Glandular Inclusions in Hernia Sacs of Children and Adults: Potential Source of Diagnostic Error: Report of 21 Cases, 3 Involving Females
Daniel Mockler, Philip Kane, Sonya Hwang, Alan Heimann, Carmen Tornos. Stony Brook University Medical Center, Stony Brook, NY
Background: Glandular inclusions in hernia sacs are more commonly seen in children and usually represent Mullerian duct-derived structures. Morphologically, they can be classified as vas deferens-like, epididymis-like and Mullerian-like. To date, most reports have described them in males younger than age 19. Our study was designed to determine whether benign inclusions are also found in adults and females and to study their morphology.
Design: We performed a computer search at our institution of all cases coded with the diagnosis of hernia sac with an additional diagnosis, from 1/1/1981 until 1/1/2011. Slides and reports were reviewed in all cases. Immunohistochemical stains were prepared if needed to confirm the diagnosis.
Results: We found 21 cases containing benign glandular inclusions. Six of them were vas-deferens-like (4 in children and 3 in adult males; ages 30, 62 and 71), 3 epididymis-like (all in male children ages 11 weeks, 3 months and 5 months), 9 Mullerian-like (all in males, 3 adults ages 20, 20 and 30, and 6 children ages 3 months to 8 years). We also found 3 cases with mesothelial inclusions, all in females; ages 9 weeks, 28 years, and 39 years. Classification of inclusions as mesothelial was confirmed with calretinin stains.
Conclusions: The presence of benign glandular inclusions in hernia sacs can occur, not only in male children, but also in females and adults. In males, the lesions are morphologically similar to vas deferens, epididymis or Mullerian remnants. In females, on the other hand, inclusions are mesothelial in origin and are strongly positive for calretinin. Awareness of these lesions can avoid their misinterpretation as metastatic adenocarcinoma or transected true anatomic vas deferens.
Category: Genitourinary (including renal tumors)
Monday, March 19, 2012 1:00 PM
Poster Session II # 141, Monday Afternoon