Calcinosis escrotal: ¿una entidad idiopática? / Scrotal Calcinosis: an Idiopathic Entity?

La calcinosis escrotal es una enfermedad benigna e infrecuente que se presenta en adultos de mediana edad, con múltiples nódulos asintomáticos a nivel de la piel del escroto. Algunos autores vinculan la aparición de estas lesiones a la calcificación secundaria de quistes epidérmicos o ecrinos. Cuando no se encuentra relacionada con dichas entidades ni con alteraciones del metabolismo fosfocálcico, el cuadro se considera idiopático. El tratamiento de elección es quirúrgico, en caso de impacto en la calidad de vida o relevancia estética para el paciente. (AU)

Scrotal calcinosis is a rare, benign disease that presents in middle-aged adults with multiple asymptomatic nodules on the skin of the scrotum. Some authors link the appearance of these lesions to the secondary calcification of epidermal or eccrine cysts. When it is not related to these entities or to alterations in phosphocalcic metabolism, the condition is considered idiopathic. The treatment of choice is surgical, in case of impact on the quality of life or aesthetic relevance for the patient. (AU)

Tumor germinal mixto maligno de testículo de inicio súbito: presentación de un caso / Testicle´s malignant mixed germ tumor of sudden onset: a case presenting

Los tumores germinales mixtos representan el 40-60% de las neoplasias testiculares, pueden presentarse en testículos descendidos o no, y en sitios extratesticulares. Están asociados a condiciones como criptorquidia, atrofia testicular y hernia inguinal. Pueden debutar con síntomas que incluyen aumento unilateral del volumen escrotal, con o sin dolor. Microscópicamente se observan varias combinaciones de componentes histológicos germinales, es indispensable la determinación del porcentaje de cada uno de ellos, y la medición de marcadores tumorales, por sus implicaciones pronósticas. El tratamiento principal está basado en la orquiectomía radical y dependiendo del estadio la quimioterapia y o radioterapia complementaria. En los pacientes adecuadamente tratados, la sobrevida es muy buena, aun en estadios avanzados de la enfermedad. Se presenta masculino de 20 años con dolor de inicio súbito y sensación de masa en testículo derecho. Ecografía revela lesión sólida que compromete parénquima testicular. Se realiza orquiectomía radical. Estudio anatomopatológico muestra tumor maligno con áreas sólidas y quísticas, tipo tumor germinal mixto con componente de carcinoma embrionario, teratoma maduro, y tumor de seno endodérmico, sin componente seminomatoso.

Mixed germ cell tumors represent 40-60% of testicular tumors, they can occur in undescended testicles or not, and Extratesticular sites. They are associated with conditions such as cryptorchidism, testicular atrophy and inguinal hernia. They may present with symptoms including unilateral scrotal volume increase, with or without pain. Microscopically various combinations of components observed histological germ is indispensable determining the percentage of each, and measurement of tumor markers for prognostic implications. Treatment is based on surgical resection plus chemotherapy and / or adjuvant radiotherapy. In treated patients, survival is good, even in advanced stages of the disease. Male 20 years presents with sudden onset of pain and sensation of mass in the right testicle. Ultrasound reveals solid lesion that compromises testicular parenchyma. Radical orchiectomy is done. Pathological study shows malignant tumor with solid and cystic areas, with mixed germ cell tumor type component of embryonic carcinoma, teratoma, endodermal sinus tumor and without seminoma component.

Changes of calcific density in pediatric patients with testicular microlithiasis

PURPOSE: Testicular microlithiasis (TM) is a relatively rare clinical entity of controversial significance characterized by the existence of hydroxyapatite microliths located in the seminiferous tubules. The aim of this study was to observe the natural course of changes in the calcific density of pediatric TM. MATERIALS AND METHODS: We included a total of 23 TM patients undergoing scrotal ultrasound (US) on at least two occasions from July 1997 to August 2014. We retrospectively analyzed the patient characteristics, clinical manifestations, specific pathological features, and clinical outcomes. We measured the calcified area and compared the calcific density between the initial and final USs. RESULTS: The mean age at diagnosis was 11.3+/-4.6 years, and the follow-up period was 79.1+/-38.8 months (range, 25.4-152.9 months). During the follow-up period, no patients developed testicular cancer. Calcific density on US was increased in the last versus the initial US, but not to a statistically significant degree (3.74%+/-6.0% vs. 3.06%+/-4.38%, respectively, p=0.147). When we defined groups with increased and decreased calcification, we found that diffuse TM was categorized into the increased group to a greater degree than focal TM (10/20 vs. 4/23, respectively, p=0.049). In addition, five of eight cases of cryptorchidism (including two cases of bilateral cryptorchidism) were categorized in the increased calcification group. CONCLUSIONS: Diffuse TM and cryptorchidism tend to increase calcific density. Close observation is therefore recommended for cases of TM combined with cryptorchidism and cases of diffuse TM.

Efficacy of scrotal Doppler ultrasonography with the Valsalva maneuver, standing position, and resting-Valsalva ratio for varicocele diagnosis

PURPOSE: To determine effectiveness of Valsalva maneuver and standing position on scrotal color Doppler ultrasound (CDU) for the varicocele diagnosis. MATERIALS AND METHODS: We reviewed the physical examination and CDU finding in 87 patients who visited National Police Hospital from January 2011 to April 2014. Diameters of pampiniform plexus were measured bilaterally during resting and Valsalva maneuver in the supine position and standing position. We calculated the ratio of mean of maximal vein diameter (mMVD) during resting and Valsalva maneuver (resting-Valsalva ratio) and compared in the both position. RESULTS: In the resting and supine position, mMVD of varicocele testis units were 1.8 mm, 2.1 mm, 2.6 mm (grades I, II, III, respectively), and that of normal testis units (NTU) 1.2 mm. During Valsalva maneuver in the supine position, mMVD were 3.0 mm, 3.4 mm, 4.2 mm (grades I, II, III) vs 1.8 mm (NTU) (p=0.007, p<0.001, p<0.001, respectively). Average of resting-Valsalva ratio in the supine position were 0.69, 0.74, 0.74 (grades I, II, III) and 0.67 (NTU). Whereas in the resting and standing position, mMVD were 2.8 mm, 3.3 mm, 3.8 mm (grades I, II, III) and 1.8 mm (NTU) (p=0.002, p<0.001, p<0.001). During Valsalva maneuver in the standing position, mMVD were 5.0 mm, 5.8 mm, 6.6 mm (grades I, II, III) and 2.5 mm (NTU) (p=0.002, p<0.001, p<0.001). And average resting-Valsalva ratio were 0.76, 0.90, 0.71 (grades I, II, III) and 0.26 (NTU), which showed significant differences from all grades (p<0.001, p<0.001, p<0.001). CONCLUSIONS: It is suggested that the standing position and Valsalva maneuver during CDU could improve diagnostic ability for varicocele. Resting-Valsalva ratio in the standing position could be a new diagnostic index for varicocele diagnosis using CDU.

Adolescent Varicocele: Are Somatometric Parameters a Cause?

PURPOSE: It has been reported that varicocele is found less frequently in obese men. Accordingly, we evaluated varicocele patients and statistically analyzed the correlation between varicocele and somatometric parameters. MATERIALS AND METHODS: A total of 211 patients underwent surgery for varicoceles. All patients underwent history taking, physical examination, and scrotal ultrasound to determine the presence and severity of varicocele. An age-matched control group consisted of 102 patients who were found not to have varicocele according to physical examinations and scrotal ultrasound. The age, weight, height, and body mass index (BMI) of the two groups were compared. The statistical analyses were performed by use of PASW Statistics ver. 18.0. A p-value of less than 0.05 was used for statistical significance. RESULTS: In the varicocele group, the mean age, height, weight, and BMI were 29.42+/-14.01 years, 168.53+/-9.97 cm, 62.14+/-13.17 kg, and 21.66+/-3.21 kg/m2, respectively. The distribution of varicocele grade was as follows: 103 (48.8%) grade III, 72 (34.1%) grade II, and 36 (17.1%) grade I. In the control group, the mean age, height, weight, and BMI were 30.83+/-17.31 years, 161.93+/-19.83 cm, 64.69+/-17.86 kg, and 24.04+/-3.64 kg/m2, respectively. Analyzing these data specifically in adolescents, they showed significant differences in age, height, and BMI (p=0.000, p=0.000, and p=0.004, respectively) between two groups. There were no significant differences in somatometric parameters between patients with different grades of varicocele. CONCLUSIONS: Our results showed that patients with varicoceles were significantly taller and had a lower BMI than did patients without varicoceles, especially among adolescents. Carefully designed future studies may be needed.

Shear-Wave Elastography of Segmental Infarction of the Testis

Segmental testicular infarction (STI) is a rare cause of acute scrotum. The spectrum of findings on gray-scale and color Doppler ultrasonography differ depending on the time between the onset of testicular pain and the ultrasonography examination. We are not aware of the usefulness of shear-wave elastography for the diagnosis of STI. We report the shear-wave elastography features in a case of STI and discuss the role of this diagnostic modality in the differential diagnosis.

validity of testicular catch-up growth and serum FSH levels in the long-term postoperative assessment of laparoscopic varicocele correction in adolescents

Postoperative assessment after varicocele surgery in adolescence is commonly centred around catch-up growth of the testis. There is paucity of evidence on the correlation of catch-up growth with underlying testicular function in these patients. To assess the reliability of catch-up growth of the testis as an indicator of normalization of testicular function and the utility of serum FSH levels in the long-term postoperative assessment of varicocele surgery in adolescence. Prospective cohort study of young adults [18-27 years] who had laparoscopic varicocele correction in adolescence [11-16 years]. Evaluation included serum FSH levels, scrotal ultrasonography and semen analysis. Anatomical and functional parameters of participants with equal and normal testicular size were compared to those of participants with persistent testicular hypotrophy or hypertrophy. Sensitivity and positive predictive value of postoperative serum FSH levels were estimated and elevated levels of serum FSH were checked for association with suboptimal outcomes of varicocele correction. The serum FSH levels of participants with unequal testicular sizes [n=6, median 6.65 IU/l], which included testicular hypertrophy [n=3, median 7.2 IU/l] and persistent testicular hypotrophy [n=3, median 6.1 IU/l], were significantly higher than the group with equal testicular sizes [n=8, median 3.5 IU/l; P=0.014, Mann-Whitney U test]. Postoperative elevated serum FSH levels were significantly associated with suboptimal outcomes of varicocele surgery [P=0.015, Fisher's exact test]. The test also had a high positive predictive value. Testicular catch-up growth may not be a reliable postoperative assessment criterion by itself. Serum FSH levels may be of value in detecting suboptimal outcomes of varicocele surgery in adolescents

Sonographic findings in the scrotum of infertile on-road cyclists

Exercise helps keep a man sexually fit, but Dr. Irwin Goldstein, a Boston University impotency specialist, says that bicycling is one workout to avoid. When a man uses a standard bike seat, his weight flattens the main penile artery temporarily occluding the blood flow required for erections. Goldstein believes that, over time, this pressure can permanently damage the vessel. He also detected -using X-rays, ultrasound and arterial pressure readings- a reduction in blood flow as high as 66% when a patient sat on a skinny bike saddle. Also some experts believe prolonged sitting on a bicycle seat could compress the arteries and nerves to the testicles, causing the overheating of the testicles and lower sperm conut. Add to this, the constant rubbing and pressure on the area of perineum from the bike saddle, these can diminish sperm production. To sonographically investigate whether infertile on-road bikers have a higher prevalence of scrotal abnormalities compared with that in non bikers. A reproductive health assessment study. National Hepatology and Tropical Medicine Research Institute [NHTMRI]. Forty-six infertile male on-road bikers [mean age, 30.5 years; age range, 24-37 years] and 46 infertile non-bikers [mean age, 24 years; age range, 21-45 years] were examined for scrotal findings at ultrasonography [US]. Only male subjects with a history of extensive on-road biking [> 2h/d 6/wk] were assigned to the group of on-road bikers, whereas the control group did not engage in bicycling. In addition to clinical evaluation, US examination of the scrotum was performed by using a linear-array transducer operating at a frequency of 8.0 MHz. Forty [86.96%] on-road bikers had abnormal findings at scrotal US. Abnormal findings at US included varicoceles 34/46 [73.91%], hydroceles in 16/46 [34.78%], spermatocele in 2/46 [4.35%], testicular micro-calcifications in 2/46 [4.35%] and epididymal cysts in 4/46 [8.70%]. In the control group abnormal findings were noted in 34/46 [73.913%]. Abnormal findings at US included varicoceles in 24/46 [52.174%] hydroceles in 12/46 [26.086%], and spermatocele in 2/46 [4.35%] The overall difference in the number of scrotal abnormalities in bikers compared with the number in nonbikers was significant. US show a higher prevalence of testicular disorders in those on-road bikers compared with non-bikers. The quality and the high percentage of testicular abnormalities in bikers could be an indication of a developing reproductive health problem. The nose of the bicycle saddle exerts excessive pressure to the perineum, which appears to affect the semen quality. Men who ride bicycles many hours a day should be concerned about the pressure exerted on the perineum. They should take rest breaks off the bicycle saddle when possible. They should also consider replacing their bicycle saddle with a design that does not have a protruding nose or replacing their bicycle with one that has a recumbent design. Whereas alternative saddle designs may decrease pressure applied to the perineum, the overall health effects of long-term use of these saddles is unknown and it needs to be evaluated

Isolated tuberculous epididymitis: a case report and literature review

We present a case of isolated tuberculous epididymitis [TBE] in an 18-year-old male with normal fertility profile. The importance of high-resolution scrotal ultrasonography and fine needle aspiration cytology [FNAC] of the epididymis for early detection of tuberculous infection, particularly in underprivileged and developing countries, is discussed. The utility of high-resolution scrotal ultrasonography to observe the course of the disease and efficacy of treatment is also evaluated

Epididymal masses: impact of sonographic diagnosis on management

The aim of this work is reported the experience of using the scrotal ultrasound [USS] and color doppler flow studies [CDS] in the evaluation of epididymal masses For that, sixty three cases of epididymal masses were studied. Their ages ranged from 10 to 78 years with mean age of 35.5 years. The evaluations were included history taking, clinical examination routine laboratory investigations and USS with CDS. Clinical presentation included painless scrotal mass [34 cases] and scrotal pain [15 cases], while the masses were detected incidentally in [14 cases]. In 5 cases, serum levels of a-fetoprotein, beta-human chorionic gonadotropin [HCG], FSH, LH, estradiol, prolactin and testosterone were measured. On USS, 58 [92.1%] masses were within the epididymis, and 5 [7.9%] cases were indeterminate On USS the epididymal masses localized as following: 35 [55.6%] were located in the head of the epididymis, 15 [23.8%] in the tail and in 8 [12.7%] cases the masses were occupied the whole epididymis Sonographic echogenicity ranged from hypoechoic to hyperechoic relative to that of the testis. Forty-nine [77.8%] masses were cystic and anechoic and 14[22.2] were solid [5 hypoechoic, 3 hyperechoic and 6 had mixed echogenicity] The longest diameter of the masses ranged from 5.5 to 85 mm [mean, 32.5 mm] as measured by USS. In 44 [69.8%] cases there were associated hydrocele. CDS revealed increased vascularity of the lesions in 10[15.9%] cases and decreased vascula.rity in 4 [6.3%] cases while the 49[77.8%] cystic masses were avascular. Surgery was required in 18 [28.6%] cases. Pathological evaluation of the 18 specimens revealed 17 benign masses and one malignant lesion [rhabdomyosarcoma] Benign lesions consisted of 7 cysts, 6 benign inflammatory nodule [4 had fibrous pseudotumors and 2 had tubercubus epididymitis] 3 adenomatoid tumors and one fibroma. The USS is valuable in localization of epididymal masses and in differentiation between cystic and solid masses but even with CDS could not differentiate inflammatory from neoplastic solid lesions

Sonographic evaluation of the intrascrotal disease.

PURPOSE: To determine the causes of intrascrotal disease in patients who were sent for scrotal sonography at King Chulalongkorn Memorial Hospital and whether the imaging findings can help differentiate the tumor from infection of the testis. MATERIAL AND METHOD: Retrospective review was performed in 72 cases of extratesticular lesions and 48 cases of the intratesticular lesions to find out the causes of intrascrotal disease. The sonographic findings in the cases with final diagnosis of intratesticular infection and testicular tumor were analyzed according to the following criteria including the size of the testis, number, echogenicity, and margin of the mass, diffuse abnormal echogenicity of the testis, presence of fluid in the scrotal sac, epididymal lesion, scrotal skin thickening and calcification. RESULTS: Hydrocele was the most common extratesticular lesion (29.87%) and epididymitis was the second most common (14.28%). Infection was the most common intratesticular pathology (54.17%) and tumor was the second most common (31.25%). Most testicular tumors appeared as a focal mass while testicular infection usually caused diffuse abnormal echogenicity throughout the testis (p = 0.008). Epididymal lesions and skin thickening were usually detected together with intratesticular infection while they were not present in the cases of tumor (p = 0.000061 and 0.017). The number, echogenicity, margin of the mass, presence of testicular enlargement, fluid in the scrotal sac and calcification did not differ between testicular infection and tumor CONCLUSION: Hydrocele was the most common cause of extratesticular disease, followed by epididymitis. Most of the extratesticular pathology was benign entities. For intratesticular disease, the most common cause was infection, followed by intratesticular tumor Findings of a solitary intratesticular mass without epididymal lesion or skin thickening prefered malignant entity, while diffuse abnormal echogenicity of the testis with epididymal lesion and skin thickening prefered infectious process.

Torsion of testis: R.G.H. experience

A retrospective study of thirty two patients presenting to Emergency department of Rawalpindi General Hospital with acute scrotal pain, all being subjected to surgery. Seventeen [54%] were found to have gangrenous testis with mean time of presentation 9 hours. Nine [28%] patients could be salvaged with bilateral fixation. Seven [22%] were found to have torsion of appendix testis with mean time of presentation being 18 hours. Torsion in undescended testis was encountered in seven [22%] patients. Six[19%] patients had negative explorations and all were above 25 years of age

Comparative study between scrotal physical examination and scrotal ultrasonography in the detection of varicocele in men with infertility.

From September 1989 to March 1991, we evaluated 110 men from our infertility clinic to determine the correlation between scrotal physical examination and scrotal ultrasonography in the detection of varicocele in men seeking clinical evaluation for infertility, depicting scrotal ultrasound as the gold standard. Of 110 men with infertility, clinically palpable varicocele was found in 40 patients (36.36%). Fifteen were of grade 1, nineteen of grade 2 and four of grade 3. Of these 40 patients, 32 (80%) had left sided varicocele 2 (5%) had right sided varicocele and the remaining 6 patients (15%) had bilateral varicoceles. Of the 40 patients with clinically palpable varicocele, 34 (85%) had the diagnosis confirmed by scrotal ultrasound. Of these 34 patients who had varicocele diagnosed by scrotal ultrasound, 17 (50%) had varicocele on the left side, 1 (2.94%) had varicocele on the right side and the remaining 16 patients (47.07%) had bilateral varicoceles. Seventy patients in whom initial scrotal physical examination failed to detect varicocele, 12 (17.14%) were found to have varicocele by scrotal ultrasound, all of which were on the left side. This group of patients was classified as subclinical varicocele. Statistical analysis revealed that scrotal physical examination in the detection of clinical varicocele has sensitivity of 73.90 per cent, specificity of 90.60 per cent and positive predictive value of 85.00 per cent with negative predictive value of 82.80 per cent.(ABSTRACT TRUNCATED AT 250 WORDS)

value of scrotal ultrasound in the management of testicular trauma

Seventeen patients were examined with ultrasound following severe testicular trauma. Six patients had signs of testicular rupture and underwent surgery that confirmed the diagnosis of rupture in five patients and the testes were repaired. Preoperative scrotal ultrasonography correctly predicted the presence of rupture testes in patients with testicular trauma