Uncommon pediatric painless scrotal masses: a puzzle of pediatricians and urologists

Abstract

A broad spectrum of scrotal pathologies, including tumors, malformations, and inflammation, can present as painless scrotal masses in the pediatric age groups. The aim of our single institutional retrospective study was to survey data regarding uncommon painless scrotal masses collected over the past 22 years in order to better diagnose and treat these pathologies. This retrospective study included children referred to our hospital because of scrotal masses between October 1986 and May 2009. In all cases, age at diagnosis, history, and physical examination details, biochemical markers, and findings of imaging were collected and analyzed. Definite diagnoses of the causes of the scrotal masses were made through histopathological examination. A total of 161 children were examined because of scrotal masses during the study period. Their ages ranged from 1 month and 2 days to 14 years and 9 months (median, 2 years 11 months). Bilateral scrotal masses were observed in 17 cases. Of 161 scrotal masses, 119 (73.9%) originated from testes, 27 (16.8%) from epididymis, and 15 (9.3%) from the scrotal wall. Of these, 116 (72%) were diagnosed as tumors, 22 (13.7%) as malformations, and 23 (14.3%) as inflammation. Fourteen patients had misdiagnosed histories; of these, the majority (11) were diagnosed with yolk-sac tumors. Although testicular tumors are the major causes of pediatric painless scrotal masses, other causes are possible. Patient history and physical examination can provide some clues as to the source of the mass. Ultrasound, alpha-fetoprotein levels, and biochemical analysis have a significant role in the evaluation of uncommon pediatric painless scrotal masses.