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Scrotal Masses

Dr. Hasan FarsiDr. Hasan Farsi

Ref.: Current Surgical Diagnosis & Treatment

1

Anatomy

Dr. H.Farsi

Anatomy

Cremasteric m.

Dr. H.Farsi

Pampeniform plexusp

T. Vaginalis T. Albugenia

Cremasteric M.

Dr. H.Farsi

HydroceleHydrocele• Fluid within Tunica or Processus vaginalis• Etiology:

– Primarya y– Secondary:

• Injury infection tumorInjury infection tumor

• Clincal Picture:Symptoms: Swelling Pain– Symptoms: Swelling Pain

– Examination:• Mass cystic not tender transilluminate• Mass cystic not tender transilluminate

? herniaInvestigation: Scrotal Ultrasound

Dr. H.Farsi

– Investigation: Scrotal Ultrasound

Hydrocele

Dr. H.Farsi

Types of HydroceleTypes of Hydrocele

• Types:– Infantile

(communicating)V i l (Si l )– Vaginal (Simple)

– Encysted hydrocele of th dthe cord

Dr. H.Farsi

CoveringsCoveringsof Hydroceley

Tunica Vaginalis

Dr. H.Farsi

Spermatocele

• Cystic mass• Above & posterior to testis• Painless mass• Painless mass• Transilluminate• Sperms

Dr. H.Farsi

Varicocele

• Dilatation of pampiniform plexus• Etiology: ??• Left > right• Left > right• Examine: supine & erect• Infertility:

35%– 35%– 60-70% success rate

Dr. H.Farsi

Varicocele & RCC

Dr. H.Farsi

Varicocele

Dr. H.Farsi

Orchitis

• Etiology:– Epididymitis– MumpsMumps– Syphilis

h t– hematogenous

Dr. H.Farsi

Testicular TumorsTesticular Tumors• Young patient• Undescended testis• Typesyp

Dr. H.Farsi

Histological Types of Testicular TumorsHistological Types of Testicular Tumors

Testicular Tumor

1ry 2ry

LymphomaGerminal Non-germinal LymphomaGerminal Non germinal

Nonseminoma Seminoma

b lEmbryonal Teratoma

Choriocarcinoma Yolk sac

Mixed

Dr. H.Farsi

…..cont. testicular tumor

• Metastasis:e s s s:– LN Lung Liver

Cli i l Pi t• Clinical Picture– Symptoms: enlargement (+/-pain) back pain

hydrocele respiratory– Signs: hard mass no tenderness ?hydrocele g y

abdomen gynecomastia • Tumor marker:• Tumor marker:

– B-HCG alph-fetoprotein

Dr. H.Farsi

…..cont. testicular tumor

Dr. H.Farsi

Testicular Torsion

• Children or adolescents• Etiology• Pathology:• Pathology:

– Rotation venous occlusion arterial occlusion necrosis

– Bilateral

Dr. H.Farsi

….cont. Testicular Torsion

• Symptoms:– Pain: sudden & severe– Swellingg– Nausea & vomiting

Lower abdominal or inguinal pain– Lower abdominal or inguinal pain• Examination:

– Tenderness– SwellingSwelling– Elevated (short spermatic cord)

R dDr. H.Farsi

– Redness

Dr. H.FarsiTorsion

Torsion

Dr. H.Farsi

Epididymitisp y• Etiology

– STD: C. Trachomatis Gonorrhoeae– UTI– T.B.

Cli i l i t• Clinical picture:– Symptoms: pain(gradual) swelling

UTI ?fever– Signs: swelling redness tender g g

+/- hydrocele urethral discharge

Dr. H.Farsi

Epididymitis

Dr. H.Farsi

Cryptorchidism (UDT)yp ( )• Etiology:

– GubernaculumGubernaculum– Testicular defect– Hormonal defect

• Pathology:– Temp changes by age 2p g y g

• C/P:– Scrotum: small & emptyp y– If in inguinal region cannot bring to scrotum

• Complications:p– Tumor trauma hernia torsion

infertility

Dr. H.Farsi

……cont. Cryptorchidism (UDT)

Dr. H.Farsi

……cont. Cryptorchidism (UDT)

Dr. H.Farsi

Retractile Testis

• A normally descended testis.• C/O: Some times the testis is in the scrotum

& some times it disappears& some times it disappears.• Examination:

– Well developed scrotum– Testis in the inguinal region BUT can be g g

brought to bottom of scrotum

Dr. H.Farsi

Ca Scrotum

Dr. H.Farsi

Flow Chart of Scrotal MassFlow Chart of Scrotal Mass

Scrotal Mass

Pure Scrotal Inguinoscrotal

Testis & Epididymis definable Testis & Epididymis undefinableVaricocele Infantile Hydrocele

Translucent Opaque Translucent OpaqueInguinal hernia

epididymal cyst Tumor Epididymitis Hydrocele Hematocele Torsion Epididymitis

Dr. H.Farsi

Dr. H.Farsi