Scrotal Masses

Dr. Hasan Farsi

Ref.: Current Surgical Diagnosis & Treatment

Anatomy

Dr. H.Farsi

Anatomy
Cremasteric m.

Dr. H.Farsi

Pampeniform p plexus

Cremasteric M.

T. Vaginalis

T. Albugenia

Dr. H.Farsi

Hydrocele
Fluid within Tunica or Processus vaginalis Etiology:
Primary ay Secondary: Injury infection

tumor

Clincal Picture:
Symptoms: Swelling Pain Examination: Mass cystic not tender transilluminate ? hernia Investigation: Scrotal Ultrasound
Dr. H.Farsi

Hydrocele

Dr. H.Farsi

Types of Hydrocele
Types:
Infantile (communicating) Vaginal V i l (Simple) (Si l ) Encysted hydrocele of th cord the d

Dr. H.Farsi

Coverings of Hydrocele y

Tunica Vaginalis

Dr. H.Farsi

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

Dr. H.Farsi

Varicocele
Dilatation of pampiniform plexus Etiology: ?? Left > right Examine: supine & erect Infertility:
35% 60-70% success rate
Dr. H.Farsi

Varicocele & RCC

Dr. H.Farsi

Varicocele

Dr. H.Farsi

Orchitis
Etiology:
Epididymitis Mumps Syphilis h hematogenous t

Dr. H.Farsi

Testicular Tumors
Young patient

Undescended testis
Types yp

Dr. H.Farsi

Histological Types of Testicular Tumors

Testicular Tumor 1ry Germinal Nonseminoma Embryonal b l Choriocarcinoma Mixed Non-germinal Non germinal Seminoma 2ry Lymphoma

Teratoma Yolk sac

Dr. H.Farsi

..cont. testicular tumor

Metastasis: e s s s:
LN Lung Liver

Clinical Cli i l Picture Pi t

Symptoms: enlargement (+/-pain) back pain hydrocele respiratory Signs: g hard mass no tenderness ?hydrocele y abdomen gynecomastia

Tumor marker:
B-HCG alph-fetoprotein
Dr. H.Farsi

..cont. testicular tumor

Dr. H.Farsi

Testicular Torsion
Children or adolescents Etiology Pathology:
Rotation Bilateral venous occlusion arterial occlusion necrosis

Dr. H.Farsi

.cont. Testicular Torsion

Symptoms:
Pain: sudden & severe Swelling g Nausea & vomiting Lower abdominal or inguinal pain Tenderness Swelling Elevated (short spermatic cord) R d Redness
Dr. H.Farsi

Examination:

Torsion

Dr. H.Farsi

Torsion

Dr. H.Farsi

Epididymitis p y
Etiology
STD: C. Trachomatis Gonorrhoeae UTI T.B.

Clinical Cli i l picture: i t

Symptoms: pain(gradual) swelling UTI ?fever Signs: g swelling g redness tender +/- hydrocele urethral discharge
Dr. H.Farsi

Epididymitis

Dr. H.Farsi

Cryptorchidism yp (UDT) ( )
Etiology:
Gubernaculum Testicular defect Hormonal defect

Pathology:
Temp p changes g by y age g 2

C/P:
Scrotum: small & empty py If in inguinal region cannot bring to scrotum

Complications: p
Tumor infertility trauma hernia torsion

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 disappears. Examination:
Well developed scrotum Testis in the inguinal g region g BUT can be brought to bottom of scrotum
Dr. H.Farsi

Ca Scrotum

Dr. H.Farsi

Flow Chart of Scrotal Mass

Scrotal Mass Pure Scrotal Testis & Epididymis definable Translucent epididymal cyst Tumor Opaque Epididymitis Testis & Epididymis undefinable Translucent Hydrocele Hematocele Opaque Torsion Epididymitis
Dr. H.Farsi

Inguinoscrotal Varicocele Inguinal hernia Infantile Hydrocele

Dr. H.Farsi