An inguinal hernia sac tumor of extrahepatic cholangiocarcinoma origin
© Yokoyama et al; licensee BioMed Central Ltd. 2006
Received: 02 November 2005
Accepted: 06 March 2006
Published: 06 March 2006
Metastatic hernia sac tumor from biliary malignancy is extremely rare with only one such case previously reported. We herein report an additional case of extrahepatic cholangiocarcinoma presenting as a hernia sac tumor.
A 78-year-old man presented with an irreducible right inguinal hernia associated with a firm tumor, 2.0 cm in diameter. A computed tomography scan demonstrated a soft tissue density mass with heterogeneous enhancement within the right inguinal canal. The patient underwent a hernia repair and the hernia sac tumor was resected. Histological examination of the tumor revealed a metastatic adenocarcinoma suggesting the tumor was of pancreato-biliary origin. Further investigation using imaging studies disclosed a primary tumor in the upper bile duct. The patient died of the disease nine months after the resection.
Hernia sac tumors should be considered when an irreducible, growing mass appears within an inguinal hernia. Computed tomography may be useful for the early detection of hernia sac tumors from undiagnosed intra-abdominal malignancies.
Tumors associated with inguinal hernias are rare, occurring in less than 0.5% of surgically excised sacs . Thus far, computed tomography (CT) features of hernia sac tumors have been poorly documented [2, 3]. We herein report the case of a hernia sac tumor that originated from an extrahepatic cholangiocarcinoma, and specifically focus on the CT features exhibited by a metastatic tumor within an inguinal hernia.
Hernia sac tumors can be classified into one of three groups: intrasaccular, in which an organ bearing the tumor is incarcerated within the sac; saccular, in which the tumor encompasses the sac or spermatic cord structures; or extrasaccular, in which the tumor protrudes through the hernia defect but is located outside the sac . Accordingly, the metastatic tumor described in this case can be classified as a saccular hernia sac tumor. The most common cause of saccular tumors is metastases from abdominal malignancies that migrate under the influence of gravity . Hernia sac tumors are associated with a wide spectrum of tumor types. Among them, the most frequent primary site is the colon followed by the ovaries, prostate, pancreas, and appendix [1, 4]. The hernia sac tumor described in this case originated from an extrahepatic cholangiocarcinoma, which is an extremely rare event with only one such case previously reported .
CT features of metastatic inguinal saccular tumors have been poorly documented, and to our knowledge there are only two documented cases that present CT findings of saccular tumors [2, 3]. Yokota and colleagues reported that a saccular tumor of colonic carcinoma origin was depicted in a contrast CT scan as a soft tissue density mass with heterogeneous enhancement . These CT scan findings are consistent with those described in the present case, suggesting that a soft tissue density mass with heterogeneous enhancement is a common CT feature of saccular tumors of gastrointestinal carcinoma origin. However, the contrast CT scan results for a saccular tumor originating from pseudomyxoma peritonei show a low-density mass without enhancement, suggesting a gelatinous composition . CT scan findings from the present and previous studies highlight the potential use of preoperative CT scans for the differential diagnosis of hernia sac tumors.
Hernia sac tumors can be suspected when an irreducible, growing mass appears within an inguinal hernia. Since hernia repair offers an opportunity for peritoneal biopsy, selective microscopic examination of grossly abnormal hernia sac specimens is recommended. Preoperative CT imaging may also be useful for the early detection of hernia sac tumors from undiagnosed intra-abdominal malignancies.
Written consent was obtained from the patient for reporting the case.
- Nicholson CP, Donohue JH, Thompson GB, Lewis JE: A study of metastatic cancer found during inguinal hernia repair. Cancer. 1992, 69: 3008-3011.View ArticlePubMedGoogle Scholar
- Yokota R, Hata Y, Matsuoka S, Nakajima S, Makita K, Sano F: A case of sigmoid colon carcinoma metastasized to an inguinal hernia sac. J Japan Surg Asso. 2003, 64: 999-1002.View ArticleGoogle Scholar
- Shimoyama S, Kuramoto S, Kawahara M, Yamasaki K, Endo H, Murakami T, Kaminishi M: A rare case of pseudomyxoma peritonei presenting an unusual inguinal hernia and splenic metastasis. J Gastroenterol Hepatol. 2001, 16: 825-829. 10.1046/j.1440-1746.2001.02401.x.View ArticlePubMedGoogle Scholar
- Lowenfels AB, Rohman M, Ahmed N, Lefkowitz M: Hernia-sac cancer. Lancet. 1969, 1: 651-10.1016/S0140-6736(69)92013-3.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.