, painless and slow growing. Possible presentations include sexual dysfunction, most commonly dyspareunia, followed by erectile dysfunction, abnormal penile curvature, or pain with ejaculation. Our patient presented with painful nocturnal penile tumescence, which is not a well-known presentation of penile schwannomas. There is limited published literature on such cases and hence little is known about this condition (Figures 1&2).

Case Presentation

A 26-year-old man with a history of ankylosing spondylitis (HLA B27 gene) and previous circumcision first presented with a oneyear history of recurrent painful nocturnal erections. He had prior consultations with various urologists and did not respond to oral analgesia. The frequency of painful nocturnal erections increased from once per week, to thrice per week over the past year. Each episode of painful nocturnal tumescence lasted approximately five minutes and the patient was often awaken from sleep by the severe pain, which affected his sleep and quality of life (Figure 3). There was no history of priapism, sexual transmitted disease, or genital trauma. There were no persons with known neurofibromatosis in his family. On examination, four lumps could be palpated over the dorsum of the stretched penis. Two were superficial nodules on the distal shaft, with one deep nodule each at the mid shaft and base of the penis. The nodules were 0.5cm or less in diameter and firm in nature. The mid shaft nodule was tender on palpation and correlated with the site of painful nocturnal erections. The penis was otherwise unremarkable and there was neither penile curvature on erection nor any palpable lymph nodes in the femoral or inguinal areas. Nodules or café-au-lait spots were not present in the rest of the body (Figure 4). Over a five-year follow-up, patient developed worsening symptoms with the painful erections occurring twice every night from one episode a week. Physical examination and interval ultrasound imaging demonstrated an increase in the number of nodules from four to five with further growth of the existing nodules. Most noticeably, the right intracavernosal nodule increased from 4 mm to 7 mm in diameter. The patient decided for surgical excision of multiple penile nodules (Figures 5&6).

Investigations

Laboratory findings included normal blood cell counts, chemistries and urinalysis. Initial ultrasound penis showed multiple rounded heterogeneously echogenic nodules in the subcutaneous region of the dorsal penile shaft. The nodules show minimal central and peripheral vascularity. A small cystic lesion with internal echoes is also noted in the corpus cavernosum. The patient initially declined surgical intervention and opted for annual ultrasound imaging (Figure 7). Magnetic resonance imaging (MRI) of the penis performed prior to surgery showed multiple enhancing sub-centimetre nodules in the penile shaft, most of which were superficial. There was a nodule in the right corpus cavernosum, and another in the dorsal midline which disrupts the wall of both corpora cavernosa.

Treatment

Patient underwent excision of multiple penile tumors under general anaesthesia. A circumferential incision was made at the previous circumcision site. The penis was then degloved to its base and the layers dissected down to Buck’s fascia. There were five superficial tumors adherent to the tunica albuginea (two at right distal shaft, two at midshaft, one at base of penis). A deep-seated tumor was located at the right corporal mid shaft. The tumors measured approximately 1-1.5cm in diameter (Figure 8). The cut surface of the tumors was homogenously yellowish with noted feeding vessels. All tumors were excised, and histology was sent from all locations.

Outcome and Follow-Up

All specimens show similar morphology. The circumscribed and thinly encapsulated nodules were made up of Schwann cells arranged as a mixture of more cellular Antoni A and less cellular Antoni B areas. The more cellular Antoni A areas consists of Schwann cells arranged as short fascicles or parallel rows of nuclear pallisading (Verocay bodies). The less cellular Antoni B areas show a looser myxoid stroma. The nodules are associated with thickened and oedematous nerve fibres, and occasional more plexiform Schwannian areas are seen involving the nerve fibres (Figures 9&10). No high-grade nuclear atypia, increased mitosis or tumour necrosis is seen. On immunostaining, the lesion shows diffuse staining with S-100, which is indicative of Schwannoma. In the follow up consultations over a year after surgery, there was no further nightly painful erections and patient was able to sleep well. On examination there is a small nodularity at mid shaft which is likely due to scar tissue formation. However, the patient did experience difficulty maintaining erection due to discomfort over the surgical site. This was managed well with Viagra 25mg, with an improvement in International Index of Erectile Function score from 8/25 to 19/25. Patient declined genetic testing as he was not keen on childbearing.

Discussion

Schwannomas rarely present with penile pain. There have been postulations made regarding the correlation of symptoms to neuroanatomy. A literature review done by Huang et al. concluded that patients with penile root schwannomas are more prone to symptoms with discomfort or sexual dysfunction (4 of 6) compared with patients with penile shaft schwannoma (7 of 16) or glans schwannoma (2 of 7) [6]. Based on anatomy, penile schwannomas at the mid shaft or glans should originate from the dorsal nerve of the penis, which is the deepest division of the pudendal nerve. The pudendal nerve does pass through the penile root, but there is no clear branching or tracking of the nerve origin of the tumor [7]. Pain may occur in the region of the tumor and any nerve the tumor originates from, but pain may not be specific enough to discern the particular involved nerve. Neurologic deficits of sensory and motor function correspond to the nerve in which the tumor originates or which it is compressing, and as such will often be most useful in localizing the tumor [8,9]. This patient presented with painful nocturnal erections corresponding to the mid shaft schwannoma. Our hypothesis is that the mid shaft schwannoma lies along the axis of the dorsal penile nerve and pain could arise when the nerve is compressed by the schwannoma during full erection. During nocturnal tumescence, the cavernosus arteries dilate, leading to engorgement of the corpora cavernosa and increase of intracorporal pressure. This pushes the schwannoma towards the dorsal penile nerve leading to nerve irritation, compression and pain. Penile schwannomas normally occur at the dorsal penile shaft. However, there have been documented cases where the tumor has infiltrated the glans and prepuce [10]. In such cases, we have to consider other possible diagnoses including benign soft-tissue lesions such as lipoma, fibroma, leiomyoma, Peyronie’s disease, injection-related fibrosis, and rarely malignant sarcomas. Clinical history taking and clinical examination are important, but imaging can aid in narrowing the differentials by locating the plane of the lesion and delineating the mass. Ultrasound examination can demonstrate hypoechoic lesions, and doppler ultrasound can detect hypervascularity. CT scan is rarely used, and mostly performed to exclude metastasis. Schwannomas demonstrate typical MRI features of T1 isointensity to hypointensity, T2 hyperintensity, and postcontrast enhancement. Heterogeneous signal intensity and postcontrast enhancement are suggestive of internal hemorrhage and myxoid/cystic changes [11]. Otherwise, excision biopsy of the tumor would be the gold standard for final diagnosis. Treatment of penile schwannomas is symptomatic, focused primarily on pain management. Complete surgical excision is the recommended treatment for penile schwannomas, with low recurrence rates [1- 10]. This patient recovered well with no signs of recurrence one year postoperatively. Schwannomas of the penis are usually benign, but four malignant variants have been reported in literature. No cases of benign penile schwannoma have been reported to be associated with hereditary diseases [12]. Schwannomatosis is the third major form of neurofibromatosis, and is characterized by a predisposition for schwannomas, in the absence of schwannomas on both vestibular nerves. Its diagnosis is based on a criterion [13]. Most patients present in adulthood with multiple schwannomas and pain, and approximately 20 percent of patients have a family history of schwannomas or schwannomatosis [14]. So far, there have been no confirmed causes of penile schwannoma with schwannomatosis. There is no strong evidence about the correlation between schwannoma and erectile dysfunction [15]. This patient’s postoperative erectile dysfunction is likely due to pain surrounding the surgical wound site. Also, there were no surgical complications other than possible scar tissue formation on the penile shaft.

Conclusion

Schwannomas of the penis are extremely rare and typically present as a solitary, asymptomatic, painless and slow-growing tumor. The rarity in this case is that our patient presented with painful nighttime erections. Based on the penile neuroanatomy, penile schwannomas at the mid shaft should originate from the dorsal nerve of the penis. Our hypothesis is that the schwannoma lies along the axis of the dorsal penile nerve and compression of this nerve occurs during his erection causing pain. However, there are limited presentations of painful erections in penile schwannomas, and we hope that future studies can help confirm this theory.

For more Lupine Journals please click here: https://lupinepublishers.com/index.php

For more  Journal of Urology & Nephrology Studies  articles please click here: https://lupinepublishers.com/urology-nephrology-journal/index.php

[tremendouspersonarbiter]

Laparoscopic Surgeon in Hyderabad | Laparoscopic Surgery in Secunderabad: Dr. NS Babu

Best Laparoscopic Surgeon in Hyderabad - Dr. N.S. Babu

Looking For Laparoscopic Surgery in Hyderabad? or a Laparoscopic surgeon in Secunderabad? Dr. N Subrahmaneswara Babu is a renowned Surgical Gastroenterologist and Laparoscopic Surgeon in Hyderabad with +15 years of experience in the field of surgeries. He has a special interest in Laparoscopic surgeries. Laparoscopic surgery has operations within the abdominal or pelvic cavities. Laparoscopic cholecystectomy and Laparoscopic appendicectomy are the most generally performed surgeries. Dr. N Subrahmaneswara Babu is the best Laparoscopic surgeon in Hyderabad for such surgeries with his vast experience.

What Is Laparoscopic Surgery?

Laparoscopic surgery is also known as keyhole surgery. This is an advanced method of surgery. It allows the surgeon to access the pelvis and abdomen without making large incisions. In laparoscopic surgery, the Surgeon makes several little incisions that measure around 0.5-1.2cm. Then the surgeon inserts a narrow tool with a small camera and light at the end, called the laparoscope, through the small incision into your body.

When Is Laparoscopy Surgery Recommended?

Dr. N Subrahmaneswara Babu is an expert in Laparoscopic Surgery in Hyderabad. He suggests laparoscopic surgery to diagnose and treat the following conditions:

Pelvic pain or mass formation

Abnormal accumulation of fluid in the pelvic region

Inability to conceive

Tubal pregnancy

Ovarian cyst or tumor

Scarring from pelvic infection

What are the benefits of laparoscopic surgery?

Dr. N Subrahmaneswara Babu is a highly-qualified and experienced laparoscopic surgeon in Hyderabad. He always explains the advantages of laparoscopic surgery to his patients to make informed decisions. The benefits of laparoscopic surgery are as follows:

Less pain

Very small scars

Lower Blood Loss

Less tissue cutting

Reduced Risk of Infections

Quick healing as the scar is small

Stay for fewer days in the hospital

Types of Laparoscopic Surgery:

Dr. N Subrahmaneswara Babu is an outstanding laparoscopic surgeon in Hyderabad. His forte is advanced laparoscopic gastrointestinal surgery. Here are the laparoscopic surgeries provided by Dr. N Subrahmaneswara Babu:

Colorectal surgery: Colorectal surgery treats problems in the intestines. Colorectal surgery is used to describe different surgical procedures to treat diseases of the lower gut. It can be used to treat conditions like piles, colon and rectal cancer, hemorrhoids, anal fistula, congenital disabilities, diverticulitis surgery, and stoma creation & revision

Upper GI surgery: Upper gastrointestinal surgery is performed to treat pathologies of either the upper gastrointestinal tract, gall bladder, pancreas, liver, etc. It can be used to treat conditions like gastroesophageal reflux disease (GERD), diaphragmatic hernia repair, duodenal perforation repair, stomach cancer, etc.

Bariatric surgery: Bariatric surgery is a type of surgery used for weight loss. These surgeries make changes to your digestive system to support you lose weight. Sleeve gastrectomy, Roux-en-Y gastric bypass, and Mini gastric bypass are the types of Bariatric surgery

HPB Surgery: HPB surgeries include the treatment of benign and malignant diseases of the liver, gallbladder, pancreas, and bile ducts. It involves CBD Exploration, Open HPB Cancer Surgeries, Subtotal Cystogastrostomy, Cystogastrostomy

Laparoscopic inguinal hernia repair: Dr. N Subrahmaneswara Babu also specializes in TEP – Total extraperitoneal pre-peritoneal repair and TAPP – Transabdominal pre-peritoneal repair.

Why Dr. N S. Babu is the best Laparoscopic surgeon in Hyderabad?

He has more than 15 years of experience as a Laparoscopic surgeon.

He provides his patients with excellent treatment and considerate and acute care, assuring their quick recovery.

Dr. N S. Babu values communication and takes the time to explain medical conditions and treatments to his patients to understand their health concerns.

Dr. N S. Babu will provide you with a friendly and honest opinion regarding your suitability for surgery, putting your safety and well-being as the priority.

How to book an appointment for laparoscopic surgery With Dr. NS Babu?

You can fill out the patient form on our website www.hillsgastrocare.com. Once your appointment form is submitted, a team of medical coordinators will reach out to you at the earliest and fix an appointment with the laparoscopic specialist Dr. N.S. Babu according to your schedule. or You can also directly connect with our medical coordinators through the contact number 09490808080. The medical coordinator will listen to your query and connect you with the laparoscopic doctor near your area and book an appointment consecutively.