According to the previous literature, the old hydrocele often contains in the fluid fibrous bodies or crystals about the size of a pea which are concretions of earthy phosphates or carbonates covered with fibrin or some substance of the cartilage. On these cases, the tunica is very much thickened and has an irregular surface with perphaps projections resembling synovial villi which have hardened with time, sometimes going on to calcareous degeneration, which later break off and become free in the fluid. Sometimes, the sac wall is not so thickened, but, in the course of time, the fluid in it becomes more and more thickened and at last deposits the hydrocele salts. This fluid is cloudy, and may be brownish red in case of hemorrhage. In very rare cases, the fluid and sac wall, also testis and epididymis etc. are apparently normal, but still it contains the small bodies. These bodies are the products of Morgagni's hydatide, Giraldes' organ or ductuli aberrantes. And the previous reports said that all these fibrous or calcareous bodies did not occur in childhood.
But I experienced a very rare case of corpus liberum which happened in a child, as follows:
He was a 24 years old man who was first seen by me in the middle of January 1939, complaining of a swelling of the left scrotum and slight pains in the left inguinal region after heavy work.
As to his past history, he had, at 6 or 7 years of age, noticed 2 or 3 small bodies in the left scrotal sac, which caused him no inconvenience, so he left it alone. In his 12th or 13th year, he marked the swelling of the left scrotum, and the bodies increased in number and he thought it contained 4 or 5 bodies, but this time he also neglected it. In about his twenty first year, he noticed that the size of the tumor increased after heavy work and decreased by rest. From that time, the growth of the tumor slowly increased and the number of the bodies also increased. Now he feel 6 bodies in the scrotum.
He was a well-developed man, no pathological parts to be seen, except the left scrotum. The left scrotum was greater than the right one. (1.5th size of the right). It was not so strained, but was elastic to the touch, and translucent to light. It could not be reduced into the inguinal canal, and it showed no reaction to the pressure of the abdomen. In the tumor, I found several perfectly round bodies. The greatest body was about the size of a pea and the smallest was about the size of a grain of rice, which moved freely, no pains caused by pressure or movement, and which felt hard elastic like cartilage.
An operation was performed on April 7th with local anaesthesia. I made an incision of about 3cm at the front surface of the middle of the scrotum, and all the bodies were easily picked out. But I did not perform the operation for hydrocele, for I considered that the bodies were the cause of hydrocele. At that time, I investigated all the organs contained in the scrotum, but I could not find any pathological change. The fluid of the hydrocele was a clear serous liquid resembling blood serum and it had no odor.
The number of the bodies picked out was 18. All the bodies were white and had a spherical form, but 4 of them, one above the other, formed a gourd-like figure. The hardness resembled cartilage. After one night, the bodies rapidly dried up and showed an irregular form of yellow. The hardness increased and they became like stone. The weight after being dried up was 2.1g. On the cutting surface, I found a hard ash-white substance, covered with a fibrinous or cartilage-like substance. By the analysis of the hard substance, at least calcium carbonate and phosphate were proved to be present, but it had no cholesterin.
One week after the operation, the patient was cured, with no further symptoms developing. About 2 months after the operation, he noticed again a tumor of the left scrotum, and felt one small body in it.
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