Cancer in inguinal and femoral hernias

Three cases of malignant tumors associated with hernial sacs are presented. One case of a primary liposarcoma of the spermatic cord illustrates the necessity of examining all excised specimens microscopically. The two cases of metastic disease from colonic and rectal primaries support the observation that the most frequent primary site for neoplastic disease within hernial sacs in the large bowel. Neoplasm within a hernial sac should be suspected in patients with previously diagnosed intraperitoneal malignancy who present with a new hernia, and in elderly patients who develop incarceration of a chronic, previously reducible hernia. Local phenomena such as intraperitoneal seeding by gravity are probably most important in explaining the unusual finding of metastatic tumor foci within hernial sacs. Suggestions for increasing diagnostic yield include biopsy and frozen-section examination of suspect specimens and, in cases in which tumor is confirmed, thorough intraperitoneal digital palpation and laparoscopy. The hernial sac offers a unique opportunity for peritoneal biopsy that should not be overlooked.