腹腔鏡腹股溝疝氣修補手術中發現之濾泡淋巴瘤：罕見個案報告

邱泰樺、錢祖明

高雄醫學大學附設中和紀念醫院 泌尿部

Follicular lymphoma discovered incidentally during laparoscopic inguinal hernia repair: an uncommon case report

Tai-Hua Chiu, Tsu-Ming Chien

Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

Abstract:

We present a case of a 57-year-old male with a medical history of hepatitis B presented with a chief complaint of bilateral inguinal protruding mass for several months. Bilateral inguinal indirect hernia was strongly suspected by physical examination. We performed laparoscopic repair of the inguinal hernia with total extraperitoneal approach. Bilateral indirect hernia was identified during operation, and hernia repair were performed successfully using monofilament polyethylene terephthalate meshes. Two large lymph nodes over area between external iliac vessels and testicular vessels were incidentally observed, and lymph nodes dissection was performed. We did not note any gross abnormalities of the hernia sac during operation. The cut surface of lymph nodes specimen was grossly described as grayish white. The final pathology report of the lymph node (left side) revealed follicular lymphoma, grade 1, with extracapsular invasion. The immunochemical stain was positive for CD20, CD10, Bcl-2, Bcl-6, MEF2B, and negative for CD3, CD5, MNDA. His post-operative course was smooth and recovered uneventfully. Further computed tomography and positron emission tomography scan revealed suspicious follicular lymphoma involving the mesentery, portocaval, paraaortic, aortocaval, paracaval, and bilateral iliac and inguinal regions, with peritoneal seeding and multiple bone metastases. The patient was later referred to oncology department for further chemotherapy with rituximab + COP (cyclophosphamide + vincristine + Prednisolone).

Laparoscopic repair of the inguinal hernia is a common operation, and triangle of doom, the anatomical area between vas deferens and spermatic vessels, can be routinely observed during the operation. As lymphoma can present variably, any suspicious enlarged lymph nodes in this area should not be ignored and the specimen should be submitted to pathology to avoid compromising the diagnosis of occult malignancy.