Bilateral Testicular Swelling Research Articles

Case 2: Chronic Testicular Torsion in a Healthy Neonate

A male newborn, weighing 3,180 g, is born via spontaneous vaginal delivery at 38 3/7 weeks’ gestation to a 26-year-old, gravida 4, para 3 woman. The pregnancy is uncomplicated and the family history negative. At birth, the right scrotum is swollen and the left testis is not palpable. Scrotal ultrasonography shows a right hydrocele with mild swelling and reduced perfusion of the right testicle (Fig 1A and 1B). The left testicle appears to be in the left inguinal canal with blood flow present (Fig 2A and 2B). He is discharged on day 2 with outpatient follow-up scheduled with urology in 1 week. Figure 1. Sagittal views of the right testicle demonstrate course, heterogeneous echotexture and a moderate-sized hydrocele and no focal mass. Figure 2. These transverse and sagittal images of the left testicle demonstrate coarse hetrogeneous echotexture with a trace hydrocele and no focal mass. The family does not follow up, and the infant presents at 4 weeks of age with bilateral testicular swelling. On examination, the left testis is not palpable and there is diffuse scrotal swelling with no surrounding erythema. Cremasteric reflex is present on the right, but absent on the left. No chordee is noted and transillumination of scrotal skin is …

RECTAL PERFORATION COMPLICATED BY FOURNIER’S GANGRENE SECONDARY TO ACCIDENTAL TOOTHPICK INGESTION

SESSION TITLE: Case Report Semifinalists 9 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Necrotizing fasciitis (NF) is a life threatening soft-tissue infection. Fournier’s Gangrene (FG) is NF involving the genital, perianal and perineal regions. Accidental Foreign body (FB) ingestion resulting in life threatening NF and FG is extremely rare. We report one such interesting case. CASE PRESENTATION: A 57-year-old male with past medical history of diabetes mellitus presented with chief complaints of vomiting, non-bloody diarrhea and rectal pain. Physical exam was remarkable for high grade fever and normal digital rectal exam. Laboratory investigations were remarkable for leukocytosis with negative infectious workup and autoimmune panel. CT abdomen/pelvis was suggestive of proctitis. The patient was started on broad spectrum antibiotics. He continued to spike high grade fevers with up trending leukocytosis, followed by hypotension and new onset painful bilateral testicular swelling . CT pelvis of soft tissues showed a peri-rectal opacity, massive subcutaneous edema, air in the perineum and scrotum with extension to the right lateral aspect of the anus concerning for FG. The patient underwent sigmoidoscopy followed by local exploration via a peri-rectal incision. A toothpick 3.1 x 0.2 x 0.1 cm was found to have perforated the rectum 6cm from the anal sphincter forming a fistulous connection, with perirectal abscess and extending cephalad to the base of the scrotum. The patient had multiple debridements and eventually underwent sigmoid colostomy. A follow up colonoscopy at eight months showed recovery from the perforation and the colostomy was closed electively. DISCUSSION: Accidental ingestion of a foreign body (FB) is not uncommon. FB has been reported to cause bleeding, obstruction, perforation, fistula formation and in rare cases necrotizing fasciitis (NF). Symptoms, complications and site of lodgment depends on size and sharpness of the FB and frequently involve the duodenum (23%) and large intestine (37%). Less than 1 % FB cause perforation. Investigation modalities include plain film, ultrasound, CT scan and MRI. Broad-spectrum antibiotics, surgical debridement and control of the perforation are imperative in the management of cases like our patient. The option for stoma creation versus primary colonic repair depends on severity of the perforation and the patient’s general condition. It should be noted that while cases of intestinal perforations secondary to diverticulitis or gastrointestinal tract malignancies resulting in NF are not uncommon. To the best of our knowledge, this is the third case in literature of NF and FG caused by accidental tooth pick ingestion. CONCLUSIONS: This case brings to light an interesting and rare presentation of accidental tooth pick ingestion leading to life-threatening FG. Reference #1: Intestinal Perforation by a Toothpick as Reason for Necrotizing Fasciitis. Markus Rupp, Gero Knapp, David Weisweiler, Christian Heiss, Volker Alt. J Bone Jt Infect. 2018; 3(4): 226–229. Reference #2: Right Hip Necrotizing Fasciitis. Lee I-H, How C-K, Chen J-D, Yen DH-T, Chiu Y-H. N Am J Med Sci. 2011;341:499 Reference #3: Necrotizing fasciitis. Green RJ, Dafoe DC, Rajfin TA. Chest. 1996;110:219–29. DISCLOSURES: No relevant relationships by Andrey ILiev, source=Web Response No relevant relationships by Muneer Khan, source=Web Response No relevant relationships by Mariam Saeed, source=Web Response

Extra Pulmonary Sarcoidosis Disguised as Nodular Lung & Testicular Lesions

Introduction: Sarcoidosis can affect multiple systems in the body especially the lungs and the skin. In our case, we highlight an extrapulmonary case of sarcoidosis masquerading as lung & testicular mass in a 30-year-old African-American male. Hospital Course: An African American male without previous medical history presented with coughing and testicular swelling for over 1 month. The patient had adrastic weight loss, exertional dyspnea, and bilateral testicular swelling. Smoked daily one-fourthpack-per-day. On physical exam, patient had clear auscultation of the chest bilaterally and large left testicular mass measuring at least 6 cm. Laboratory tests show relatively unremarkable CBC and CMP. LDH was high at 238. Computed tomography of the chest/abd/pelvis without contrast showed innumerable pulmonary nodules in the bilateral lungs. Ultrasound of testicles found numerous bilateral hypoechoic testicular lesions. A right upper lung endobronchial biopsy revealed granulomatous inflammation without malignant cells related to pulmonary sarcoidosis with testicular involvement. ACE send-out was high at 138 U/L. Patient was started on steroids with 10 mg daily and doxycycline 100 mg twice daily for seven days. Discussion: The “great mimicker” is a well-deserved moniker for sarcoidosis because of its multisystem involvement and broad symptomology it can be a challenging diagnosis. In order to diagnose sarcoidosis, a thorough history and physical exam are required. The genitourinary presentations of sarcoidosis are extremely rare. Extrapulmonary sarcoidosis can regress spontaneously or it can progress in select patients to malignancy which requires tailored treatment with either corticosteroids or orchiectomy.

Carcinoma of Unknown Primary: A Case Report

Cancer of unknown primary (CUP), is a rare malignancy with unknown site of origin. The disease accounting for 2%-3% of all fatal malignancies, have variable histologic tumour types and clinical presentations. The present study discusses a case of CUP in a 68-year-old male subject, presenting with a 6-month history of abdominal pain in the upper abdomen. The patient was a chronic smoker and had the presence of bilateral testicular swelling for the past 15 years. The clinical examination of the patient revealed bilateral inguinal lymphadenopathy. The findings of the abdominal CT scan and the bone biopsy of the patient suggested metastatic carcinoma. 18F-fluorodeoxyglucose PET CT scan showed lytic lesions. The study recommends the need for a focused search, comprising of robust immunohistochemical profiling, for locating the primary tumors in CUP.

Clinical diagnosis and treatment of 21-hydroxylase deficiency nonclassic congenital adrenal hyperplasia complicated by testicular adrenal rest tumors(one-case report)

Objective To assess the clinical diagnosis and treatment of 21-hydroxylase deficiency nonclassic congenital adrenal hyperplasia (NCCAH) complicated by testicular adrenal rest tumors (TART), thus to improve the recognition of the disease. Methods The clinical data of one patient of NCCAH with TART from our department in 2016 were retrospectively studied, and were analyzed combined with related literature, and the diagnosis was established for treatment. Results The patient was a 17 years old boy.At the age of seven began to appear the pubic hair, voice and other secondary sexual performance.More than their big penis development was significantly higher than their peers.At the age of 12 found bilateral testicular gradually enlarged and attendance.Physical examination: bilateral testicular swelling and a sense of nodules, hard texture, epididymis, normal bilateral varicocele.Laboratory exam indications showed increased levels of progesterone(P), adrenocorticotropic hormone(ACTH), 17 hydroxyprogesterone(17α-OHP), aaldosterone(ALD), 17-hydroxyl corticosteroids(17-OHCS), 17-ketone corticosteroids(17-KS). By the ACTH stimulating test, 17α-OHP was increased.Bilateral testes MRI: irregular bilateral testes, signal, see in space.Enhanced scan lesions uniform reinforcement, germ cell tumors to row.Adrenal CT: bilateral adrenal hyperplasia.Testicular biopsy: testicular adrenal genital syndrome . Genetic testing: CYP21A2 heterozygous mutations.The above test results were diagnosed of NCCAH 21-OHD with TART.The patient was orally given 10mg/d prednisone 2 time.3 months after treatment, the 17α-OHP, CO and sex hormones returned to normal.Review the adrenal CT showed significant bilateral adrenal shrink, Pa/testis tubercle was narrow, but not obvious.Semen routine still suggested no sperm, considering the TART medical treatment effect was poor.Hence, further line tumor removed, followed up for 3 months without tumor recurrence at present. Conclusion NCCAH complex and varied clinical manifestations and hidden.Not easy to be noticed by patients and clinicians.For the early childhood in pubic hair growth accelerated leading to premature epiphyseal fusion and make the adult height is short stature consideration should be given to the disease.Further lines of sex hormones, adrenal related endocrine examination, genetic testing and ACTH stimulating test, etc.If concurrent bilateral testicular nodules, should consider to merge TART may.Testicular biopsy can be clear.Treatment can choose according to TART classification of glucocorticoid (a hormone steroid) or surgical treatment, concrete scheme should be individualized. Key words: 21-hydroxylase deficiency; Adrenal cortex diseases; Testicular adrenal rest tumors

A Young Man with Bilateral Testicular Pain and Swelling.

A Young Man with Bilateral Testicular Pain and Swelling.

English

A 71-year-old Indian male presented with a five-month history of progressive bilateral testicular swelling and swelling of the left orbit or one month duration. Nine months ago, he had undergone four cycles of chemotherapy (bortezomib, cyclophosphamide, and dexamethasone) for an immunoglobulin A (IgA) lambda multiple myeloma (3.8 grams per decilitre [g/dL]). This was stage 3 according to the International Staging System (ISS) and had no adverse cytogenetics. The patient had undergone six more cycles of treatment prior to presentation. Physical examination revealed gross distension of the left orbital tissues with violaceous colouring (Figure 1A). The abdomen was distended with ascites. Genitourinary examination revealed testicular enlargement (Figure 1B). There was no erythema or warmth associated with either area. Laboratory tests failed to demonstrate monoclonal paraproteinemia, but his lactate dehydrogenase (LDH) level was elevated at 2068 units per litre (units/L). Abdominal paracentesis revealed a fluid cell count of 16,180 106/L and a fluid LDH of 10,591 units/L. Cytology showed CD138 positivity, 80% for Ki-67, and lambda light chain restriction. These findings supported a diagnosis of dedifferentiated extramedullary multiple myeloma. The prognosis and available management plans were discussed with the patient, and he was discharged to the community to be placed in the care of the palliative care team per his wishes.

English

Isolated tubercular epididymo-orchitis usually presents with a clinical pictures and radiographic illustrations similar to those of a testicular neoplasm; therefore diagnosis may be challenging for clinicians. In our case, a 25years male presented with bilateral testicular swellings without any evidence of tuberculosis elsewhere in the body. We report this case firstly because isolated epididymo-orchitis is an unusual presentation of tuberculosis. Secondly this case may help clinicians in diagnostic approach when testicular tuberculosis masquerade testicular neoplasm, and thus avoids unnecessary orchiectomy and save the clinicians from the possible charges of medical negligence. CASE REPORT: A 25 years male, non-smoker presented in surgery OPD with complains of swelling of both testes with pain over a period of 6 months; Testicular swelling was gradually increasing in size. There was no history of fever, weight loss, night sweats, cough or haemoptysis. Even there were no history of dysuria, frequency, urgency of micturition or history of any trauma. He has two children. clinical examination of chest and the abdomen were normal. Physical examination of the genitalia revealed firm enlargement of both testes with irregular surface, while epididymis and spermatic cords were thickened. The scrotal skin showed no signs of inflammation. Transillumination test of the swellings was negative. There was bilateral inguinal lymphadenopathy. Prostate was found normal on digital rectal examination.

Striated pattern on scrotal ultrasonography: A marker for Non-hodgkins lymphoma of testis

We present a case of 52 year old man who presented with bilateral painless testicular swelling. On evaluation with high resolution ultrasonography of the scrotum, typical “striated pattern” which is highly suggestive of Non Hodgkins lymphoma of the testis was seen. The patient underwent bilateral inguinal orchidectomy and the histopathological examination confirmed the diagnosis of Non Hodgkins lymphoma.

Testicular masses in a man with a plausible sarcoidosis

Genitourinary involvement with sarcoidosis is very rare. The objective of this report was to present a case of a patient with testicular swelling. The patient was an infertile 42-year-old man with bilateral testicular swelling. Semen analysis in the past 10 years revealed no abnormality; however, gradually he became azoospermic in 3 years. A diagnosis of sarcoidosis made on the basis of hilar and mediastinal lymphadenopathy in chest CT scan was confirmed through testicular and epididymal biopsy. Testicular masses vanished after administering steroids, and azoospermia recovered. To conclude, although genitourinary sarcoidosis is rare, it must be kept in mind in patients with confirmed sarcoidosis.

Polyarteritis Nodosa Presenting with Bilateral Testicular Swelling and Complicated by Unilateral Facial Nerve Palsy

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that is generally restricted to medium-sized vessels. Here we describe the first case of a patient in which a bilateral testicular mass was a presenting symptom and the diagnosis was made on the basis of testicular histopathology. A 53-year-old Asian man presented with a history of constitutional symptoms and testicular swelling. Scrotal ultrasound revealed two avascular, bilateral, intratesticular lesions. The bilateral testicular abscess was treated without improvement. The patient developed left seventh cranial nerve palsy during his admission. The clinical changes made vasculitis or a related disorder more likely and the patient underwent a right testicular biopsy. Histopathology demonstrated features of transmural inflammation and fibrinoid necrosis of medium-sized vessel walls, consistent with PAN. This case illustrates the difficulty in diagnosing polyarteritis nodosa with isolated bilateral testicular swelling and the delay in the diagnosis. After 9 months of follow-up, no relapse had occurred and the patient's testosterone level was on the lower side of normal.

Conservative management of bilateral Sertoli cell tumors of the testicle in association with the Carney complex: a case report

Large cell calcifying Sertoli cell tumor of the testicle is a rare, hormonally active sex cord-stromal tumor seen in patients with Carney complex. When such tumors occur bilaterally, treatment options for preserving fertility and addressing the secondary effects of excess hormone production must be considered. The availability of specific antiestrogen drugs means that bilateral orchiectomy for this benign tumor may no longer be warranted. Testicular-sparing surgery and advances in reproductive technology may also improve the overall prognosis for fertility. Gynecomastia in prepubescent boys can be emotionally very distressing. Approximately two thirds of teenaged boys will develop some degree of breast enlargement that spontaneously regresses as testosterone levels rise ( Ill Med J 1938;73:113). In all cases, a thorough history and physical examination are required to exclude nonphysiologic causes such as drugs, pulmonary disease, chronic liver disease, exogenous estrogens, and estrogen-producing tumors (Seashore J. Disorders of the breast. In: Rowe MI, O'Neill JA, Grosfeld JL et al, editors. Pediatric surgery, 5th ed. St Louis (MO): Mosby Year Book, 1998). We report on a child who presented with a 2-year history of gynecomastia with associated bilateral testicular swellings and discuss a novel treatment strategy for managing bilateral testicular tumors in the context of the Carney complex.

A case of scrotal sarcoidosis that mimicked tuberculosis

A 38-year-old man presented with bilateral testicular swelling, night sweats and weight loss with little response to antibiotics. Examination revealed systemic lymphadenopathy and multiple small masses arising from both testes. Scrotal ultrasound revealed multiple intratesticular, hypoechoic lesions; chest radiograph and abdominal ultrasound were normal. A CT scan revealed multilevel lymphadenopathies. A Heaf (tuberculin) skin test was negative. Testicular biopsy revealed multiple granulomata, some of which showed patchy central necrosis. A diagnosis of tuberculosis was initially made. After 3 months of clinical deterioration despite antitubercular drug therapy, however, the diagnosis was changed to sarcoidosis because blood results revealed hypercalcemia, elevated serum angiotensin-converting enzyme, and an elevated erythrocyte sedimentation rate. The patient improved dramatically on corticosteroid therapy, with complete regression of all testicular lesions on imaging after 2 months. Steroids were tapered, then discontinued after 6 months. The patient remained in complete remission, but became oligospermic by the 3 year follow-up.

Testicular metastasis from hepatocellular carcinoma

We document a case of testicular metastasis from hepatocellular carcinoma. The patient suffered from bilateral testicular painful swelling for 6 months. Scrotal ultrasonography showed bilateral testicular tumors and the whole abdominal computed tomography revealed a huge tumor in the left lobe of the liver. Bilateral orchiectomy and postoperative ultrasound-guided liver biopsy were done. Pathological examination revealed metastatic hepatocellular carcinoma. Hepatocellular carcinoma with testicular metastases is a very rare disease.

Extramedullary blast crisis in a patient with chronic myelogenous leukemia in complete cytogenetic and molecular remission on interferon-α therapy

We report the previously undescribed occurrence of extramedullary blast crisis in a patient with chronic myelogenous leukemia in complete cytogenetic and molecular remission on interferon-α. Development of bilateral testicular swelling prompted a biopsy showing stromal infiltration with CD20 and TdT positive immature cells. On repeated examinations, the bone marrow remained BCR/ABL negative by RT-PCR analysis. However, the cerebrospinal fluid (CSF) contained atypical lymphocytes positive for the P210 BCR-ABL product. Following treatment with testicular irradiation, intrathecal methotrexate, systemic chemotherapy and an unrelated donor transplant, the patient showed no evidence of disease until 9 months post-transplant, when he relapsed in lymphoid blast crisis in both bone marrow and CSF.

Scrotal and Orbital Involvement in Extramedullary De-differentiated Multiple Myeloma

A 71-year-old Indian male presented with a five-month history of progressive bilateral testicular swelling and swelling of the left orbit or one month duration. Nine months ago, he had undergone four cycles of chemotherapy (bortezomib, cyclophosphamide, and dexamethasone) for an immunoglobulin A (IgA) lambda multiple myeloma (3.8 grams per decilitre [g/dL]). This was stage 3 according to the International Staging System (ISS) and had no adverse cytogenetics. The patient had undergone six more cycles of treatment prior to presentation. Physical examination revealed gross distension of the left orbital tissues with violaceous colouring (Figure 1A). The abdomen was distended with ascites. Genitourinary examination revealed testicular enlargement (Figure 1B). There was no erythema or warmth associated with either area. Laboratory tests failed to demonstrate monoclonal paraproteinemia, but his lactate dehydrogenase (LDH) level was elevated at 2068 units per litre (units/L). Abdominal paracentesis revealed a fluid cell count of 16,180 106/L and a fluid LDH of 10,591 units/L. Cytology showed CD138 positivity, 80% for Ki-67, and lambda light chain restriction. These findings supported a diagnosis of dedifferentiated extramedullary multiple myeloma. The prognosis and available management plans were discussed with the patient, and he was discharged to the community to be placed in the care of the palliative care team per his wishes.