Scrotal Mass Research Articles

Paratestiküler Kitlelerin Güncel Tanı, Tedavi ve Takip Prosedürleri

Objective :The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly. Materials and Methods :The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature. Results :Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM). Conclusion :The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Unusual case of splenic haemangiosarcoma with suspected scrotal metastasis in a 13-year-old English Pointer

Visceral haemangiosarcoma is an aggressive neoplasm, often associated with a high metastatic potential. The most common sites for metastases are the liver, lungs, peritoneum, muscle and lymph nodes. This report...

A rare case of discontinuous type splenogonadal fusion in a 13 year old boy: a case report and review of literature

Splenogonadal fusion (SGF) is a rare developmental anomaly in which an abnormal connection between the splenic tissue and gonads or mesonephric derivatives is present. This entity often presents with scrotal mass, inguinal hernia, or cryptorchidism. Less than 200 cases have been reported since it was first described in 1883. It can be of continuous and discontinuous type based on the presence of a band of connecting splenic tissue. Report a rare case of discontinuous type of SGF in an adolescent male presenting as nonpalpable testis. On evaluation, ultrasonography (USG) and magnetic resonance imaging of abdomen and pelvis, his left scrotal testis was atrophied and right intra-abdominal undescended testis. This is the first reported case of SGF from Bosnia and Herzegovina. Laparoscopy was demonstrated to be the only accurate exploratory procedure for the diagnosis and surgical treatment of SGF with non‑palpable testis.

Prenatal Diagnosis of Right Sided Inguinoscrotal Hernia Associated with Severe Growth Restriction in a Fetus with Trisomy 18: A Case Report

AbstractFetal inguinoscrotal hernia is an uncommon occurence in the prenatal life, and published literature on it is scarce. This is a type of indirect hernia that results from abnormal migration of the small bowel into the scrotum via the patent processus vaginalis. We present a case of prenatal diagnosis of right sided fetal inguinoscrotal hernia, with contralateral hydrocele and severe fetal growth restriction confirmed as Trisomy 18 in subsequently performed chromosomal analysis. The index case presented at 35+2 weeks of gestation with a right sided solid scrotal mass with a regular contour, mixed echogenic texture with a few echo-free areas, a distinctive arterial supply and characteristic peristaltic movements. Fetal demise was noted one week later. The diagnosis was confirmed by postnatal examination. Prenatal diagnosis of fetal inguinoscrotal hernia should be followed up with detailed anatomical assessment and chromosomal analysis if indicated by the presence of additional abnormalities. Isolated cases require surgical repair in the neonatal period to avoid sequelae and complications.

Polyorquidism: case report comparing ultrasonography and magnetic resonance imaging

Abstract Introduction: polyorchidism is an unusual pathology, about 200 cases in the world literature. Case report: we reported a case of polyorchidism in a 16-year-old male patient diagnosed by ultrasound and confirmed by magnetic resonance imaging. Discussion: most of the cases presented, there is a supernumerary testis, but there are reports on more than three, up to five testicles with supranumerical gonads on both sides of the scrotum. The diagnosis is usually performed in late puberty, incidentally, with a painless scrotal mass or at the emergency room, presenting a testicular torsion of the whole hemiscrotum or supernumerary testisalone, and the differential diagnosis should be made with epididymal cyst and spermatocele, besides other extra-testicular masses (hydroceles, varicoceles, lipomas, tumors.) and para-testicular masses (hernias, scrotal calculi). After the initial clinical evaluation, ultrasound is the first line subsidiary exam. Magnetic Resonance Imaging is very helpful, just in case the ultrasound diagnosis is uncertain. The supernumerary testishave the same Magnetic Resonance Imaging characteristics as the normal testes (intermediate signal intensity on T1- weighted images and high signal intensity on T2-weighted images).

Abstract 5799: Epidemiology and prognostic factors of primary paratesticular lymphoma (PPTL): A pooled case-series since 1980

Abstract PPTL involving the spermatic cord &/or epididymis and sparing the testicular parenchyma is an extremely rare and heterogeneous disease. It doesn't exceed 1.5-2% of all tumors of the spermatic cord. Old cases indicated that PPTL was highly lethal. Many significant changes in classification and treatment have occurred since these reports were published. This retrospective epidemiologic review was conducted to update our knowledge of PPTL using more recent cases that reflect the current state of medicine. This study included all published cases of PPTL in English between 1980-2019 attempting to explore the demographic characteristics, presentation and metastases patterns, types of therapies, and survival of patients with PPTL. The Kaplan-Meier method was used to estimate survival. Log-rank test and multivariate Cox regression models were used to assess the influence of demographic and clinical factors on survival. A total of 34 (27 spermatic cord, 6 epididymis, 1 seminal vesicle) patients with PPTL were identified. The median age was 65 years. A sharp increase in the reported PPTL cases aged 50 and above was noted, peaking within the 72-82 year age-bracket. Diffuse Large B- Cell Lymphoma (DLBCL) was the most prevalent histology (85%). Other types consisted of 1 PEL-like DLBCL, 2 Follicular lymphomas, 1 Marginal Zone Lymphoma, and 1 Intravascular T-cell Lymphoma. The majority presented with Ann-Arbor stage I (65%), followed by II (18%), IV (15%) and III (3%). Only one patient had B-symptoms. All cases presented with growing painless scrotal masses except 2 patients who reported pain including one with bilateral scrotal masses. The average tumor size was 6cm (3-8.5cm). When presenting with stage IV, the majority had involvement of the abdominopelvic and cervical/supraclavicular lymph nodes with additional prostate involvement in one patient and tonsillar involvement in another. All the patients underwent orchiectomy for diagnostic purposes followed by chemotherapy except one who was treated with primary radiation alone. Twenty-eight percent received radiation and only 12% received intrathecal chemotherapy. Median overall survival of the whole group was 12 months. Univariate analysis revealed that PPTL of the epididymis and cases reported after 1990 had significantly better survival. Early stages I&II was of borderline significance. While Age <50 seemed to have better survival, it did not reach statistical significance. However, in multivariate analysis, stage, reporting year, and age significantly impacted the survival of this cohort. This retrospective study presents an updated epidemiologic descriptive data and provides prognostic factors from a relatively recent PPTL cohort. Moreover, it clarifies the perception of the lethality of the disease as PPTL seems to have a similar median overall survival to testicular lymphoma. Citation Format: Philip A. Haddad. Epidemiology and prognostic factors of primary paratesticular lymphoma (PPTL): A pooled case-series since 1980 [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5799.

Non Seminomatous Mixed Germ Cell Tumor of Testis with a Large Abdominal and Retroperitoneal Extension: A Case Report

Primary testicular germ cell tumors (PGCT) can be classified as seminomatous and non-seminomatous germ-cell tumor (NSGCT) types. Mixed germ cell tumors (MGCT), a subtype of NSGCT, contain more than one germ cell components. Here, we present a rare case of a MGCT composed of yolk sack tumor and teratoma which had a continuous large abdominal and retroperitoneal extension. A 43 years old male presented with complaints of discomfort and swelling over the right inguinoscrotal region. Ultrasonography (USG) showed a large ill-defined heteroechoic mass in the right inguinoscrotal region with vascularity and without separate visualization of right testis. Subsequent contrast enhanced Computed Tomography (CT) showed large enhancing mass in the right scrotal sac which was continuous with large abdominopelvic and retroperitoneal mass through the right inguinal canal. Tru-Cut biopsy of the scrotal mass showed MGCT with yolk sac and teratoma component. Patient underwent 6 cycles of chemotherapy followed by Right Radical Inguinal Orchidectomy.

Paratesticular spindle cell rhabdomyosarcoma: A case report of a rare tumor

Spindle cell rhabdomyosarcoma (RMS) is a rare variant of embryonal rhabdomyosarcoma. This tumor commonly involves paratesticular region of young males. Herein we report a case report of right paratesticular spindle cell rhabdomyosarcoma in a 16-year-old boy, who was referred to us for painless right scrotal mass. Staging computerized tomography (CT) showed no nodal or distant metastasis. The right radical inguinal orchidectomy was performed. Diagnosis of paratesticular spindle cell rhabdomyosarcoma was confirmed by histopathological and immunohistochemical examination. Paratesticular spindle cell RMS is a rare tumor and morphologically it may mimic other spindle cell neoplasms. Immunohistochemistry plays a pivotal role in its diagnosis. Making a correct diagnosis is crucial owing to the different treatment modalities available for this tumor.

Comparative study of pediatric non-neoplastic scrotal masses using high resolution sonography and colour doppler with histopathological correlation

Aim: To compare non-neoplastic and neoplastic scrotal masses by characterization on B-mode scan and Colour Doppler ultrasonography. Results: Of 56 cases of non-inflammatory scrotal swellings, 5 cases were neoplastic lesions, remaining 51 cases were non-neoplastic swellings. The 5 cases of neoplastic swellings were three cases of testicular neoplasm, two case of spermatic cord neoplasm which was histopathologically confirmed. Conclusion: When color Doppler sonography is supplemented with High frequency gray scale US, the sensitivity of diagnosing acute scrotal pathology will be increased.

Scrotal Epidermoid Cyst Presenting as Extra-Testicular Scrotal Mass: A Diagnostic Dilemma

We hereby report a scrotal epidermoid cyst presenting as a scrotal mass which a rare entity in the absence of trauma. 36years old male presents with a complaint of left sided testicular swelling and discomfort. The workup included clinical examination, alpha-fetoprotein (αFP) and beta-human chorionic gonadotropin (β-hCG) analyses and scrotal ultrasound. Clinically confused as testicular malignancy. Complete surgical excision of the cyst was performed. Histopathology confirmed epidermoid cyst with no evidence of malignancy.

Klinefelter Syndrome Mosaicism 46,XX/47,XXY: A New Case and Literature Review.

Most cases of Klinefelter syndrome (KS) have 47,XXY karyotype. We reported the first case of 46,XX/47,XXY KS whose genital ambiguity was detected prenatally with postnatal confirmation of the mosaicism and ovotesticular disorder of sex development (OT-DSD). The paternal origin of the extra X chromosome was identified using trio cytogenomic single-nucleotide polymorphism array. Additional 18 cases were also reviewed. The clinical presentation of 46,XX/47,XXY is age-dependent with two age peaks, including ambiguous genitalia during infancy and gynecomastia with or without cyclical hematuria and left scrotal pain and mass in adolescence. The 46,XX is the predominant karyotype both in peripheral blood and gonadal tissue. The risk of germ cell tumor is very high throughout life in these individuals. Individuals with 46,XX/47,XXY mosaicism should be treated more as OT-DSD other than a simple mosaic KS. A multidisciplinary approach and long-term monitoring are necessary.

TRIORCHIDISM WITH TORSION OF ACCESSORY TESTIS: A CASE REPORT

Polyorchidism is an extremely rare congenital anomaly of the urogenital system and is defined as the presence of more than two testes. The majorities of patients are asymptomatic or present with painless inguinal or scrotal masses. We present the case of an 31-year-old male presented in surgery opd with pain and sudden increase in size of swelling right groin. Although it was present since birth but it was painless and small in size. No history of trauma, fever, pus discharge. On examination single ovoid mobile tender swelling was present in right groin, overlying skin was normal and bilateral testis and penis was normal. USG and CT scan showed triorchidism with torsion of accessory testis. Exploration was done under LA and accessory testis was removed. Polyorchidism is a rare congenital anomaly. Patients with polyorchidism can be managed conservatively unless there are no accompanying problems such as inguinal hernia, cryptorchidism or torsion.
 Keywords: polyorchidism, Acessory testis, Triorchidism.

P-06-2 A True Hermaphrodite With 46XX/46XY Karyotype, Gynecomastia, Testosterone Deficiency and a Painless Scrotal Mass

P-06-2 A True Hermaphrodite With 46XX/46XY Karyotype, Gynecomastia, Testosterone Deficiency and a Painless Scrotal Mass

Testicular Tuberculosis in an HIV Positive Patient Co-infection with Pulmonary Tuberculosis Mimicking Malignancy: A Case Report

Background: Extrapulmonary involvement can be seen in more than 50% of patients with concurrent HIV and tuberculosis (TB). Approximately 7% of those are presented as a rare case, namely testicular TB, with scrotal mass as common clinical manifestation. Testicular TB should be a different diagnosis, especially in areas with a high prevalence rate for TB.Case: A 24-year-old male with HIV positive co-infection with pulmonary TB presented with a progressively increasing painless right testicular swelling of 1-month duration. History of chronic cough was complained, accompanied by loss of appetite and decrease of body weight. There was no history of testicular traumatic accident before. Genital examination was right testicular mass measuring 7cm x 4cm and depletion of right side scrotal skin with pus and necrotic tissue. He had right orchidectomy by an urologist in a private hospital; then an anatomical pathology was examined. The result of the microscopic evaluation showed granuloma inflammation process typical for orchitis tuberculosis. The patient was reactive for HIV and had Mycobacterium tuberculosis (MTB) detected, Rifampicin resistant not recognized as the result of Gene Xpert MTB/RIF assay.Conclusion: Although a rare case, testicular TB should be a different diagnosis when there is a patient with HIV positive concurrent pulmonary TB with scrotal mass as clinical manifestation, especially in areas with a high prevalence rate for TB.

Aggressive Angiomyxoma in an 11-Year-Old Boy - Diagnostic and Therapeutic Dilemmas: An Unusual Case Report and Review of the Literature

Aggressive angiomyxoma(AAM) is a rare tumor with a high risk of local recurrence. Scrotal AAM mimics common pediatric pathologiesincluding hernia or hydrocele. We present 11-year-old boy who underwent macroscopically radical excision of right scrotal AAM. The patient has been already followed up for 29 months utilizing US every 6 months and MRI every 2 years. Residual scrotal mass has been visualized in MRI 3 months after surgery however no further growth was reported. Long term follow up with reliable local imaging is mandatory.

SUN-523 Thyroid Storm: A Rare Presentation of HCG Producing Metastatic Choriocarcinoma

Background: The beta subunit of human Chorionic Gonadotropin (hCG) and TSH are very similar and hCG is known to weakly bind the TSH receptor. hCG induced hyperthyroidism has been previously reported as a rare paraneoplastic syndrome in non-seminomatous germ-cell tumors and usually presents with subclinical thyrotoxicosis. We present a noteworthy case of thyroid storm in a patient with hCG producing testicular Choriocarcinoma. Clinical case: A 19-year-old Hispanic man presented to an outside emergency department (ED) with one day of abdominal pain, nausea, recurrent emesis and subjective fever. He had presented to the same ED 9 days prior with similar symptoms which prompted contrasted CT Abdomen/Pelvis demonstrating hepatic masses and a large right testicular mass, suspicious for primary testicular malignancy. On return evaluation, he was noted to have tachycardia with HR 165, mild scleral icterus, tenderness to palpation of right upper quadrant, abdominal pain and a right scrotal mass (5x5 cm). CBC revealed; WBC 12.0 k/uL (n: 4-10.8), AST: 428 u/L (n: 3-34); ALT: 176 u/L (n: 15-41); total bilirubin: 6.3 mg/dL (n: 0.2-1.3), TSH <0.005 uIU/mL (n: 0.4-4.0) and FT4 5.02 ng/dL (n: 0.7-1.4). Clinical scenario was consistent with thyrotoxicosis concerning for thyroid storm (Burch-Wartofsky Point Scale: 50) requiring intensive care for which he was transferred to our institution. Thyroid US revealed increased thyroid vascularity without nodularity. Laboratory workup revealed negative TG Ab, Anti-TPO Ab, TRAb, and TSIG. Conversely, TBG was elevated at 31.2 mcg/ml (n: 13-30). Initial hCG level was obtained as 6,074. After re-testing with dilution was specifically requested, initial hCG was corrected to 6,760,713. Oncologic workup confirmed diagnosis of hCG producing testicular choriocarcinoma with liver and lung metastases. On admission, he was started on oral methimazole and propranolol as well as intravenous steroids which led to marked symptomatic improvement and normalization of FT4 to 1.37 allowing for discontinuation of antithyroid medication on 7th day of hospitalization. He completed 1 cycle of cisplatin/etoposide and experienced marked reduction of his hCG level to 951,460 which correlated with improvement of his TFTs and resolution of his hyperthyroid symptoms.Conclusion:A low threshold of suspicion should be maintained for the possibility of hyperthyroidism in patients with suspected testicular choriocarcinoma, particularly in the context of recent iodinated contrast imaging. If the clinical picture does not support a primary etiology of hyperthyroidism and hCG is not concordantly elevated, re-assessment of hCG by dilution should be considered as hCG assay is also subject to prozone (hook) effect. Hyperthyroidism should be actively managed and closely monitored as response to treatment can be rapid.

SUN-040 Hormone Replacement Therapy in Transgender Unmasks Testicular Tumor

Introduction In transwomen, hormonal replacement therapy typically usually consists of anti-androgen and/or estrogens. Per Endocrine Society 2017 guidelines, patients should be evaluated every 3 months in the first year for appropriate signs of feminization and adverse reactions. This includes measuring serum testosterone every 3 months initially and the testosterone level should be < 50 ng/dL. We describe a case of a transwoman patient diagnosed with testicular seminoma during surveillance of hormonal replacement therapy (HRT). Case presentation A 31-year-old male-to-female transgender presents to the endocrine clinic for HRT. She previously had seen another provider for HRT and was started on estradiol valerate 5 mg weekly and leuprolide 3.75 mg every month. After 5 months of therapy, she reported that her testosterone level remained elevated, so spironolactone 100 mg BID was subsequently added. Despite adherence, she was dismayed at how little physical changes she achieved after 1.5 years of HRT. She denies taking exogenous substances or OTC mediation containing androgens. Her examination reveals a male habitus and musculature with male voice, male diamond pubic hair pattern, adult penis size and scrotum measuring 20 cc’s bilaterally. Initial labs revealed total testosterone 131 ng/dl, free testosterone 30.8 ng/dl, bioavailable testosterone 64.6 ng/dl, SHBG 12 nmol/L, LH < 0.07 IU/L, FSH < 0.1 IU/L, and estradiol 146 pg/ml. Due to non-suppressed testosterone level despite undetectable gonadotropins, adrenal androgen labs were obtained which was normal. However, her HCG-beta tumor marker was elevated, 12 IU/L (0-3). This prompted a scrotal ultrasound which revealed 3.2 cm right testis mass. Follow-up PET/CT revealed increased activity localized to the right testis without findings of metastasis. Patient underwent right orchiectomy with pathology revealing seminoma stage 1A pT1bMx. At 2 months postop, her total testosterone is now 8 ng/dl, and she reports that her breast tissue has increased and skin softened. Conclusion Hyperandrogenism can be easily diagnosed in females given more obvious clinical features; however, except for precocious puberty, there are typically no obvious features of exogenous testosterone production in males. Thus, typically no workup is undertaken in males to look for underlying cause, including testicular cancer. While presence of scrotal mass is the most common initial presentation, patients can be asymptomatic until tumor burden is high and there is metastasis. Transwomen should be monitored by obtaining estradiol and testosterone levels following the Endocrine Society guidelines. If patient is on GnRH agonist, her testosterone level should be almost completely suppressed (T <50). A testosterone level > 50 ng/dL while on GnRH therapy should warrant workup for exogenous sources, including testicular cancer and adrenal abnormalities.

Antenatal Idiopathic Scrotal Haematoma: A Case Report

Neonatal scrotal haematoma is a rare entity which requires prompt diagnosis and management. Mostly the diagnosis is confirmed at exploration. A male baby was delivered by Caesarean section with antenatally identified scrotal mass. Examination and work-up pointed to idiopathic scrotal haematoma which was drained surgically. No cause of scrotal haematoma could be identified. The baby is doing fine postoperatively.

Paratesticular Cyst with Benign Epithelial Proliferation Arising from a Mesonephric Duct Remnant

A 65-year-old male presented with a cystic scrotal mass that fluctuated in size. The cyst was associated with aberrant epididymal tissue and was found to have benign epithelial proliferations, with immunohistochemistry supporting a mesonephric origin (GATA3, CD10, and WT1 positive). Clinical presentation, imaging, and pathologic findings are described.

V09-07 ROBOTIC RETROPERITONEAL LYMPH NODE DISSECTION FOR STAGING OF PARATESTICULAR RHABDOMYOSARCOMA

INTRODUCTION AND OBJECTIVE: Although not a common malignancy, paratesticular rhabdomyosarcomas (PTR) are the most common non germ cell tumor scrotal masses in the pediatric population. Evidence suggest a retroperitoneal lymph node assessment of at least 7 nodes be done on patients 10 years or older with PTR with no clinical suspicion for distant metastases. On this video we aim to present an experience in the management of clinically localized PTR with a modified template robotic assisted retroperitoneal lymph node dissection (RA-RPLND). METHODS: We present the case of a 14 year old male with no significant past medical history who presented with 2 months of progressive scrotal swelling. Sonographic evaluation revealed a left 12 x 7 cm heterogeneous extratesticular mass. Tumor markers were not elevated and no staging study was conclusive for distant metastasis. The patient then underwent a left radical orchiectomy with high ligation of the spermatic cord, which revealed an embryonal PTR. It was decided to perform a modified left template RA-RPLND, using the upper margin of the left renal vein as a cepholad limit, and the common iliac vessels as an inferior limit. The ureter and aorta served as lateral limits. RESULTS: Total surgical time was 3 hours, with an estimated blood loss of 25mL. Surgery and recovery were uncomplicated. The final pathology report revealed focal metastatic rhabdomyosarcoma in the perivascular soft tissue surrounding the left common iliac chains. However, no disease was found in any of the 30 lymph nodes resected. CONCLUSIONS: A modified template RPLND allowed for the detection of this extranodal metastasis. The robotic approach facilitated the 30 lymph node yield as well as the complete cord excision while minimizing morbidity. As robotic surgery is expanding in the pediatric surgery field, RA-RPLND can serve as a safe and oncologically sound approach for these challenging cases. Source of Funding: Dept of Urology, NYU Langone Health