[Scrotal ultrasound examinations in infants and toddlers]. / Sonographie des Skrotalinhalts bei Säuglingen und Kleinkindern.

BACKGROUND: Besides physical examination, ultrasonography is the most valuable diagnostic tool to assess the scrotum and testes in the case of an acute scrotum or scrotal pathology. PROBLEMS: In infants and toddlers the examination can be challenging. Due to the limited patient compliance, the small testicular size (< 0.5 ml), and low blood flow velocity (< 3 cm/s), it can be difficult to achieve a proper flow curve when assessing blood flow. CONCLUSION: The examiner's skills are as important as adequate equipment (i. e., linear ultrasound probe, 12-14 MHz) and optimal program settings (Doppler scale < 3 cm/s, gate 1 mm). However, if there is doubt, surgical exploration is unavoidable.

Scrotal heat stress causes a transient alteration in tight junctions and induction of TGF-ß expression.

Specialized junctions, which occur at sites of Sertoli-Sertoli and Sertoli-germ cell contact of seminiferous epithelium, play pivotal roles in spermatogenesis. Slight increase in scrotal temperature can induce oligospermia or azoospermia via increasing germ cell apoptosis. In this study, we demonstrated that the expression of tight junction (TJ) components, such as occludin, claudin-3 and zonula occludens-1 (ZO-1), was reduced 24-48h after a single mild scrotal heat exposure (43°C for 30min), whereas mRNA levels of claudin-11 were increased. Moreover, the protein localization of occludin and ZO-1 was lost from the blood-testis barrier (BTB) site, whereas claudin-11 immunostaining became diffuse and cytoplasmic 2days following heat exposure. Electron microscopic analysis showed that 2days after the heat treatment, the intercellular space between the two adjacent Sertoli cells was expanded, coupled with defragmentation of actin bundles and the endoplasmic reticulum. In addition, the TJ permeability increased significantly 2days after the heat exposure and recovered approximately 10days later. Heat-induced reversible BTB disruption was associated with a transient induction of transforming growth factor (TGF)-ß2, -3 and p38 mitogen-activated protein kinase activation. However, the TGF-ß antagonist only partially prevented the heat-induced BTB disruption. In conclusion, the expression of TJ-associated molecules and BTB were reversibly perturbed after mild testicular hyperthermia, and the induction of TGF-ß expression may be partially involved in heat-induced BTB damage.

Cytochemical characterization of glycoconjugates in the apocrine glands of the equine scrotal skin.

Cytochemistry of glycoconjugates in the apocrine glands in the scrotal skin of the horse was studied using cytochemical methods for electron microscopy, particularly lectin cytochemistry. The secretory cells possessed a variable number of secretory vesicles, a well-developed Golgi apparatus, and abundant cisternae of the rough endoplasmic reticulum. Additionally, the basolateral plasma membrane formed numerous interdigitating folds. Glycoconjugates with vicinal diol groupings were present predominantly in the secretory vesicles, the Golgi apparatus, the surface coat of the plasma membrane, and the majority of the intracellular membranes. With lectin cytochemistry, the secretory vesicles of the glandular cells exhibited glycoproteins with different terminal sugars (alpha-D-mannose, beta-D-galactose beta-N-acetyl-D-glucosamine, and sialic acid). Several sugars were distinctly prominent in the surface coat of the plasma membrane of the secretory cells. The cytochemical properties of the complex glycoconjugates found are discussed in relation to the specific functions of the glandular secretions. These glands may have an important role in not only thermoregulation but protection of the scrotal skin, a specific body region.

Fine structure of intrascrotal lymphatic vessels infected by Wuchereria bancrofti adult worms.

Lymphangiectasia represents a basic phenomenon of acute and chronic pathology in lymphatic filariasis, and the prevalence or degree of lymphatic dilation caused by filarial worms is considered an indirect measurement of the altered lymphatic function. We examined the morphological alterations of intrascrotal lymphatic vessels surgically removed from a volunteer infected by adult worms of Wuchereria bancrofti. Scanning electron microscopy revealed lymphatic vessels with an irregular endothelium and adherent flattened lymphocytes and macrophages in variable proportions. On transmission electron microscopy the lymphatic vessels showed a thin endothelium which had an irregular contour and projected several cytoplasmic processes into the lumen. Numerous micropinocytotic vesicles and collagen fibers were abundant and disorganized. The hyperplastic endothelial cells and the subendothelial fibrosis suggest that abnormal changes in these cells may play a crucial role in the development of lymphangiectasia.

Local haemorrhage induced by Bothrops jararaca venom: relationship to neurogenic inflammation.

We investigated morphological alterations induced by s.c. injection of 2.5 microg of Bothrops jararaca venom in rats. Intense disorganisation of collagen fibres was observed 1 min after the venom injection, particularly at regions near vessels and nerves. Mast cells were degranulated, and erythrocytes were seen leaving venules throughout the endothelial junctions. At this time, damaged endothelial cells were not observed. In rats envenomed as above, but immediately after cardiorespiratory failure induced by deep ether anaesthesia, alterations in the connective tissue structures, as previously described, were not observed. The mediation of this haemorrhage was investigated by injecting the venom into the foot pad of mice and compared to the mediation of oedema. Local haemorrhage was significantly reduced in mice pre-treated with capsaicin or guanethidine or submitted to a surgical section of sciatic and saphenous nerves. In these animals, oedema was not affected. Groups treated with methysergide or morphine showed both haemorrhage and oedema significantly reduced. Indomethacin or dexamethasone pre-treatments significantly reduced the oedema, but not the haemorrhage. Moreover, in animals treated with promethazine or mepyramine, oedema and haemorrhage were not affected. These data suggest that local haemorrhage induced by Bothrops jararaca venom is partially controlled by serotonin and neurohumoral mediators. Furthermore, results indicate that haemorrhage and oedema are mediated by different pharmacological systems.

Scrotal leiomyomas with bizarre nuclei: a report of three cases.

We discuss here three cases of scrotal leiomyoma with bizarre nuclei. The patients, ranging in age from 44 to 58 years, presented with painless scrotal masses that were clinically diagnosed as cysts. Clinical follow-up, available for two of the patients, revealed no evidence of local recurrence or distant metastasis 5 years after resection. The tumors were well circumscribed and ranged from 2 to 3 cm in maximal diameter. They were characterized by interlacing fascicles of spindle-shaped cells with pleomorphic nuclei. Nuclei were large and multilobulated with hyperchromatic chromatin and macronucleoli. Multinucleated tumor cells were infrequent. Intranuclear invagination of eosinophilic globules of cytoplasm produced pseudonucleoli. There was no mitotic activity. Immunohistochemically, the tumor cells expressed vimentin, desmin, smooth muscle actin, and muscle-specific actin, but not cytokeratin, neurofilament, or glial fibrillary acidic protein. In contrast to scrotal leiomyosarcomas, scrotal leiomyomas with bizarre nuclei are not hypercellular, and they lack mitotic activity.

Posttraumatic spindle cell nodules. Immunohistochemical and ultrastructural study of two scrotal lesions.

We studied two cases of proliferative spindle cell lesions that developed in the scrotum secondary to trauma. The two patients, 22 and 67 years of age, presented clinically with tumor masses and were treated with surgical excision. No recurrences were seen after 12 and 13 months, respectively, of follow-up. In both cases the tumor nodules were associated with hematomas of the scrotal subcutaneous tissue, with disruption of the tunica dartos. The lesions were composed of monomorphic, dense, spindle cell proliferations that formed irregular nodules in the wall of the hematoma and disrupted the smooth-muscle bundles of the area. On immunohistochemical and ultrastructural studies, the tumor cells were consistent with myofibroblasts with pronounced smooth-muscle differentiation. Both cases had a striking histologic resemblance to the postoperative spindle cell nodules that occur in the genitourinary tract secondarily to surgical trauma. The morphological features, proliferating cell type, and benign clinical course are identical in both of these conditions, which appear to represent a stereotyped form of reactive change after injury and hemorrhage in the vicinity of smooth muscle.

Scrotal angiokeratoma (Fordyce): histopathological and ultrastructural findings.

Bioptic findings related to four cases of scrotal angiokeratoma-Fordyce, were studied under light and electron microscopy. A particular heterogeneity of the structural and ultrastructural patterns typical of this lesion was thus observed. Light microscopy study pointed out, in particular, different degrees of dilation of papillary vessels, whereas ultrastructural study highlighted marked alterations of endothelial cells with structural and quantitative modifications of cytoplasmic organelles.

Idiopathic calcinosis of the scrotum: scanning electron microscopic study with X-ray microanalysis.

In a 31-year-old man 12 nodules up to 1 cm in diameter were observed in the scrotum; these had developed over 3 years. Energy-dispersive x-ray analysis of the dermal foci showed a high content of calcium and phosphorus even in nodules smaller than 1 mm in diameter. No increased mineral deposition was observed in the surrounding connective tissue, however. Scanning electron microscopy revealed finely granulated crystals, and cellular remnants giving rise to development of calcified nodules were disclosed. The results support the hypothesis of a degenerative origin of scrotal calcinosis.

Capillary leakage in inflammation. A study by vascular labeling.

The local injection of pure inflammatory mediators induces venular leakage. To test the effect of endogenous mediators from dying tissue on vascular leakage, the authors devised an experimental model simulating an infarct, whereby living vessels would be exposed to fragments of organs undergoing aseptic necrosis. Tissues from donor rats were implanted aseptically in the cremasteric sac. Control rats were implanted with materials deemed to be as close as possible to nonirritating: boiled tissues and spheres of Teflon or glass. At different points the rats were injected intravenously with carbon black and killed an hour later. Whole cremaster mounts showed that vascular labeling was strictly venular up to 8 hours, mixed with capillary labeling between 12 and 24 hours, and mainly or exclusively capillary at 48 hours. Histology showed an acute inflammatory infiltrate in the labeled areas. A similar but weaker labeling pattern accompanied by milder inflammation was seen in controls. These results indicate that the vascular leakage in aseptic inflammation is biphasic, first venular, then capillary; and that the capillary phase is induced by the inflammatory reaction itself, possibly through a form of diffuse angiogenesis.

Unusual intracytoplasmic lamellar bodies in a malignant gonadal stromal tumor.

Characteristic intracytoplasmic lamellar bodies were found in a malignant gonadal stromal tumor. These bodies consisted of the stacks of up to 200 tubular cisternae arranged in parallel. Each cisterna had a circular section in tangential view and a diameter of about 85 nm. The cisternae on the outermost side of these lamellar bodies tended to be dilated and adorned with ribosomes. The ends of cisternae were often contiguous with rough-surfaced endoplasmic reticulum. The latter feature is also seen in annulate lamellae, but periodically spaced annuli or discontinuities characteristic of annulate lamellae were never observed. Furthermore, fine ribosomal granules resembling a rosary were recognizable along the whole circumference of the outer surface of each cisterna. The unique structure we describe is a cytoplasmic organelle which, like annulate lamellae, is closely associated with the endoplasmic reticulum and is presumed to be related to the genesis of rough-surfaced endoplasmic reticulum in tumor cells.

Giant scrotal hemangioma with azoospermia.

We report a case of giant scrotal hemangioma with azoospermia, which was 37 cm in maximum circumference and 20 cm in length along the raphe. The biopsy specimens of the testes were examined histologically and cytologically. The testicular damage was believed to be due to the heat generated by hemangioma.

[Idiopathic calcinosis of the scrotum : note on ultrastructure]. / Calcinose idiopathique du scrotum : note sur l'ultrastructure.

Calcium deposits develop in the vacuoles of fibroblasts and histiocytes within the granuloma at the periphery of the nodules. There is no clue for an epithelial origin.

Electron microscopic study of mineral deposits in idiopathic calcinosis of the scrotum.

An excised specimen from a 39-year-old man with idiopathic calcinosis of the scrotum was examined by electron microscopy. Mineral deposits were located in the dermis in which collagen fibers were numerous. These collagen fibers appeared mineralized to varying degrees. Mineral crystals frequently were present in the cytoplasm of fibroblasts near large deposits. The mineral portion was identified as a compound consisting of calcium and phosphorus, and the elementary mapping of calcium and phosphorus in the skin tissue was analyzed by an energy dispersive x-ray spectrometer. No calcification was observed in dartos muscle cells or in mast cells.

[Scrotal leiomyosarcoma]. / Léiomyosarcome scrotal.

A case of leiomyosarcoma of the scrotum in a 65 year old man is presented. It is, we believe, the sixth case reported in the literature. A hemiscrotectomy was performed with preservation of both testes. Three years after the operation the patient is well and free of metastases. The electron microscopy study is reported and the features are discussed.

Ultrastructural and histochemical identification of sclerosing liposarcoma.

A paratesticular tumour by light microscopy showed large amounts of partly hyalinized collagenous stroma, spindle shaped fibroblast-like cells, pleomorphic cells with foamy cytoplasm, multinucleated tumour type giant cells and lipid inclusions. By light microscopy, there was a problem as to whether the tumour should be classified with the liposarcomas or with the fibrous histiocytic group. Ultrastructurally, spindle shaped cells resembled fibroblasts and, in a few cells, intracellular collagen fibres were seen. Histochemical studies revealed the presence of mannose-rich glycoprotein which is characteristic for collagen producing cells, but frequently these cells also showed numerous lipid inclusion. The foamy cytoplasmic areas of pleomorphic cells were shown to consist of dilated ergastoplasmic sacs and large vacuoles lined by smooth endoplasmic reticulum negating the possibility that these cells were of histiocytic origin. This is supported further by the dearth of lysosomes and absence of lysozyme (muramidase) in the tumour cells. The presence of numerous lipid inclusions in many of the tumour cells, which are otherwise ultrastructurally similar to fibroblast, suggests that these cells represent precursors of lipoblasts. The above findings taken together allowed the tumour to be categorized as a sclerosing liposarcoma.

The histochemistry of complex carbohydrates in the scrotum of the boar.

In the scrotal skin of the boar, the histochemistry of complex carbohydrates has been studied by means of a series of selected methods of light microscopy. The epidermis of the scrotal skin was found to contain neutral and acidic complex carbohydrates with different saccharide residues. The secretory epithelial cells and secretory substances of the saccular apocrine sweat glands contained sulfated, other acidic and neutral complex carbohydrates, whereas the secretory epithelial cells and secretory substances of the tubular apocrine sweat glands involved largely neutral complex carbohydrates. The two types of complex carbohydrates from the both glands were shown to contain commonly substantial amounts of various saccharide residues but were devoid of notable amounts of sialic acid residues. In addition, complex carbohydrates in the smooth muscle cells were reacted for relatively small amounts of saccharide residues. From the present results, the histophysiological significance of complex carbohydrates in the particular histologic structures of the scrotum have been discussed with special reference to the functions of the skin in the boar.

Ultrastructure of normals and castrates and the effects of testosterone and ultraviolet (UVL-B) irradiation on scrotal skin of rats.

The ultrastructure of the testosterone dependent epidermal melanocyte system of the scrotal skin of normals and castrates, with and without testosterone replacement therapy, and UVL-B (280-315 nm) radiation in black Long Evans rats is reported. UVL-B increases melanocyte activity, melanosome forming apparatus, (size of Golgi zone and RER, and quantity of cytoplasmic vesicles, dendrites, and stages of melanosomes) in normals and in castrates. Testosterone replacement therapy to castrates is not a prerequisite for stimulation by UVL-B, but it enhances the effects of UVL-B without restoring normalcy as melanosome packaging into complexes predominates. After UVL-B stimulation of normals or castrates, melanocyte dendrites are observed more often. Melanocyte dendrites of skin of castrated rats are observed less often than in normals, but with testosterone replacement therapy, the dendrites become more numerous. Melanosomes donated to keratinocytes are mostly located as singles in normals and as complexes in castrates. After UVL-B, castration, or testosterone replacement therapy, the melanosomes are packaged in keratinocytes in complexes larger than in normals. In the epidermis of long term castrates (9-109 days), non-specific clear cells are observed and Langerhans cells containing melanosomes; we did not observe them in normals. Melanocytes of castrates have a reduced melanosome forming apparatus. The dermis of castrates contains many dermal melanocytes in the superficial dermis with melanosomes in several stages of formation. These cells are not apparent in normals at this location in the dermis. Testosterone replacement therapy and/or UVL-B administered to castrates does not restore the epidermal melanocyte system nor the dermis to precastration ultrastructural appearance; castration has a permanent altering effect as melanosomes are packaged into complexes.

Giant pigment granules in dermal melanocytes of rat scrotal skin.

Giant melanosomes, ellipsoidal (1.5 micron X 1.3 micron) or spherical (1.1 micron-1.4 micron in diameter) exist in the scrotal skin of the black pelted Long Evans rat. They are longer and wider than normal stage IV melanosomes (0.7 micron X 0.4 micron) found in these dermal melanocytes.