Scrotal Mass Research Articles

Discontinuous splenogonadal fusion: new sonographic findings

Splenogonadal fusion is an uncommon cause of scrotal mass in children that is rarely diagnosed before surgery. Occasionally it leads to unnecessary orchiectomy. We report a case highlighting US findings that could help with correct diagnosis.

A case of continuous-type splenogonadal fusion

Splenogonadal fusion is a rare developmental anomaly in which an abnormal connection between the splenic tissue and gonads or mesonephric derivatives is present. Less than 200 cases have been reported since it was first described in 1883. Preoperative misdiagnosis is common and may lead to unnecessary orchidectomy if testicular neoplasm is suspected. To avoid such outcomes, it is important to be aware of the features of splenogonadal fusion. We report the case of a five-month-old male infant with continuous-type, left-sided splenogonadal fusion, which was discovered during groin exploration for a scrotal mass. Although the lesion was first noted during an episode of nonspecific viral fever, such an association is uncommon. Preoperative ultrasonographic evaluation favoured a diagnosis of a large haemangioma. This is the first reported case of splenogonadal fusion from Sri Lanka.

Amyand’s hernia with perforated appendicitis in a premature infant

We present a case of Amyand's hernia with perforated appendicitis in a premature infant. The favorable outcome compared to perforated abdominal appendicitis is discussed. Despite its rarity, this diagnosis should be considered in the differential diagnosis of a scrotal mass in premature infants.

Testicular Teratoma, Mimicking a Simple Testicular Cyst, in an Infant

Prepubertal testicular tumors are rare, and teratoma is the second most frequent histologic type. Its typical features are those of a hard and painless scrotal mass at clinical examination, and nonhomogeneous, echoic, often with calcifications at ultrasonography. Rare but reported is the atypical presentation as a transilluminating scrotal mass, due to the presence of some internal cystic areas, detectable at ultrasonography. We report the case of an infant with a transilluminating scrotal mass, mimicking at ultrasonography and surgery a simple, fully liquid cyst, which the pathologic examination revealed to be mature cystic testicular teratoma.

Malignant lymphoma of the testis: a study of 12 cases

Testicular lymphoma is a rare and deadly disease representing 1% to 2% of all non-Hodgkin lymphomas (NHLs) and approximately 5% of all testicular neoplasms. Our objective is this study was to identify the presenting signs and symptoms, treatment and outcome of patients with testicular lymphoma diagnosed at our institution from 1992 to 2005, and to identify any differences in survival based on Ann Arbor Stage and International Prognostic Index (IPI). A retrospective chart review was performed to identify demographic characteristics, presenting signs and symptoms, treatment and outcomes. Survival was assessed using Kaplan-Meier survival curves and log-rank testing. Thirteen cases were identified; 1 of these cases was ultimately excluded due to a diagnosis of lymphoma a year before he presented with testicular involvement. Of the remaining 12 cases, the mean age was 65 years. Most patients presented with testicular and scrotal swelling or mass. B symptoms (weight loss, fever, night sweats) were present in 1 case. Of the 12 cases, 7 cases were stage I, 1 stage II and 4 stage IV. International Prognostic Index was low risk (</=1) in 7 cases and high risk (>1) in 4 cases. Orchiectomy was performed in all cases. Three patients received no further treatment. Of the remaining 9 patients, overall 7 received systemic chemotherapy, and 7 radiation therapy (prophylactic in 6). Three patients received intrathecal chemotheraphy prophylaxis. Seven patients achieved complete remission. Four patients (57%) relapsed following complete remission. Median time to relapse was 32 months (range 11 to 73 months). Six patients died. Median survival was 29 months, and was significantly different between early versus advanced stage (stage I/II disease: 71 months; stage IV: 5 months p = 0.007). Testicular lymphoma is a rare and deadly form of extra-nodal lymphoma. Survival was significantly different in early stage I/II and IPI low-risk versus advanced stage IV and IPI high-risk disease. Randomized, prospective treatment trials may help to establish better treatment strategies.

Hemodynamic classification of varicoceles in men: our experience

The aim of this work is to propose a new hemodynamic classification of male varicoceles that can improve the accuracy of staging and the quality of the examination report. We retrospectively analyzed data on outpatients referred to our vascular ultrasonography service by general practitioners or urologists for work-up of "varicoceles." Quantification and characterization of venous reflux is essential for selecting patients who require treatment and for evaluating the latter's effectiveness, as demonstrated by our experience in a subgroup of 58 patients referred for imaging after surgery on endovascular procedures. We performed scrotal Doppler sonography on 278 males seen during the period 2009-2011 for doubts raised during clinical assessment of varicoceles or for postoperative evaluation of residual reflux. The diagnosis of varicocele was confirmed on 193 subjects; in 32 patients who had undergone percutaneous or surgical treatment the examination demonstrated the presence of residual reflux, while in 85 cases the presence of pain or a scrotal mass was not associated with venous reflux. Standardized instrumental criteria have been developed for the diagnosis of varicoceles but not for their staging. The classification system we propose provides a simple, hemodynamically accurate method for qualitatively evaluating venous reflux, and it can be a useful tool for verifying the success of surgical and endovascular procedures for correcting varicoceles.

Unilateral primitive hydatid cyst with surgical resection of the scrotum: a case report

IntroductionHydatid disease remains a public health problem in many Mediterranean countries. Liver and lung localizations are the most common. Renal hydatid cysts represent 2 percent to 4 percent of the visceral forms of this disease. To the best of our knowledge a scrotal location has only previously been described in five papers in the literature, all being secondary localizations. In this paper, we report a case of a primitive scrotal hydatid cyst.Case presentationA Moroccan man aged 29 years old presented to our facility with scrotal pain. A clinical examination identified a painless scrotal mass. The results of a scrotal ultrasound showed intra-scrotal cystic formations with different sizes associated with scrotal effusion of average abundance. Chest cavity and abdominal computed tomography scans did not reveal any other localizations. Our patient benefited from surgical protruding dome resection. A partial cysto-pericystectomy was realized. The first stage consisted of injecting a scolicide solution; hydrogen peroxide is the most commonly used agent. This is injected into the cystic cavity and retained for 10 minutes. This process allows for sterilization of the cyst while avoiding the risk of rupture and transmission of the hydatid liquid into the circulation. After 10 minutes, the cystic contents are removed by suction. The cyst is then opened, and the endocyst containing the hydatid membrane and daughter vesicles are removed. It is of note that our patient did not receive any additional medical treatment. Our diagnosis was made using an imaging approach and was confirmed during surgery.ConclusionsUltrasound is often the key diagnostic approach for cases of a scrotal hydatid cyst. Treatment is primarily surgical, aiming for resection of the protruding dome via a longitudinal scrotectomy.

Embryonic paratesticular rhabdomyosarcoma: a case report

IntroductionAn embryonic paratesticular rhabdomyosarcoma is a very rare mesenchymal tumor. It is an intrascrotal tumor that is localized in paratesticular structures such as the epididymis or spermatic cord. Rhabdomyosarcoma is most often observed in children and adolescents, presenting as a painless scrotal mass.Case presentationOur patient was an 18-year-old Moroccan man who presented with a painless left scrotal mass that had evolved over four months. An inguinal orchiectomy was performed. A histological examination of the excised tissue revealed an embryonic rhabdomyosarcoma.Our patient had three sessions of chemotherapy with vincristine, actinomycin C and cyclophosphamide. Each chemotherapy session was conducted over five days, with a cycle of 21 days. Our patient was assessed two months after the last chemotherapy session and demonstrated good clinical improvement.ConclusionParatesticular rhabdomyosarcoma is a rare aggressive tumor manifesting in children and very young adults. Localized forms have a good prognosis whereas metastatic tumors show very poor results. A well-defined treatment based on surgery and chemotherapy yields good results.

Xanthogranulomatous Orchiepididymitis: A Very Uncommon Cause of Scrotal Mass in Childhood

Xanthogranulomatous orchitis (XGO) is an extremely rare inflammatory destructive lesion of testis. We report a case of a 14-year-old boy who presented with painful right testicular mass and discharging scrotal fistulas. Serologic tumor markers were normal. Tissue destruction was profound in the initial biopsy. The antibiotic treatment did not change the course of the disease. The definitive cure was achieved by orchiectomy and excision of the fistulous extension to the scrotum. Histopathological investigation was consistent with xanthogranulomatous process. Although XGO is very rare, the basic interest in the present report is considering this entity in the broad differential diagnosis spectrum of scrotal masses in childhood.

Epididymal cyst, a rare cause of pediatric childhood scrotal mass: Case report

Epididymal cyst, a rare cause of pediatric childhood scrotal mass: Case report

Clear cell papillary cystadenocarcinoma of the epididymis: a case report and immunohistochemistry of markers for renal cell carcinoma.

Neoplasms of the epididymis are uncommon, and malignant tumors are extremely rare. We report a case of clear cell papillary cystadenocarcinoma of the epididymis presenting with a long history of painless scrotal mass on the left side. Immunohistochemical markers for clear cell renal cell carcinoma (RCC) were examined to distinguish between clear cell papillary cystadenocarcinoma of the epididymis and metastatic clear cell renal cell carcinoma. The present case was positive for cytokeratin-7, PAX2, vinculin, vimentin and carbonic anhydrase IX. Expression of CD10 was focally observed. In contrast, no immunoreactivities for α-methylacyl-CoA racemase, RCC marker, glutathione S-transferase α or C-KIT were detected. The immunophenotypic profile of clear cell papillary cystadenocarcinoma of the epididymis closely resembles that of clear cell papillary RCC, although the immunohistochemical markers tested in this study are useful to make a differential diagnosis between clear cell papillary cystadenocarcinoma of the epididymis and metastatic clear cell RCC.

A rare testicular solid mass in children: juvenile granulosa cell tumour of testis

Juvenile granulosa cell tumour (JGCT) of the testis is a benign neoplasm rarely seen in children. It usually presents as a unilateral scrotal mass and can be associated with genital ambiguity and chromosomal anomalies. Radical orchiectomy is the treatment of choice. We present an infant with a JGCT of the testis and were view the typical findings of the disease.

Abscesos testiculares: abordaje quirúrgico. A propósito de 2 casos

Testicular abscess is a rare condition that often arises due to complications of untreated or advanced orchiepididymitis. Clinical symptoms and physical exam do not always provide an accurate diagnosis because the pain and swelling often limit adequate palpation of the scrotal contents. Therefore, scrotal ultrasound is the imaging technique of choice to determine the nature of the scrotal mass and also to detect presence of scrotal abscesses. Although initial treatment is medical, it is sometimes necessary to resort to orchiectomy. This purpose of this paper is to propose inguinal approach for the surgical treatment of testicular abscesses. This approach makes it possible to maintain the infectious process isolated and thus avoid “violation of the scrotum” in the case of a tumor.We report two cases of testicular abscess successfully treated by inguinal orchiectomy.

Liposarcoma of the spermatic cord mimicking a left inguinal hernia: a case report and literature review

Liposarcoma of the spermatic cord (LSC) is a rare condition characterized by a painless inguinal or scrotal mass. To our knowledge, only about 200 cases have been previously reported in the literature. These tumors are often mistaken for common scrotal swellings, such as hydroceles and hernias. We present a LSC case in which a definitive diagnosis was obtained upon histological examination. We also provide a literature review of other cases that have been reported.

An adolescent presenting with malignant fibrous histiocytoma of the testis: a case report

IntroductionMalignant fibrous histiocytoma is a very common subtype of soft-tissue sarcoma in middle and late adulthood. However, malignant fibrous histiocytoma of the testis is very rare in adolescents.Case presentationWe report here the case of a 14-year-old Han Chinese boy, who presented with left scrotal mass lasting for 20 days along with distending pain for 5 days. A physical examination revealed a chicken egg-sized, firm, well-defined mass and unclear epididymis. A B-scan ultrasonography of the left scrotum displayed a 9.0×5.2×4.5cm medium- or low-echoic lobulated mass, which suggested a left testicular neoplasm. A fine needle aspiration cytology examination revealed that the cells obtained from the patient’s testicular neoplasm were composed of myxoid spindle, and ovoid cells with nuclear atypia and mitotic activity, and arranged in a whirlpool or storiform pattern. Under histological examination, the tumor cells were arranged in a storiform pattern, which displayed mucoid matrix degeneration, and grew invasively. Consequently, a histopathological diagnosis suggested myxofibrosarcoma (or myxoid malignant fibrous histiocytoma).ConclusionsAn ultrasonic examination combined with fine needle aspiration cytology should be helpful for the initial differential diagnosis of testicular malignant fibrous histiocytoma. However, the final confirmation relies on histopathological examination. To the best of our knowledge, this is the first reported case of malignant fibrous histiocytoma of the testis in an adolescent.

Tuberculous epididymo-orchitis mimicking a testicular tumour: a case report

Isolated tuberculous epididymo-orchitis may closely mimic testicular tumour particularly in patients with no history of systemic TB thereby presenting a diagnostic and treatment challenges. A 44-year old man presented with 4 months history of left scrotal mass and had left orchidectomy following a presumptive diagnosis of testicular tumour. Histopathological diagnosis of testicular tuberculosis was subsequently made. Although the patient was thereafter referred for antituberculosis treatment at the local tuberculosis treatment centre, he defaulted after commencing treatment. Adequate evaluation of patients with testicular mass by means of abdominal and scrotal ultrasound coupled with fine needle aspiration cytology is critical to diagnostic accuracy, optimal treatment and possibility of avoiding surgery in those with testicular tuberculosis.

Malacoplakia of the Epididymis

Malacoplakia is a chronic inflammatory disease. The disease mainly affects the urinary bladder, although involvement of extravesical sites is increasingly being documented. Most frequently involved is the urinary tract, particularly the urinary bladder, although the testis, epididymis, lungs, bone, colon, prostate, female genital organs, and retroperitoneum can also be involved. Here we report the case of a 61-year-old man with a scrotal mass with histology that was specific for malacoplakia of the epididymis. The histologic workup demonstrated extensive involvement of the epididymis by diffuse infiltrates of large histiocytes with eosinophilic granular cytoplasm and numerous Michaelis-Gutmann bodies, which were diagnostic of malakoplakia. This is the first case of epididymal malacoplakia in our country and the first case of epididymal malacoplakia without concurrent involvement of the testis. There have been few reports of this condition worldwide.

A Rare Content in Inguinal Hernial Sac, Masquerading as Scrotal Tumour

Some of the commonly performed operations can become difficult due to unusual findings which are seen during surgery. One such sort of operation is hernia repair. Decision making during such situations could be challenging, even for experienced surgeons. We are reporting here a rare case of a terminal ileal intussusception in inguinal hernial sac, which presented as a scrotal tumour. A 45-year-old man presented with an uncomplicated left inguinoscrotal swelling of 4 years duration. He had a large non-transilluminant hydrocoele (20x 10cm) with a partially reducible inguinal hernia, with another scrotal mass mimicking a scrotal tumour. Sonographic evaluation showed a complex scrotal mass with bowel loops in the sac. On surgical exploration, a terminal ileal intussusception mass was noted in the sac, which required ileocaecal resection by laparotomy. This case report is an unusual presentation of a common disease. Surgeons should be aware of these unusual contents in hernial sac, for better decision making and management during hernia operations.

Infarcted Adenomatoid Tumour of Epididymis: A Rare Case Report

Paratesticular tumours are pathologically rare. The vast majority are benign in nature with adenomatoid tumours representing the most common pathological entity. We present the case of a 32-year-old man, from the Indian subcontinent, who presented with a painful scrotal swelling sustained after trauma. The history suggested that the scrotal mass had been present for approximately 12 months, and a preliminary diagnosis of a haemorrhagic cyst caused by trauma was made. Initial management included scrotal support, analgesia, and a follow-up magnetic resonance imaging (MRI) scan. Subsequent imaging and then further histological analysis confirmed a partly necrotic/infarcted adenomatoid tumour of the right epididymis. After scrotal exploration and epididymectomy, the patient made a complete recovery, and, with the histological diagnosis, he was discharged with no further followup. The case is presented as a learning point in the identification and management of such pathologies.

Surgical repair of giant inguinoscrotal hernia containing the urinary bladder

Inguinal hernia repair is one of the commonest operations in surgical practice. Unusual contents of hernia sac are uncommon, but are likely to be encountered by a surgeon in his career due to the frequency of hernia repair. The bladder is involved in less than 4% of inguinal hernias. These patients usually present with frequent episodes of urinary tract infection, difficulty in walking and difficulty in initiating micturition because of incarceration of the urinary bladder into the scrotum. The incidence may reach 10% among obese men who are 50-70 years old. Most cases are asymptomatic and are usually found incidentally during radiographic evaluation or at the time of herniorrhaphy. Massive inguinoscrotal bladder hernia, also known as scrotal cystocele, is very rare. In India, there was only few reported case of inguinoscrotal bladder hernia. Here we report a case of left inguinoscrotal bladder hernia who presented with a scrotal mass. We also provide a review of the relevant literature.