The Inguinal Canal: Anatomy and Imaging Features of Common and Uncommon Masses
Abstract
A variety of benign and malignant masses can be found in the inguinal canal (IC). Benign causes of masses in the IC include spermatic cord lipoma, hematoma, abscess, neurofibroma, varicocele, desmoid tumor, air, bowel contrast material, hydrocele, and prostheses. Primary neoplasms of the IC include liposarcoma, Burkitt lymphoma, testicular carcinoma, and sarcoma. Metastases to the IC can occur from alveolar rhabdomyosarcoma, monophasic sarcoma, prostate cancer, Wilms tumor, carcinoid tumor, melanoma, or pancreatic cancer. In patients with a known malignancy and peritoneal carcinomatosis, the diagnosis of metastases can be suggested when a mass is detected in the IC. When peritoneal disease is not evident, a mass in the IC is indicative of stage IV disease and may significantly alter clinical and surgical treatment of the patient. A combination of the clinical history, symptoms, laboratory values, and radiologic features aids the radiologist in accurately diagnosing mass lesions of the IC. Supplemental material available at radiographics.rsnajnls.org/cgi/content/full/28/3/819/DC1.
© RSNA, 2008
References
- 1
, Ellis H, Healy JC, Johnson D, Williams A. Inguinal canal. In: Standring S, ed. Gray’s anatomy: the anatomical basis of clinical practice. 39th ed. Edinburgh, Scotland: Elsevier Churchill Livingstone, 2005; 1109–1111.Standring S - 2
, van Wessem KJ, Halm JA, et al. Patent processus vaginalis in the adult as a risk factor for the occurrence of indirect inguinal hernia. Surg Endosc2007; 21: 202–205.van Veen RN - 3
, Cerkaska K, Tretyn A, Dabrowiecki S. Etiology of inguinal hernia: ultrastructure of rectus sheath revisited. Hernia2006; 10: 266–271.Szczesny W - 4
, Ozdogan M, Ozlem N, Yildirim A, Kulacoglu H, Aydin R. Uncommon content in groin hernia sac. Hernia2006; 10: 152–155.Gurer A - 5
, Mason AC, Brown C, Brown JA. CT findings of normal and inflamed appendix in groin hernia. Emerg Radiol2007; 14: 97–100.Maizlin ZV - 6
, Raptopoulos V. CT of the acute abdomen: findings and impact on diagnosis and treatment. AJR Am J Roentgenol1994; 163: 1317–1324.Siewert B - 7
, Luo CC, Chao HC, Chu SM, Yu YJ, Yen JB. The presentation of asymptomatic palpable movable mass in female inguinal hernia. Eur J Pediatr2003; 162: 493–495.Huang CS - 8
, Giorgi LJ Jr, Kogan BA. Orchiopexy practice patterns in New York State from 1984 to 2002. J Urol2006; 176: 1180–1183.Capello SA - 9
, Clarke MC. Current management of the undescended testicle. Semin Pediatr Surg2007; 16: 64–70.Hutson JM - 10
, Arregui ME. Lipomas of the cord and round ligament. Ann Surg2002; 235: 586–590.Lilly MC - 11
, Marucci DD, Dunn T, Barr EM, Houang M, Dos Remedios C. Inguinal canal “lipoma.” Clin Anat2002; 15: 280–285.Heller CA - 12
, Alper A, Emre A. Inguinal cord lipomas. Hernia2004; 8: 252–254.Carilli S - 13
, Ofsti AM, Nyheim T, Abedini S. Acute groin pain and femoral nerve deficit in a warfarin treated patient [in Norwegian]. Tidsskr Nor Laegeforen2002; 122: 2360–2361.Thorgersen EB - 14
, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology2003; 227: 18–36.Dogra VS - 15
, Heinze SB, Dietrich RB. Imaging of groin masses: inguinal anatomy and pathologic conditions revisited. RadioGraphics2001; 21(spec issue): S261–S271.Shadbolt CL - 16
, Pacary J, Broze B. Sonographic diagnosis of appendicitis within a right inguinal hernia (Amyand’s hernia). J Clin Ultrasound2006; 34: 454–457.Coulier B - 17
, Rutten MJ, de Valois JC, Jansen JB, Rosenbusch G. Masses and pain in the groin: a review of imaging findings. Eur Radiol1998; 8: 911–921.van den Berg JC - 18
, Murovic JA, Tiel RL, Moes G, Kline DG. A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg2005; 102: 246–255.Kim DH - 19
, Hotta T, Morita T, et al. Diagnosis of peripheral nerve sheath tumors around the pelvis. Jpn J Clin Oncol2004; 34: 405–413.Ogose A - 20
, Parham DM, Lasater OE, Chari RS, Chen G, Fletcher BD. MR imaging differentiation of benign and malignant peripheral nerve sheath tumors: use of the target sign. Pediatr Radiol1997; 27: 124–129.Bhargava R - 21
, Jones L, Wright MP, Kabala J. Percutaneous retrograde varicocele embolisation using tungsten embolisation coils: a 5 year audit. Int Urol Nephrol2001; 33: 517–520.Keoghane SR - 22
, Dogra VS, Seftel AD, Resnick MI. Benign intrascrotal lesions. J Urol2004; 171: 1765–1772.Rubenstein RA - 23
, Kammer J, Felfe R, Sturzebecher B, Knispel HH. Surgery is inadvisable: massive varicocele due to portal hypertension. Int J Urol2005; 12: 852–854.Schulte-Baukloh H - 24
, Cheng SW. Nutcracker phenomenon presenting as left varicocele. Hong Kong Med J2002; 8: 380.Ting AC - 25
, Prabakaran S, Allamaneni SS. Relationship between oxidative stress, varicocele and infertility: a meta-analysis. Reprod Biomed Online2006; 12: 630–633.Agarwal A - 26
, Semelka RC, Firat Z, Kubik-Huch RA. Male pelvis. In: Semelka RC, ed. Abdominal-pelvic MRI. 2nd ed. Hoboken, NJ: Wiley, 2006; 1179–1217.Noone TC - 27
, Reitamo JJ, Totterman S, Hopfner-Hallikainen D, Sivula A. The desmoid tumor. II. Analysis of factors possibly contributing to the etiology and growth behavior. Am J Clin Pathol1982; 77: 674–680.Hayry P - 28
, Azorin J, Giraud JP, Rath AM. Total reconstruction of the femoral canal and the inguinal wall after resection of a recurrent desmoid tumor. Hernia1999; 3: 153–158.Chevrel JP - 29
, Chugh R, Baker L, Doherty G. Gardner’s syndrome in a 40-year-old woman: successful treatment of locally aggressive desmoid tumors with cytotoxic chemotherapy. World J Surg Oncol2006; 4: 96.Bhama P - 30
, Semelka RC, Elias J, Kelekis NL. Retroperitoneum. In: Semelka RC, ed. Abdominal-pelvic MRI. 2nd ed. Hoboken, NJ: Wiley, 2006; 1127.Martin DR - 31
, Temple WJ, DeHaas WG, Schachar N, Morris DG, Kurien E. Groin soft tissue tumors: a challenge for local control and reconstruction—a prospective cohort analysis. J Surg Oncol2004; 86: 147–151.Mack LA - 32
, Konen O, Shapiro M, Lazar L, Grunebaum M, Werner M. Ultrasound features of spermatic cord hydrocele in children. Br J Radiol2001; 74: 818–820.Rathaus V - 33
, Gochev D, Khinev A. Indications and procedures for the surgical treatment of hydrocele and funiculocele in childhood [in Bulgarian]. Khirurgiia (Sofiia)1988; 41: 61–63.Denchev Kh - 34
, Abouassaly R, Angermeier KW, Montague DK. Three-piece inflatable penile prostheses can be safely implanted after radical prostatectomy through a transverse scrotal incision. Urology2007; 70: 539–542.Lane BR - 35
, Khan A, Shaikh T, Shergill IS, Junaid I. The artificial urinary sphincter. Expert Rev Med Devices2007; 4: 567–575.Mohammed A - 36
. Penile prosthesis surgery: a review of prosthetic devices and associated complications. J Sex Med2007; 4: 296–309.Sadeghi-Nejad H - 37
, Buras R. Incidental liposarcomas identified during hernia repair operations. J Surg Oncol1999; 71: 50–53.Montgomery E - 38
, Arcara LK, Fanburg-Smith J. Imaging of musculoskeletal liposarcoma with radiologic-pathologic correlation. RadioGraphics2005; 25: 1371–1395.Murphey MD - 39
, Hasegawa T, Beppu Y, Satake M, Moriyama N. Primary dedifferentiated liposarcoma of the retroperitoneum: prognostic significance of computed tomography and magnetic resonance imaging features. J Comput Assist Tomogr2003; 27: 799–804.Tateishi U - 40
, Demetri G. Medical management of unresectable, recurrent low-grade retroperitoneal liposarcoma: integration of cytotoxic and non-cytotoxic therapies into multimodality care. Surg Oncol2000; 9: 53–59.Goss G - 41
. Burkitt’s lymphoma: clinicopathologic features and differential diagnosis. Oncologist2006; 11: 375–383.Ferry JA - 42
, Kaplan GW. Urological manifestations of Burkitt’s lymphoma. J Urol1974; 112: 402–405.Lamm DL - 43
. Malignant lymphoma in African children. II. A pathological entity. Cancer1961; 14: 270–283.O’Conor GT - 44
, Shreck EH, Doshi V. Burkitt lymphoma involving the epididymis and spermatic cord: sonographic and CT findings. AJR Am J Roentgenol1989; 153: 85–86.Zwanger-Mendelsohn S - 45 American Joint Committee on Cancer. Manual for staging of cancer. Philadelphia, Pa: Lippincott, 2002.
- 46
, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood2004; 104: 3009–3020.Blum KA - 47
, Longo WL, Williams EC, et al. A 5-drug regimen maximizing the dose of cyclophosphamide is effective therapy for adult Burkitt or Burkitt-like lymphomas. Cancer Invest2007; 25: 87–93.Kujawski LA - 48
, Hill-Harmon MB, Murray T, Thun M. Cancer statistics, 2001. CA Cancer J Clin2001; 51: 15–36.Greenlee RT - 49
, Porrozzi S, Roila F, Gatta G, De Giorgi U, Marangolo M. Germ cell tumours of the testis. Crit Rev Oncol Hematol2005; 53: 141–164.Gori S - 50
, Amin MB, Young RH. Tumors of the testis, adnexa, spermatic cord, and scrotum. In: Atlas of tumor pathology, fasc 25, ser 3. Washington, DC: Armed Forces Institute of Pathology, 1999; 1–290.Ulbright TM - 51
, Chilvers CE, Davey G, Pike MC, Oliver RT, Forman D. Risk factors for testicular germ cell tumours by histological tumour type. United Kingdom Testicular Cancer Study Group. Br J Cancer1999; 80: 1859–1863.Coupland CA - 52
, Schwartau M. Mumps orchitis and testicular tumours. Br Med J1977; 2: 191.Ehrengut W - 53
, Ro JY, Kee KH, Ayala AG. Spermatic cord contamination in testicular cancer. Mod Pathol1996; 9: 762–766.Nazeer T - 54
, Tal R, Golijanin D, et al. Adult genitourinary sarcoma: the 25-year Memorial Sloan-Kettering experience. J Urol2006; 176: 2033–2038; discussion 2038–2039.Dotan ZA - 55
, Brady MS, Conlon K, et al. Adult urological sarcoma. J Urol1992; 147: 1032–1036; discussion 1036–1037.Russo P - 56
, Zagars GK, Pisters PW, Feig BW, Patel SR, von Eschenbach AC. Spermatic cord sarcoma: outcome, patterns of failure and management. J Urol2001; 166: 1306–1310.Ballo MT - 57
, Morgan M, Treuner J. Soft tissue sarcoma in children: prognosis and management. Paediatr Drugs2002; 4: 21–28.Koscielniak E - 58
, Yamamoto H, Ishimaru Y, et al. Clinical characteristics and surgical treatment of perianal and perineal rhabdomyosarcoma: analysis of Japanese patients and comparison with IRSG reports. Pediatr Surg Int2006; 22: 129–134.Okamura K - 59
, Kobayashi S, Machida T, et al. Alveolar rhabdomyosarcoma originating in spermatic cord: a case report [in Japanese]. Hinyokika Kiyo2004; 50: 653–655.Ozeki Z - 60
, White B, Kaplan AL, Alberto A. A case of monophasic synovial sarcoma presenting as a vulvar mass. Gynecol Oncol2006; 100: 433–436.Ambani DS - 61
, Nagral S, Khemani R, Pandit A. Pseudomyxoma peritoneii. J Postgrad Med1997; 43: 21–22.Devalia H - 62
, Kanthan R, Kanthan S. Pseudomyxoma peritonei: a revisit—report of 2 cases and literature review. World J Surg Oncol2006; 4: 60.Li C - 63
, Colaiacomo MC, Parlanti S. Ulcerative colitis: value of MR imaging. Abdom Imaging2005; 30: 584–592.Maccioni F - 64
. Pseudomyxoma peritonei and selected other aspects of the spread of appendiceal neoplasms. Semin Diagn Pathol2004; 21: 134–150.Young RH - 65
, Rosenberg AE, Clement PB. Mucin deposits within inguinal hernia sacs: a presenting finding of low-grade mucinous cystic tumors of the appendix—a report of two cases and a review of the literature. Mod Pathol1997; 10: 1228–1232.Young RH - 66
, Venbrux AC, Prescott CA, Osterman FA Jr. Pseudomyxoma peritonei. AJR Am J Roentgenol1996; 167: 471–474.Walensky RP - 67
, Bertrand C, Maddern GJ, et al. Appendiceal mucoceles and pseudomyxoma peritonei. Surg Gynecol Obstet1992; 175: 401–404.Landen S - 68
, Chan JM. Prostate cancer. J Urol2007; 177: 2020–2029.Penson DF - 69
, Mazhar D. How are we looking after prostate cancer? QJM2003; 96: 75–79.Waxman J - 70
, Lannes P. Metastases to the spermatic cord, epididymis and testicles from carcinoma of the prostate: five cases. Scand J Urol Nephrol1983; 17: 249–251.Johansson JE - 71
, Dome JS. Current therapy for Wilms’ tumor. Oncologist2005; 10: 815–826.Metzger ML - 72
, Feinberg AP, Brandenburg SA, Grundy PE, DeBaun MR. Children with idiopathic hemihypertrophy and Beckwith-Wiedemann syndrome have different constitutional epigenotypes associated with Wilms tumor. Am J Hum Genet2005; 77: 887–891.Niemitz EL - 73
, Rattan KN, Magu S, Parshad S. Aniridia and Wilm’s tumor. Indian J Pediatr2003; 70: 837–838.Nada M - 74
, Isuani BH, Heller RM, et al. Pediatric renal masses: Wilms tumor and beyond. RadioGraphics2000; 20: 1585–1603.Lowe LH - 75
, Pathak IC. Wilms tumour with left cord metastasis. Br J Urol1977; 49: 536.Yadav K - 76
, Sandstedt B, Harms D, Kelsey A, Leuschner I, de Kraker J. Revised International Society of Paediatric Oncology (SIOP) working classification of renal tumors of childhood. Med Pediatr Oncol2002; 38: 79–82.Vujanic GM - 77
, Dome JS, Perlman EJ, et al. Management of Wilms’ tumour: current practice and future goals. Lancet Oncol2004; 5: 37–46.Kalapurakal JA - 78
, Ciftci AO, Yalcin B, et al. Paratesticular metastasis from Wilms tumor associated with a hydrocele. Pediatr Blood Cancer2006; 47: 97–99.Aydin GB - 79
, Visser O. Epidemiology of neuroendocrine tumours. Neuroendocrinology2004; 80(suppl 1): 3–7.Taal BG - 80
. Multiple endocrine neoplasia syndromes. West J Med1980; 132: 301–312.Pont A - 81
, al-Arfaj AL, Sowayan SA, Qutub HO, Kutty MK. Unusual presentation of cancer. Aust N Z J Surg1991; 61: 707–708.al-Idrissi HY - 82
, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer2003; 97: 934–959.Modlin IM - 83
, Janson ET, Sundin A, et al. High-dose treatment with a long-acting somatostatin analogue in patients with advanced midgut carcinoid tumours. Eur J Endocrinol2004; 151: 107–112.Welin SV - 84
, Rizzotti A, Gramegna V. A metastatic melanoma in the spermatic cord. Br J Urol1979; 51: 416.Anselmo G - 85
, Mihm MC Jr. Melanoma. N Engl J Med2006; 355: 51–65.Miller AJ - 86
, Schrope B, Kaufman HL. Adjuvant therapy for malignant melanoma. Expert Rev Anticancer Ther2004; 4: 823–835.Stoutenburg JP - 87
, Kapadia CR, Da Costa PE. Pancreatic carcinoma: report of two cases presenting with unusual metastases. Indian J Gastroenterol2005; 24: 75–76.Bandyopadhyay D - 88
, Santaularia JM, Villavicencio H. Metastatic tumor of the epididymis and spermatic cord. Eur Urol1983; 9: 56–59.Algaba F