Painless Scrotal Swelling Research Articles

A Case of Cystic Dysplasia of the Rete Testis in a 17-Months-Old Boy

Cystic dysplasia of the testis (CDT) is a benign, congenital malformation of the testis and a rare cause of painless scrotal swelling in children, mimicking testicular cancer. It is commonly unilateral, often associated with ipsilateral wolffian duct and ureteral abnormalities. Cystic dysplasia of the rete testis (CDT) represents a diagnostic challenge made easier if age, precise localisation, typical ultrasonographic features, the presence or absence of associated genitourinary malformations, as well as tumor markers are considered. The definite treatment of such a benign lesion is testis-sparing surgery, however in most cases watch and wait strategy can be recommended. We present a case of cystic dysplasia of the testis in a 17-month-old boy with right multicystic dysplastic kidney, epididymal cyst, history of vesicoureteral reflux (VUR), as well as of solitary umbilical artery. We performed epididymidal cyst enucleation and right testicular biopsy.

Pleomorphic Malignant Fibrous Histiocytoma/Undifferentiated High-grade Pleomorphic Sarcoma of the Scrotum in a Patient Presenting As Fournier Gangrene

Pleomorphic malignant fibrous histiocytoma (MFH), also known as undifferentiated high-grade pleomorphic sarcoma according to the latest World Health Organization classification, is a diagnosis of exclusion and extremely rare in adult scrotal/paratesticular region. Clinical presentation of scrotal/paratesticular pleomorphic MFH is usually a painless and gradual scrotal swelling. We report a case of scrotal MFH in a 63-year-old man who presented as Fournier gangrene after 10-month painful scrotal swelling and multiple procedures. The specimen of emergent debridement was submitted for pathologic and bacteriologic examination. Microscopically, the lesion had marked architectural and cytologic pleomorphism. The neoplastic cells were positive for vimentin, but negative for all lineage-specific markers. Fluorescence in-situ hybridization showed an aneuploid karyotype and negative results for lipomatous tumor abnormalities. Bacterial cultures of the specimen showed extensive growth of virulent polymicrobes. The diagnosis of scrotal/paratesticular pleomorphic MFH with concurrent Fournier gangrene was made. Thoracic computed tomography scan showed bilateral multiple pulmonary nodules. The patient died 1 month later.

Lymphoma of the testis as primary location: tumour review

Non-Hodgkin's lymphoma as a primary testicular neoplasm accounts approximately 9% of all testicular malignant tumours and about 1-2% of all non-Hodgkin's lymphoma. This neoplasm is the most common malignant tumour of the testis in the elderly. The most common histotype in primary forms is the diffuse large B-cell lymphoma, whereas more aggressive histologies such as Burkitt's lymphoma are principal founded in cases of secondary involvement of the testis. Regarding clinical presentation, the most common sign is a unilateral painless scrotal swelling, sometimes with sharp scrotal pain or hydrocele. In patients with advanced stage, the systematic B symptoms are present in 25-41% of all cases. In 35% of patients, bilateral testicular involvement is detected. In more advanced stages with para-aortic lymph-node involvement, ascites and abdominal pain is evident. Despite the fact that responses to doxorubicin- containing chemotherapy, especially in early stages, show good results, relapses are often seen, and the prognosis of this tumour is very poor. Testicular lymphoma often disseminates to other extranodal organs, such as contralateral testis, central nervous system (CNS), lung, pleura, Waldeyer's ring and soft tissue. For patients with limited disease, the recommended first-line treatment is orchiectomy followed by rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) combination chemotherapy, with central nervous system (CNS) prophylaxis and prophylactic irradiation of the contralateral testis. In more advanced or relapsed disease, management should follow the worldwide recommendations for nodal diffuse large B-cell lymphoma (DLBCL). Here we present a review of this tumour.

精巣網腺癌の１例

Adenocarcinoma of the rete testis is a rare malignant tumor with a poor prognosis. About 60 cases of this adenocarcinoma have been reported in the literature. The diagnosis is often difficult and made incidentally. Herein, we report a case of adenocarcinoma of the rete testis and review the literature. Our patient was an 80-year-old man who presented with painless scrotal swelling for 2 years. Physical examination revealed an enlarged, hard mass of the left scrotum. The serum markers alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (beta-HCG), and carcinoembryonic antigen (CEA) were negative. Magnetic resonance imaging (MRI) showed a left hydrocele with central necrosis of the testis. After 4 months, the patient presented with appetite loss, general fatigue, and pain in the left scrotum. Positron emission tomography (PET) was performed in another hospital, and the patient was referred for a left testicular tumor, multiple lung metastases, and para-aorta lymph node metastasis. The patient underwent left high inguinal orchiectomy. Pathological examination revealed a hard whitish mass around the testis involving the epididymis and tunica vaginalis and spreading under the subcutaneous tissue. Histological examination revealed adenocarcinoma in the hilum of the testis, which extended to the subcutaneous tissue but not to the surface of the scrotum. The tunica albuginea was intact, and no invasion of carcinoma in the testis was seen. After the histological diagnosis of adenocarcinoma of the rete testis was confirmed, computed tomography (CT) was performed and showed multiple pulmonary nodules and para-aortica lymph node swelling of 3 cm diameter. Because the patient did not wish to receive chemotherapy or other aggressive treatment, he has been followed-up with palliative care since his diagnosis. Although local recurrence has occurred 4 months later, he is still alive for 8 months since his diagnosis.

A rare case of lymphangioma of the scrotum in a 3 year old boy: a case report

Cystic hygromas, also known as lymphangiomas, are unusual congenital malformations of the lymphatic system. They are normally seen in the head and neck region and very rarely occur in the scrotum. This anomaly manifests as a painless scrotal swelling and is easily misdiagnosed. We report a rare case of a 3-year-old boy who presented with a gradually enlarging, painless scrotal mass which was identified sonographically and histologically as a scrotal lymphangioma and treated by surgical excision. A brief review of the literature is included.

Role of ultrasonography in diagnosis of scrotal disorders: a review of 110 cases

ObjectiveTo determine the role of ultrasonography in diagnosis of scrotal disorders.Materials and methodsThis study was carried out after institutional review board approval was granted, and informed consent was waived. Between January 2005 and January 2007, 144 patients aged 12 years and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analysed. The presentation symptoms were divided into three groups including scrotal pain, painless scrotal mass or swelling, and others. Surgery was performed in 32 patients.ResultsOf 144 patients, 110 had clinical follow-up and constituted the material of this study. The patients ranged in age from 13 to 82 years (mean 38.6 years). Of 110 patients, 84 (76.4%) presented with scrotal pain, 21 (19%) had painless scrotal mass or swelling and 5 (4.5%) had other symptoms. Of the 84 patients with scrotal pain, 52 had infection, 4 had testicular torsion, 7 had testicular trauma, 10 had varicocele, 4 had hydrocele, 1 had epididymal cyst, 1 had scrotal sac and groin metastases, and 5 had unremarkable results. Of the 21 patients who presented with painless scrotal mass or swelling, 18 had extratesticular lesions and 3 had intratesticular lesions. All the extratesticular lesions were benign. Of the 3 intratesticular lesions, one was due to tuberculous epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcoma. Of the 5 patients who presented with other symptoms, 4 had undescended testes, and 1 had gynaecomastia. US gave incorrect diagnosis in only one patient with scrotal pain.ConclusionThe most common cause of scrotal pain was infection. The most common cause of scrotal mass or swelling was extratesticular lesion. US plays an important role in the diagnosis of scrotal disorders and in planning for proper management.

Scrotal Hydrocele as the First Clinical Manifestation of Occult Gastric Cancer

Jeong Kyun Yeo From the Department of Urology, College of Medicine, Inje University, Pusan, Korea We report a rare case of a metastatic tumor of the tunica vaginalis and epididymis with hydrocele from occult gastric cancer. A 72-year-old patient showed a painless scrotal swelling. Scrotal ultrasound showed a right hydrocele and a follow-up hydrocelectomy showed a mass on the epididymis. The operation was thus converted to radical orchiectomy. The tumor was revealed as an adenocarcinoma in the tunica vaginalis and epididymis. Abdominal computed tomography found gastric cancer, which was confirmed by a gastric fibroscopy biopsy. The patient was referred to the hemato-oncology department for chemotherapy but died after 3 months. (Korean J Urol 2009;50:1151-1153) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Delayed Post-Endoscopic Retrograde Cholangiopancreatography Perforation Presenting as Scrotal Subcutaneous Emphysema

62-year-old Caucasian man presented to the Emerency Department (ED) with a chief complaint of bilatral scrotal swelling. The evening before arrival he noiced painless scrotal swelling, accompanied by mild to oderate penile swelling. Overnight he developed 4/10 ain in his groin, at which point he decided to seek medical ttention. Further questioning and review of records reealed that the patient was 9 days post-operative from an ndoscopic retrograde cholangiopancreatography (ERCP) ith sphincterotomy, performed due to choledocholithisis. Review of systems was also positive for sore throat nd neck discomfort, but was otherwise essentially egative. Vital signs showed a blood pressure of 124/79 mm g, pulse 82 beats/min, respiratory rate 16 breaths/min, emperature 36.3°C (97.7°F), and oxygen saturation 97% n room air. Physical examination revealed a wellppearing, well-nourished gentleman in no acute disress. The head and neck examination was significant for cleral icterus, as well as crepitus and mild tenderness to alpation of the anterior soft tissues of the neck. The ropharynx was normal and trachea midline. The geniourinary examination was positive for penile and bilatral scrotal swelling (Figure 1), as well as palpable repitus. Palpation of the right inguinal area elicited pain nd additional crepitus. The remainder of the physical xamination was otherwise unremarkable.

MRI appearances of acute idiopathic scrotal oedema in an adult

Acute idiopathic scrotal oedema is an uncommon cause of acute painless scrotal swelling that is usually seen in children. Traditionally, ultrasound has been used to help establish the diagnosis in the appropriate clinical setting. We report the MRI appearances of acute idiopathic scrotal oedema in a 51-year-old male with associated involvement of the penis.

Metastatic Tumor of Tunica Vaginalis Testis with Hydrocele in a Patient with Gastric Cancer

Jong Lee, Seung Chul Kang, Jung Hyun Ban, Dong Shik Shin, Jeong Kyun Yeo, Dong Hee Yoon, Du Geon Moon, Duck Ki Yoon From the Department of Urology, College of Medicine, Korea University, Seoul, Korea Metastatic tumors of the tunica vaginalis testis from gastric cancer are extremely rare. We report here on a case of a 48-year-old man who had undergone total gastrectomy due to advanced gastric cancer 23 months previously, and he presented with right painless scrotal swelling. A hard mass was palpated along the right spermatic cord and there was an associated hydrocele around the mass. Ultrasonography showed homegenous hypoechoic lesions in the spermatic cord and anechoic lesion superior to the right testis, which was suggestive of hydrocele of the testis. Exploration was performed via inguinal incision. Multiple hemorrhagic small nodules were noted on the surface of the tunica vaginalis. Also, a tumor in the spermatic cord was present beyond the inner inguinal ring. On microscopic examination, adenocarcinoma cell nests, which were consistent with primary gastric cancer, were found in the tunica vaginalis testis, spermatic cord and peritesticular soft tissue, but not within the parenchyme of the testis or epididymis. (Korean J Urol 2007;48:667-669) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Colonic Carcinoma Masquerading as Scrotal Swelling: A Case Report and Review of Literature

Tumours of the spermatic cord are rare. Most tumours of the spermatic cord are metastatic and are typically an incidental finding at orchidectomy for other pathology. Primary pathology is usually from the gastrointestinal tract. We report a very rare presentation of an asymptomatic gastrointestinal tumour as a spermatic cord mass.male patient presented with a painless scrotal swelling. Radical orchidectomy revealed an adenocarcinoma in the spermatic cord. Further investigations disclosed an adenocarcinoma of the descending colon, metastasing to the spermatic cord that gave a false notion of a scrotal swelling secondary to infection. This unusual situation reminds us that spermatic cord metastases are rare. In the event of nonresponding scrotal swelling to antibiotics, further investigations would be prudent, whilst awaiting the definitive pathology report from the radical orchidectomy.

Acuut idiopathisch scrotaal oedeem bij kinderen

Acute idiopathic scrotal edema in children Acute idiopathic scrotal edema is an acute, painless scrotal swelling, often accompanied by scrotal erythema. Acute idiopathic scrotal edema is commonly observed in prepuberal boys. Its etiology is still unknown. The patients are in good health and blood and urine analysis is negative. Scrotal ultrasonography reveals typical thickening of the scrotal skin and normal bloodflow to the testes. Before the diagnosis of acute „idiopathic” scrotal edema may be made, other urological and surgical causes of an acute scrotal swelling have to be excluded first. Acute idiopathic scrotal edema does not require treatment since clinical features resolve spontaneously in 12-72 hours. Recurrences are rare.

Solid variant of alveolar rhabdomyosarcoma of the spermatic cord

A 20-year-old man visited the Department of Urology complaining of a painless lump in the region of the right testicle, which he noticed about four months ago. The lump did not change in size, since. The patient reported no recent trauma. Physical examination revealed a firm, nodular palpable mass in the caudal region of the epididymis. Ultrasound revealed a heterogeneous sounded tumor formation, measuring up to 3 cm, in the projection of the right epididymis tail (left). Exploration of the right hemi-scrotal region was performed. All preoperative analyses, including chest x-ray and abdominal ultrasound were normal. A tumor formation holding to the beginning of the spermatic cord, close to the epididymis tail, with no signs of infiltration of the adjacent structures, was observed. The tumor was encapsulated and presumably completely resected. On cut surface it appeared nodular. The histopathology revealed diagnosis of alveolar rhabdomyosarcoma, solid variant. Lymph node involvement and systemic metastasis survey revealed no signs of metastasis, so the patient was considered clinical stage I [1]. A radical inguinal orchidectomy was performed, combined with chemotherapy (vincristine and dactinomycin) [2]. During the second surgery, macroscopically no residual tumor mass was found. The histopathological examination of the surgical specimen, on the contrary, revealed a residual tumor mass in the region of the spermatic cord, showing vascular invasion (right). The patient is now 24 months without any sign of disease. Rhabdomyosarcomas tend to be palpable and in most patients present with painless scrotal swelling. They most often appear in the distal spermatic cord and are usually not encapsulated. Pure alveolar type is the least common and comprises only 1.7% of all paratesticular rhabdomyosarcomas [3]. As many authorities still recommend a routine lymph node dissection, the most appropriate approach to staging and treatment of these tumors seems controversial, especially regarding the stage I and vascular invasion.

Pure (non-papillary) serous cystadenoma of the epididymis: a histologic and immunohistochemical study

A 44-year-old man presented with painless right scrotal swelling of 2 years duration. A cystic tumor strictly attached to the head of the epididymis was surgically resected. The pathologic examination revealed a unilocular cyst with a thin fibrous capsule, lined by ciliated cubical or cylindrical columnar cells, mostly arranged in a single layer. No papillary projection could be detected. Immunohistochemical staining was positive for epithelial membrane antigen, low- and high molecular weight cytokeratins, progesterone receptor, vimentin, and S-100 protein, but was negative for carcinoembryonic antigen, CD10, p53 protein, and calretinin. Single MIB-1 positive cells were noted. Histologic and immunohistochemical features suggest a Müllerian origin or differentiation. The lesion was diagnosed as pure serous cystadenoma of the epididymis, possibly originating from vestigial remnants of the Müller duct in male. The differential diagnosis to spermatocele and adenomatoid tumor of the epididymis is discussed.

Scrotal Cystic Lymphangioma: The Misdiagnosed Scrotal Mass

Purpose We report 7 cases of scrotal cystic lymphangioma and review the literature on this unusual lesion, which is often misdiagnosed as other conditions and treated incorrectly. Materials and Methods We retrospectively reviewed the medical records of 7 patients with scrotal cystic lymphangioma treated from 1984 to 1996 at 5 institutions. Results Mean patient age at presentation was 3 years and painless scrotal swelling was the most common symptom. Physical examination demonstrated an unusual cystic scrotal mass with a normal testis and cord in most patients, and ultrasound in 4 showed a complex septated cystic mass. Preoperative misdiagnosis in all 7 patients included hernia, hydrocele, hematocele, varicocele and possible torsion. In 6 children the lesions were more extensive than expected with deep perineal and/or inguinal involvement, including 2 who also had pelvic and retroperitoneal extension. Incomplete excision led to recurrence in 4 patients. Conclusions Scrotal cystic lymphangioma presents as an unusual cystic scrotal mass. Although misdiagnosis has been common, awareness of the characteristic features of this lesion should lead to the correct preoperative diagnosis. When lymphangioma is suspected, imaging of the adjacent inguinal, perineal and pelvic regions should be performed. Complete excision is mandatory to prevent recurrence.

From the archives of the AFIP. Genitourinary rhabdomyosarcoma in children: radiologic-pathologic correlation.

Rhabdomyosarcoma is the most common tumor of the lower genitourinary tract in children in the first 2 decades of life. Most cases of genitourinary rhabdomyosarcoma are of the embryonal histologic subtype and include tumors of the bladder, prostate, testes and paratesticular sites, penis, perineum, vagina, and uterus. The natural history, pattern of metastatic spread, treatment, and prognosis of childhood rhabdomyosarcoma vary with the anatomic site of the lesion. In children with rhabdomyosarcoma of the bladder or prostate, presenting signs and symptoms include urinary or fecal retention, dysuria, urinary tract infection, and hematuria. Paratesticular rhabdomyosarcoma produces painless scrotal swelling, which may be ignored until the tumor has reached a large size. Vaginal tumors may manifest as a prolapsing mass in the introitus. Radiologic studies of children with genitourinary rhabdomyosarcoma reflect the nonspecific gross features of the tumor, which may be ill defined with infiltrative margins or well circumscribed by a pseudocapsule of compressed tissue. The botryoid variant of embryonal rhabdomyosarcoma results when submucosal tumor produces a polypoid mass resembling a cluster of grapes within a hollow structure. Botryoid morphology is characteristic, but not specific, for rhabdomyosarcoma within the vagina or urinary bladder, since yolk sac tumor and "tumoral" cystitis may have a similar appearance. Invasion of adjacent structures by the primary tumor may make the precise anatomic origin of genitourinary rhabdomyosarcoma difficult to determine on cross-sectional images. Recent refinements in multidisciplinary therapeutic regimens combining chemotherapy, radiation therapy, and surgery have dramatically improved outcome for children with genitourinary rhabdomyosarcoma. Diagnostic imaging plays an important role in monitoring response to therapy.

Serous papillary cystic tumor of borderline malignancy with focal carcinoma arising in testis: Case report with immunohistochemical and ultrastructural observations

A 59-year-old white man presented with painless scrotal swelling, a symptom he stated he had had for "several decades." Pathologic examination (conventional stainings, immunohistochemistry, and electron microscopy) revealed a cystic papillary tumor that was classified as a serous papillary cystadenoma, ovarian type, of borderline malignancy, with focal transition into invasive cancer. This appears to be the ninth reported case of testicular tumors of the serous or mucinous ovarian type and the first reported case with development of a circumscribed carcinoma from serous cystadenoma of borderline malignancy.

In Utero Torsion of the Testis

Letters to the EditorIn Utero Torsion of the Testis A.H. Al-Salem and FRCSI N. F. MitryFRCSE A.H. Al-Salem Department of Surgery, King Fahad Hospital of the University P.O. Box 6078, Dammam 31442, Saudi Arabia Search for more papers by this author and N. F. Mitry Department of Urology, King Fahad Hospital of the University P.O. Box 6078, Dammam 31442, Saudi Arabia Search for more papers by this author Published Online::1 Mar 1989https://doi.org/10.5144/0256-4947.1989.219SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: Testicular torsion in the newborn is a rare condition. It is usually a prenatal event, and in contradistinction to torsion in older children, it usually manifests itself silently as a painless scrotal swelling. Torsion of the test is in the newborn carries a poor prognosis, infarction being almost inevitable.1,2 This condition must be recognized early and treated if testicular damage is to be prevented. Early recognition calls for a meticulous examination of the scrotum and its contents in every newborn by the attending pediatrician or obstetrician. We describe a case of testicular torsion in a newborn which was recognized 36 hours after delivery.Weighing 3.32 kg, the patient was the product of a full-term normal vaginal delivery with Apgar scores of 9 and 10 at 1 and 5 minutes. Examination of the scrotum revealed a firm, nontender mass in the right hemiscrotum measuring 2×3 cm. The mass was adherent to the overlying skin which was dark brown in color. Ultrasound revealed a fluid-filled, demarcated and circumscribed mass anterior to the normal testis. To rule out a hematocele or a hydrocele, the patient underwent an emergency operation 36 hours after delivery via a right scrotal incision. Dark blood clots in between the tunica albuginea and tunica vaginalis were found. The testis was completely black as a result of an extravaginal torsion. Warm packs were applied with no improvement in the color; no active bleeding occurred on incising the tunica. Orchidectomy was done, and the left testis was explored and fixed at the same time. The histopathology of the removed testis confirmed testicular infarction. The patient had an uneventful postoperative period.Torsion of the testis in the newborn usually presents as an enlarged, firm, nontender, nontransilluminating mass in the scrotum without signs of systemic reaction or toxicity. It is usually fixed to the overlying skin which is discolored. This condition is known to occur in full-term babies who are of above-average birth weight,1–3 and it is usually unilateral, but simultaneous bilateral cases have been reported.4,5Neonatal torsion usually occurs extravaginally, and the treatment recommended is surgical intervention. Some advocate an inguinal approach,4 since the torsion is most likely to be extravaginal; this approach facilitates dealing with an associated inguinal hernia if present. Every attempt should be made to preserve the testis. The gross appearance of a black and apparently necrotic testis should not be considered a criterion for orchidectomy, unless the patient demonstrates signs of systemic toxicity.2,4Controversy still exists regarding the necessity to fix the contralateral testis to prevent subsequent torsion. Since the torsion in the newborn is of the extravaginal type, subsequent affection of the other side is unlikely. We share the view of contralateral fixation,1,2 as it is a simple procedure and protects the solitary testis from further torsion.6ARTICLE REFERENCES:1. Burge DM. "Neonatal testicular torsion and infarction: aetiology and management" . Br J Urol. 1987; 59:70–3. Google Scholar2. Guiney EJ, McGlinchey J. "Torsion of the testis and the spermatic cord in the newborn" . Surg Gynecol Obstet. 1981; 152:273–4. Google Scholar3. Thomas WEG, Williamson RCN. "Diagnosis and outcome of testicular torsion" . Br J Surg. 1983; 70:213–6. Google Scholar4. Frederick PL, Dushku N, Eraklis AJ. "Simultaneous bilateral torsion of the testis in a newborn infant" . Arch Surg. 1987; 94:299–300. Google Scholar5. Gerstmann DR, Marble RD,. "enlarged testicles in a newborn: an atypical presentation of intrauterine spermatic cord torsion" . Am J Dis Child. 1980; 134:992–4. Google Scholar6. Harris BH, Webb HW, et al.. "Protection of the solitary testis" . J Pediatr Surg. 1982; 17:950–1. Google Scholar Previous article FiguresReferencesRelatedDetails Volume 9, Issue 2March 1989 Metrics History Published online1 March 1989 InformationCopyright © 1989, Annals of Saudi MedicinePDF download