Eosinophilic funiculitis initially diagnosed as irreducible inguinal hernia: A case report
Kohei Yamada1, Akashi Ikubo1, Shota Ikeda1
1Departments of Surgery, Japanese Red Cross Karatsu Hospital, 2430 Watada, Karatsu-shi, Saga 847-8588, Japan.
Background:
Most groin masses are first suspected to be groin hernias. More than 80% of bulging groin lesions are reportedly diagnosed as hernias by ultrasonography. Establishment of the correct diagnosis of hernia among all differential diagnoses is not easy. We herein describe a very rare case of groin eosinophilic funiculitis that presented as an irreducible groin hernia.
Case Presentation:
A 59-year-old man presented to our hospital with suspicion of a right groin hernia. He had a 1-week history of a painful right groin tumor. The tumor was about 4 cm without skin redness or warmth, irreducible even in the supine position, and associated with mild tenderness. Enhanced computed tomography showed that the mass seemed to be connected to the intra-abdominal structures. With time, the patient's pain did not increase, the inflammatory response did not worsen, and no ischemic signs were observed by enhanced computed tomography. Therefore, we diagnosed the tumor as an irreducible but not incarcerated hernia and performed elective surgery. Intraoperative examination revealed no hernia sac, and a 4-×3-cm tumor was observed around the spermatic cord. A malignant tumor was not completely ruled out. High orchiectomy was performed after consultation with the urologists. Pathological examination of the tumor showed no malignant features, and the final diagnosis was eosinophilic funiculitis with massive inflammatory changes and eosinophil invasion.
Conclusion:
Eosinophilic funiculitis is very rare; only three cases have been reported to date. We should always consider unusual causes of groin masses during a surgical approach to hernia-like lesions.
Insights
A rare case of eosinophilic funiculitis mimicked an irreducible groin hernia. This condition, characterized by inflammation and eosinophils, requires consideration among unusual groin masses.
Area of Science:
- Medical Case Study
- Surgical Pathology
- Rare Diseases
Background:
- Groin masses are frequently misdiagnosed as hernias, with ultrasonography often confirming suspected hernias in over 80% of cases.
- Accurate diagnosis of groin hernias among differential diagnoses can be challenging.
- This report details an exceptionally rare instance of eosinophilic funiculitis presenting as an irreducible groin hernia.
Purpose of the Study:
- To present a unique case of eosinophilic funiculitis mimicking a groin hernia.
- To highlight the importance of considering rare differential diagnoses for groin masses.
Main Methods:
- A 59-year-old male presented with a painful, irreducible right groin tumor.
- Enhanced computed tomography (CT) suggested a connection to intra-abdominal structures, leading to a diagnosis of irreducible hernia.
- Surgical exploration revealed a tumor around the spermatic cord; high orchiectomy was performed, and pathological examination confirmed eosinophilic funiculitis.
Main Results:
- The patient presented with a 1-week history of a painful, irreducible groin tumor.
- Despite initial suspicion of hernia, surgery revealed no hernia sac but a 4x3 cm tumor around the spermatic cord.
- Pathological examination confirmed eosinophilic funiculitis with significant inflammation and eosinophil infiltration, ruling out malignancy.
Conclusions:
- Eosinophilic funiculitis is an extremely rare condition, with only three prior reported cases.
- Uncommon causes of groin masses, such as eosinophilic funiculitis, must be considered during surgical evaluation of hernia-like presentations.