PLATE FIG. 1 (above). —Epididymitis of the tail, showing ...
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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
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Types of HydroceleTypes of Hydrocele
• Types:– Infantile
(communicating)V i l (Si l )– Vaginal (Simple)
– Encysted hydrocele of th dthe cord
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CoveringsCoveringsof Hydroceley
Tunica Vaginalis
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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
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Orchitis
• Etiology:– Epididymitis– MumpsMumps– Syphilis
h t– hematogenous
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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
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…..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
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…..cont. testicular tumor
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Testicular Torsion
• Children or adolescents• Etiology• Pathology:• Pathology:
– Rotation venous occlusion arterial occlusion necrosis
– Bilateral
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….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
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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
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Epididymitis
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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
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……cont. Cryptorchidism (UDT)
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……cont. Cryptorchidism (UDT)
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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
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Ca Scrotum
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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