Sandbox:Preeti: Difference between revisions

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Replaced content with "__NOTOC__ {{CMG}}; {{AE}} {{Preeti}} ==References== {{Reflist|2}} {{WH}} {{WS}} Category: (name of the system)"
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{{CMG}}; {{AE}} {{Preeti}}
{{CMG}}; {{AE}} {{Preeti}}
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Scrotal Swelling
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| rowspan="11" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Painful
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptom 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Testicular Enlargement
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Epididymitis
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Orchitis
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Torsion
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|Trauma
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|Torsion of testicular appendix
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|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Scrotal Swelling
!Diseases
!Symptom 1
! colspan="1" rowspan="1" |Symptom 2
!Symptom 3
!Tenderness
! colspan="1" rowspan="1" |Testicular Enlargemet
!Physical exam 3
!Lab 1
!Lab 2
!Lab 3
!Imaging 1
!Imaging 2
!Imaging 3
!Histopathology
|'''Gold standard'''
!Additional findings
|-
| rowspan="8" |Painless
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Fragile X
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Tumors
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Henoch-Schonlein purpura
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{| class="wikitable"
! Disease Name
! History and Symptoms
! Physical Examination
! Lab Findings
! Imaging Findings
! Gross and Histologic Findings
! Genetic Studies / Immunohistochemistry
|-
| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Germ Cell Tumors'''}}
|-
|align=center|
'''[[Seminoma]]'''
|valign=top|
*Most common
*30-50 year-old with painless unilateral testicular mass or mild discomfort
|valign=top|
*Palpable, nontender unilateral testicular mass
*Usually homogeneous enlargement
|valign=top|
*Elevated serum placental ALP (PALP)
|valign=top|
*Hypoechogenic intratesticular well-defined mass on ultrasound with internal blood flow on Doppler ultrasound
*Cysts and calcificications are uncommon
*Hypointense lesion with inhomogeneous enhancement on MRI
*Homogeneous when small and heterogeneous when large
|valign=top|
*Grey-white homogeneous mass with a lobular appearance
*Fried egg appearance on histopathology (large cells and clear cytoplasm)
*Prominent lymphocytic infiltration and less commonly, granulomatous  formation
|valign=top|
*Stains positively for ALP, c-KIT, CD30, EMA, and glycogen
|-
|align=center|
'''[[germ cell tumor|Embryonal cell carcinoma]]'''
|valign=top|
*Young adults
*Painful testicular mass
*Manifests with early mestastasis (bone, lung, CNS)
|valign=top|
* Often unremarkable (small primary tumor)
|valign=top|
*Elevated serum hCG
*Elevated serum AFP, when mixed
|valign=top|
*Variable echogenicity (usually hypoechoic on ultrasound)
*No differentiating features on imaging
*Commonly invade the surrounding structures (tunica albuginea)
*Irregular calcifications
|valign=top|
*Pale-grey mass with areas of hemorrhagic and necrosis
*Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
|valign=top|
*Stains positively for CD30 and hCG stain
*May stain positively for AFP, when mixed
|-
|align=center|
'''[[Yolk sac tumor]]'''
|valign=top|
* Most common testicular cancer in children less than 3 years of age
*Rapidly growing unilateral mass in an infant or a young child
|valign=top|
*Palpable, nontender unilateral testicular mass
*Usually heterogeneous enlargement
|valign=top|
*Elevated serum AFP
|valign=top|
*Diffuse enlargement of the testis with a heterogeneous appearance on ultrasound
*Areas of hemorrhage and necrosis on MRI
|valign=top|
*Yellow, mucinous, non-encapsulated, heterogeneous mass with areas of necrosis and hemorrhage
*Patterns that resemble embryonal structures (yolk sac, allantois) with reticular, papillary, or elongated forms
*Schiller-Duval bodies (perivascular structures)
|valign=top|
*Stains positively for AFP, alpha-1-antitrypsin, PAS diastase
|-
|align=center|
'''[[Teratoma]]'''
|valign=top|
*Bimodal distribution of age (infants and middle aged adults)
*Painless tumor
*History of congenital disease (Down syndrome, klinefelter, spina bifida)
|valign=top|
*Palpable, nontender unilateral testicular mass
*Usually heterogeneous enlargement
|valign=top|
*Elevated serum hCG
*Elevated serum AFP
|valign=top|
*Heterogeneous, cystic appearance with mucinous or sebaceous depositions
*Variable echogenicity on ultrasound
*Calcifications usually irregular
|valign=top|
*Large, heterogeneous appearance with solid, cystic, mucoid, and/or cartilageanous components
*Presence of at least 2 germ layers
|valign=top|
*Chromosome 12p mutations
*Stains positively for cytokeratin. hCG, and AFP
|-
|align=center|
'''[[teratoma|Teratocarcinoma]]
|valign=top|
*Middle aged adult with painless testicular mass of mild discomfort
*May manifest with features of metastasis
|valign=top|
*Palpable, nontender unilateral testicular mass
*Usually heterogeneous enlargement
|valign=top| 
*Elevated serum hCG
*Elevated serum AFP
|valign=top|
*Variable echogenicity on ultrasound
|valign=top| 
*Features of both teratoma and embryonal carcinoma (more common) or both teratoma and choriocarcinoma (less common)
*Solid and cystic components with mucoid, cartilagenous, sebaceous gland, myxoid stroma components
*Additional features of underlying embryonal carcinoma or choriocarcinoma
|valign=top| 
*Stains positively for cytokeratin. hCG, AFP, and CD30
|-
|align=center|
'''[[Choriocarcinoma]]'''
|valign=top|
*Adolescent or young adult with extratesticular symptoms
*Mass is small and locally asymptomatic
*Manifests with early metastasis and signs of hemorrhage  (hemorrhagic stroke, hyperthyroidism, cannon-ball metastasis in lung, liver involvement, neurological deficits)
|valign=top|
*Often unremarkable (small primary tumor)
|valign=top|
*Elevated serum hCG
|valign=top|
*Variable echogenicity
*No differentiating features on imaging
*Commonly invade the surrounding structures (tunica albuginea)
|valign=top|
*Prominent areas of hemorrhage and necrosis
*Nest and sheet pattern that simultaneously includes both cytotrophoblast and syncytiotrophoblast (rarely pure)
*Paucity of intermediate trophoblasts (unlike placental site trophoblastic tumor) 
|valign=top|
*Stains positively for hCG
|-
|align=center|
'''[[Germ cell tumor|Diffuse embryoma]]'''
|valign=top|
*20-25 yo man with painful testicular mass 
|valign=top|
*Tender testicular mass 
|valign=top|
*Elevated serum hCG
*Elevated serum AFP
|valign=top|
*Poorly-defined, heterogeneous hyperechoic mass on ultrasound
|valign=top|
*Non-encapsulated mass
*Intermingled (lace-like) embryonal carcinoma and yolk sac components in equal proportions, but no discrete embyoid bodies
*Scattered trophoblastic components
*Necklace-like arrangement of cells
|valign=top|
*Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
|-
|align=center|
'''[[Polyembryoma]]'''
|valign=top|
*20-25 yo man with painful testicular mass 
|valign=top|
*Tender testicular mass 
|valign=top|
*Elevated serum AFP
*Elevated serum hCG 
|valign=top|
*Poorly-defined, heterogeneous hyperechoic mass on ultrasound 
|valign=top|
*Multiple discrete embyoid bodies (combination of both embryonal carcinoma and yolk sac components) 
|valign=top|
*Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
|-
|align=center|
'''[[Placental site trophoblastic tumor]]'''
|valign=top|
*Infant or young adult
*Painful small testicular mass
|valign=top|
*Small nontender or minimally painful testicular mass 
|valign=top|
*Elevated serum hCG 
|valign=top|
*Variable echogenicity
*No differentiating features on imaging
*May have vascular flow 
|valign=top|
*Solid yellowish mass that resembles uterine tissue
*Less prominent foci of hemorrhage and ncerosis
*Predominance of intermediate trophoblast cells (implantation-site type) that invade surrounding blood vessels
*Paucity of cytotrophoblast and syncytiotrophoblast cells (unlike choriocarcinoma) 
|valign=top|
*Stains positively for hPL (diffuse), cytokeratin, AFP, and hCG (patchy)
*Negative p63 staining 
|-
|align=center|
'''[[Epithelioid trophoblastic tumor]]'''
|valign=top|
*Infant or young adult
*Painful small testicular mass
|valign=top|
*Small nontender or minimally painful testicular mass 
|valign=top|
*Elevated serum hCG 
|valign=top|
*Variable echogenicity
*No differentiating features on imaging
*May have vascular flow 
|valign=top|
*Solid yellowish mass that resembles uterine tissue
*Less prominent foci of hemorrhage and ncerosis
*Predominance of intermediate trophoblast cells (implantation-site type) that invade surrounding blood vessels
*Paucity of cytotrophoblast and syncytiotrophoblast cells (unlike choriocarcinoma) 
|valign=top|
*Stains positively for p63 (diffuse), p63, cytokeratin, AFP, and hCG (patchy)
*Negative hPL staining
|-
|align=center|
'''[[germ cell tumor|Mixed germ cell tumor]]'''
|valign=top|
*Typical age at diagnosis and other clinical features based on underlying components
|valign=top|
*Physical exam findings based on underlying components
|valign=top|
*Elevated serum hCG, AFP, and/or PALP dependeing on the underlying compoenents 
|valign=top|
*Imaging findings based on underlying components
|valign=top|
*Histopathological findings based on underlying components
*Variable proportion of choriocarcinoma, embryonal cell carcinoma, yolk sac tumor, seminoma, and/or teratoma tissue
|valign=top|
*May stain positively for any of CD30, hCG, AFP, ALP, c-KIT, CD30, EMA,  alpha-1-antitrypsin, PAS diastase, and glycogen depending on underlying compoenents
|-
|align=center|
'''[[Carcinoid|Carcinoid<br>(pure neuroendocrine neoplasm)]]'''
|valign=top|
*Middle-aged and elderly adult
*Manifests as a minimally painful, rapidly growing mass
*May manifest as carcinoid syndrome
|valign=top|
*Tender testicular mass
*Hydrocele or cryptorchidism 
|valign=top|
*Elevated serum and urine 5-HIAA if carcinoid syndrome present
|valign=top|
*Unilateral, well-circumscribed mass without vascular invasion
*Solid and cystic appearance
*Mixed echogenicity on ultrasound
*Irregular calcifications 
|valign=top|
*Well-circumscribed, yellowish solid mass
*Occasional cystic masses
*Small acini, cord-forming rosettes, prominent cytoplasmic granularity
*Salt and pepper chromatic pattern
*Absent features of atypia
*Neurosecretory granules on electron microscopy 
|valign=top|
*Stains positively for cytokeratin, serotonin, chromogranin, synaptophysin, and CD56 
|-
|align=center|
'''[[PNET|PNET<br>(Ewing's tumor of the testes)]]'''
|valign=top|
*30-50 yo man with rapidly enlarging mass
*Often metastatic at presentation
|valign=top|
*Palpable, nontender unilateral testicular mass 
|valign=top|
*Unremarkable 
|valign=top|
*No differentiating features on imaging
*Vascular flow on Doppler 
|valign=top|
*Greyish necrotic mass of immature neural tissue
*Sheet-like / rosette distribution of small round blue tumor cells
*Neurosecretory granules on electron microscopy 
|valign=top|
*Stains positively for synaptophysin, NSE, chromogranin, CD99, GFAP, FLI1
*Split of EWS gene on chromosome 22
|-
| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Sex-cord stromal tumors'''}}
|-
|align=center|
'''[[Fibroma]]'''
|valign=top|
*Middle-aged adult (range 20-70 years) with slowly-growing, painless testicular mass
*History of nevoid basal cell carcinoma (Gorlin syndrome) 
|valign=top|
*Palpable, nontender unilateral testicular mass 
|valign=top|
*Unremarkable 
|valign=top|
*Isoechoic mass on ultrasound with prominent acoustic shadowing (fibrous component)
*May be homogeneous or heterogeneous
*Margins often blended with the tunica albuginea
*No vascular flow on Dopper 
|valign=top|
*Well-circumscribed, often non-encapsulated solid pale yellow mass
*No hemorrhage, no necrosis
*Pure fibromatous features of collagenized plaques and spindle cells that synthesize collagen.
*Low cellularity 
|valign=top|
*Mutation in ''PTCH'' gene
*Positive staining for calretinin, inhibin, CD56, CD34, actin, vimectin
*Usually (but not always) negative staining for S-100, keratin, CD99/MIC-2, and desmin 
|-
|align=center|
'''[[Granulosa cell tumor]]'''
|valign=top|
*Young or middle-aged adult (adult-type) or infant/child (juvenile-type) patient with slowly-enlarging painless testicular mass
*May manifest with symptoms of metastasis or hormonal secretion (e.g. gynecomastia in estrogen-secreting tumors) 
|valign=top|
*Palpable, nontender unilateral testicular mass 
|valign=top|
*Unremarkable 
|valign=top|
*Hypoechoic mass with solid and cystic appearance on ultrasound (swiss-cheese appearance)
|valign=top|
*Well-circumscribed tumor between the seminiferous tubules
*May be solid, cystic, of lobular
*Pseudo-capsule
*No hemorrhage, no necrosis
*Elongated grooved nuclei (coffee-bean appearance)
*Call-Exner bodies
*Variable atypia 
|valign=top|
*Stains positively for calretinin, inhibin, vimentin, actin, and MIC2 
|-
|align=center|
'''[[leydig cell tumor|Leydig (interstitial) cell tumor]]'''
|valign=top|
*Bimodal age distribution
*Slowly enlarging painless unilateral mass 
|valign=top|
*Palpable, nontender unilateral testicular mass
*Signs of excess estradiol (e.g. gynecomastia) 
|valign=top|
*Unremarkable   
|valign=top|
*Well-defined, hypoechoic solid mass on ultrasound
*May have cystic component
*Irregular calcifications 
|valign=top|
*Well-circumscribed, unencapsulated solid mass
*Yellowish-brown tumor
*May have cystic, hemorrhagic, or necrotic areas
*Often dffuse growth of large polygonal Leydig cells, but may have unique patterns of growth
*Vacuolated cells with marked atypia
*Reinke crystals
*Psammoma bodies 
|valign=top|
*Mutation in fumarate hydratase
*Stains positively for inhibin, cytokeratin, calretinin, synaptophysin, vimentin, Melan-A
|-
|align=center|
'''[[sertoli cell|Sertoli hyperplasia<br>(Sertoli adenoma, Pick's adenoma)]]
|valign=top|
*Child or young adult with history of Peutz-Jegher syndrome, androgen insensitivity syndrome, or McCune Albright syndrome
*Slowly enlarging painless bilateral masses 
|valign=top|
*Palpable, nontender bilateral testicular masses
*Signs of excess estradiol (e.g. gynecomastia) 
|valign=top|
*Elevated serum estradiol
*Elevated anti-Mullerian hormone and inhibin B
*Reduced androgen concentration 
|valign=top|
*Hyperechogenic nodules on ultrasound 
|valign=top|
*Well-demarcated yellowish nodules in the testis
*Unencapsulated nodules composed of Sertoli cells 
|valign=top|
*Stains positively for anti-Mullerian hormone, inhibin A, CK8, and CK18
*Negative staining for AFP, hCG, and p53
|-
|align=center|
'''[[sertoli cell|Large cell calcifying Sertoli cell tumor]]
|valign=top|
*Young patient with history of Carney syndrome, Peutz-Jeghers syndrome, or tuberous sclerosis
*Slowly enlarging painless unilateral/bilateral mass(es)
|valign=top|
*Palpable, nontender unilateral or bilateral testicular mass
*Signs of excess estradiol (e.g. gynecomastia) 
|valign=top|
*Elevated serum estradiol 
|valign=top|
*Diffuse and regular (smooth, rounded, large) calcifications
*Variable appearance on ultrasound
*Often multiple hyperechogenic regions with strong shadowing
*Possible increased blood flow 
|valign=top|
*Multifocal, well-circumscribed yellowish-grey nodules
*Absent hemorrhage or necrosis
*Patterrns (sheet or trabeculae) of large cells and formation of solid tubules
*Psammoma bodies
*Charcot Bottcher crystals on electron microscopy 
|valign=top|
*Stains positively for inhibin, vimentin, calretinin, S100, and cytokeratin
*Negative staining for laminin, PALP, AFP, and hCG
|-
|align=center|
'''[[Sertoli-Leydig cell tumor|Sclerosing Sertoli cell tumor]]'''
|valign=top|
*Variable age at presentation (adolescence to elderly)
*Slowly enlarging painless unilateral mass 
|valign=top|
*Palpable, nontender unilateral testicular mass 
|valign=top|
*Unremarkable 
|valign=top|
*Well-circumscribed hypoechogenic lesion on ultrasound 
|valign=top|
*Well-circumscribed, yellowish-grey nodule
*Absent hemorrhage or necrosis
*Tubuules and cords of Sertoli cells surrounded by hypocellular collagenous strome (sclerosis) 
|valign=top|
*Stains positively for calretinin, inhibin, and vimentin
*Negative staining for cytokeratin, AFP, and hCG
|-
|align=center|
'''[[Sertoli-Leydig cell tumor|Sertoli tumor, non-specific]]
|valign=top|
*Bimodal age districution: either 40-50 year old man or infants with history of Carney syndrome or Peutz-Jegher syndrome
*Slowly enlarging testicular mass
|valign=top|
*Palpable, nontender unilateral testicular mass
*Signs of excess estradiol (e.g. gynecomastia) 
|valign=top|
*Often unremarkable
*Elevated serum estradiol may be present, less common 
|valign=top|
*Well-circumscribed mass with variable echogenicity 
|valign=top|
*Well-circumscribed, yellowish-grey nodule
*Hemorrhage and necrosis may be present, but uncommon
*Features of fetal, prepubertal, and adult Sertoli cells present simultaneously
*Charcot Bottcher crystals on electron microscopy 
|valign=top|
*Stains positively for vimentin, cytokeratin, inhibin, S100, chromogranin, synaptophysin, and CD99
*Negative staining for hCG, AFP, and PLAP 
|-
|align=center|
'''[[Sertoli-Leydig cell tumor|Sertoli-Leylig cell tumor (SLCT)]]
|valign=top|
*Young adult or phenotypic female with history of androgen insensitivity
*Slowly enlarging painless unilateral mass 
|valign=top|
*Palpable, nontender unilateral testicular mass
*Signs of excess estradiol (e.g. gynecomastia) 
|valign=top|
*Often unremarkable
*Elevated serum estradiol may be present, less common
*Abrnomally elevated testosterone among pts with androgen insensitivity 
|valign=top|
*Well-circumscribed mass with variable echogenicity
*Solid mass with intratumoral cysts may be present
|valign=top|
*Heterogeneous, lobulated, encapsulated yellowish solid mass
*Mass contains combination of Sertoli cells and Leydig cells 
*Poorly differentiated cells (immature tubules of Sertoli cells, large Leydig cells) 
|valign=top|
*Stains positively for inhibin, melanA, and CD99
*Negative staining for EMA, PLAP, and S100
|-
|align=center|
'''[[CAH|Testicular tumor of andrenogenital syndrome<br>(testicular adrenal rest tumor)]]
|valign=top|
*Post-pubertal patient with history of congenital adrenal hyperplasia (CAH)
*Often asymptomatic, detected during screening in patients with CAH 
|valign=top|
*Unremarkable testicular exam
*Other signs of congenital adrenal hyperplasia 
|valign=top|
*Elevated 11-beta-hydroxylase activity
*Reduced concentrations of AFP, LDH, and hCG 
|valign=top|
*Uniform hypoechogenicity on ultrasound
*Usually multifocal and bilateral lesions 
|valign=top|
*Hyperplasia, bilateral lesions in testicular hilum
*Yellowish nodules
*Cells resemble adrenocortical cells, no mitoses
*Normal surrounding tissue
*Absent Reinke crystals
|valign=top|
*Stains positively for CD56, synaptophysin, and inhibin
*Negative staining for androgen receptor protein
|-
| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Other tumors'''}}
|-
|align=center|
'''[[Lymphoma]]'''
|valign=top|
*Elderly patient (>60 years) with history of lymphoma (commonly diffuse large B cell lymphoma)
*Unilateral or bilateral painless testicular mass 
|valign=top|
*Palpable, nontender unilateral or bilateral testicular mass 
|valign=top|
*Depends on lymphoma subtype 
|valign=top|
*Diffuse infiltration
*Hypoechoic solid masses on ultrasound
*Hypervascularity on Doppler ultrasound 
|valign=top|
*Whitish-tan colored mass
*Large, pleomorphic malignant cells
*Seminiferous tubules may be spared or undergo sclerosis
*Vascular invasion   
|valign=top|
*Stains positively for CD45
*Depends mainly on lymphoma subtype
*Usually negative staining for PLAP and SALL4
|-
|align=center|
'''[[Angiosarcoma]]'''
|valign=top|
*Bimodal age distribution
*Young man with history of teratoma or elderly man with history of radiation or chronic hydrocele
*Painless/painful testicular mass 
|valign=top|
*Tender or non-tender testicular mass
*Low-grade fever
*Scrotal swelling
*Flank pain
*Hydrocele 
|valign=top|
*Often unremarkable 
|valign=top|
*Hypervascularity on Doppler ultrasound 
|valign=top|
*Solid vascular lesion
*Classical pattern of proliferating anastomosing blood-filled channels
*2 patterns: solid (sheet proliferation without lumen) and primitive (small lumina filled withblood)
|valign=top|
*Stains positively for CD31, CD34, lectin, and factor VIII-related antigen
*Negative staining for pancytokeratin, PLAP, CD45, CD68, CAM5.2, and AE1/AE3 
|-
|align=center|
'''[[Chondrosarcoma]]'''
|valign=top|
*Young or middle-aged adult with history of teratoma
*Painless testicular mass 
|valign=top|
*Palpable, non-tender, heterogeneous mass 
|valign=top|
*Often unremarkable 
|valign=top|
*Lobulated mass 
|valign=top|
*Firm, grey mass with irregular lobulations
*Cartilaginous (chondroid) matrix surrounded by fibrovascular bands
*Most have non-cartilagenous components (rarely pure) 
|valign=top|
*Stains positively for S100
|-
|align=center|
'''[[Hemangioma]]'''
|valign=top|
*Painless testicular mass among pts of any age 
|valign=top|
*Palpable, non-tender, homogeneous mass 
|valign=top|
*Often unremarkable 
|valign=top|
*Homogeneous hypoechoic mass
*Hypervascularity on Doppler ultrasound
|valign=top|
*Well-defined hemorrhagic mass
*Red blood cells in tubules 
|valign=top|
*Stains positively for CD31, CD34, FLI1, and factor VIII-related antigen
*Negative staining for pancytokeratin, AE, keratin, PLAP, and EMA
|-
|align=center|
'''[[Mesothelioma]]'''
|valign=top|
*Middle aged man with painless testicular mass and history of hydrocele or exposure to asbestos
|valign=top|
*Palpable, non-tender testicular mass
*Scrotal swelling 
|valign=top|
*Often unremarkable 
|valign=top|
*Thickening of tunica vaginais
*Solid paratesticular mass
*Hydrocele 
|valign=top|
*May be benign or malignant
*Papillary patterns of uniform epithelioid cells with fibrovacular core
*Polygonal cells with microvilli on electron microscopy
*Psammoma bodies 
|valign=top|
*Benign: stains positively for p53 (focal) and CEA
*Malignant: Stains positively for calretinin, WT1, EMA, thrombomodulin, CK5, CK6, CK7 and negative staining for CEA and CK20 
|-
|align=center|
'''[[Plasmacytoma]]'''
|valign=top|
*Adult (of any age) with concurrent or history of plasma cell neoplasia (commonly multiple myeloma)
*Symptoms of multiple myeloma (e.g. fatigue, back pain) 
|valign=top|
*Testicular exam unremarkable 
|valign=top|
*Lab findings of plasmacytosis (e.g. anemia, elevated creatinine, hypercalcemia)
*No specific lab finding for testicular involvement 
|valign=top|
*Poorly circumscribed hypoechoic lesions on ultrasound
*Hypervascularity on Doppler ultrasound 
|valign=top|
*Large, tan-yellow mass
*Areas of hemorrahge
*Atypical plasma cells
*Tubule effacement in the center and tubule sparing in the periphery 
|valign=top|
*Positive staining for EMA, CD45, CD79am CD138, kappa or lambda light chains, and other plasma cell markers
|-
|align=center|
'''[[AIDS|AIDS-related testicular cancer]]'''
|valign=top|
*Commonly testicular lymphoma or germ cell tumor
*Patient with history of AIDS presents with testicular swelling or pain
*Systemic manifestations of underlying malignancy 
|valign=top|
*Palpable testicular mass that may be tender or non-tender 
|valign=top|
*Depends on underlying malignancy
|valign=top|
*Depends on underlying malignancy 
|valign=top|
*Depends on underlying malignancy   
|valign=top|
*Depends on underlying malignancy 
|-
| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Non-neoplastic mass'''}}
|-
|align=center|
'''[[adrenal cortex|Adrenal cortical rest]]'''
|valign=top|
*Usually asymptomatic (incidental finding)
*Young man with scrotal swelling and dull pain
*History of congenital adrenal hyperplasia (hydroxylase deficiency) 
|valign=top|
*Scrotal swelling 
|valign=top|
*May be unremarkable
*If secretory, elevated concentration of adrenal hormone 
|valign=top|
*Heterogeneous, well-circumscribed hypoechoic mass on ultrasound
*No or minimal vascularity on Doppler
*No distinguishing features 
|valign=top|
*Well-circumscribed, small, round, orange-yellow nodule
*Adrenal cortical tissue with absence of adrenal medullary tissue 
|valign=top|
*Positive staining for  markers of cortical adrenal tissue 
|-
|align=center|
'''[[filariasis|Chylocele]]'''
|valign=top|
*Scrotal swelling in a man with history of filariasis / elephantiasis 
|valign=top|
*Scrotal swelling
*Negative trans-illumination test
|valign=top|
*Unremarkable 
|valign=top|
*Fluid collection surrounding the testes 
|valign=top|
*Milky chylous fluid (not waterry) on aspiration
*Usually no evidence of microfliariae in chylous fluid
*Abundant leukocytes 
|valign=top|
*N/A
|-
|align=center|
'''[[Congenital cystic dysplasia|Cystic dysplasia]]'''
|valign=top|
*Young child with history of renal agenesis / dysplasia
*May be unilateral or bilateral, painless testicular mass 
|valign=top|
*Palpable, non-tender testicular mass 
|valign=top|
*Unremarkable 
|valign=top|
*Irregular cystic spaces witht varying sizes
*Absence of solid or vascular components 
|valign=top|
*Varying cystic spaces
*Formation of incomplete connective tissue septa
*Cells resembling the normal adult rete testes 
|valign=top|
*N/A
|-
|align=center|
'''[[Dermoid cyst]]'''
|valign=top|
*Young or middle aged adult with slowly growing painless mass
*Ruptured cyst may manifest with scrotal swelling, erythema, and pain 
|valign=top|
*Palpable, nontender unilateral testicular mass
*Usually heterogeneous enlargement 
|valign=top|
*Unremarkable 
|valign=top|
*Onioin-skin appearance on ultrasound
*Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound
*No vacular flow on Doppler 
|valign=top|
*Mature epithelial tissue
*May have hair (similar to teratoma)
*Keratin filled cyst
*Epidermal epithelium surrounded by pilosebaceious units
*Formation of lipogranulomas and microcalcifications
*Absence of atypia
|valign=top|
*Absence of any mutation (normal 12p)
*Stains positively for cytokeratin
|-
|align=center|
'''[[Epidermoid cyst|Epidermoid cyst<br>(keratocyst)]]'''
|valign=top|
*10-40 yo
*Painless slowly growing testicular mass
*Ruptured cyst may manifest with scrotal swelling, erythema, and pain
|valign=top|
*Palpable, non-tender testicular mass
*Usually heterogeneous enlargement 
|valign=top|
*Unremarkable 
|valign=top|
*Onioin-skin appearance on ultrasound
*Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound
*No vacular flow on Doppler 
|valign=top|
*Absence of dermal structures, such as hair, sebaceous glands etc. (found in dermoid cyst)
*Cyst with white keratin debris
*Lined by squamous epithelium
*Laminated keratin
*Granuloma when cyst ruptures 
|valign=top|
*Absence of any mutation (normal 12p) 
|-
|align=center|
'''[[orchitis|Granulomatous orchitis]]'''
|valign=top|
*40-60 yo man with sudden-onset testicular tenderness and mass formation
*History of infection, sarcoidosis, or testicular trauma 
|valign=top|
*Tender testicular mass
*Fever 
|valign=top|
*Unremarkable 
|valign=top|
*Solid hypoechoic mass 
|valign=top|
*Solid nodule
*Lymphocytic infiltration and formation of giant cells and macrophages
*Not true granuloma 
|valign=top|
*N/A
|-
|align=center|
'''[[Hematocele]]'''
|valign=top|
*Scrotal mass in patients with history of testicular trauma, torsion, or increased bleeding tendency 
|valign=top|
*Scrotal swelling
*Negative trans-illumination test
|valign=top|
*Unremarkable
|valign=top|
*Fluid collection surrounding the testes 
|valign=top|
*Bloody fluid on aspiration 
|valign=top|
*N/A
|-
|align=center|
'''[[Hydrocele]]'''
|valign=top|
*Scrotal mass in patients with history of testicular trauma or epidymitis
|valign=top|
*Scrotal swelling
*'''Positive''' trans-illumination test
|valign=top|
*Unremarkable 
|valign=top|
*Fluid collection surrounding the testes 
|valign=top|
*Clear fluid on aspiration 
|valign=top|
*N/A 
|-
|align=center|
'''[[Macroorchidism]]'''
|valign=top|
*History of fragile X syndrome, FSH secreting adenoma 
|valign=top|
*Large testicle (the testicle itself is large)
*Signs of underlying disease 
|valign=top|
*May have elevated hormone concentration (e.g. FSH) if secretory adenoma 
|valign=top|
*Large testicle, but normal architecture 
|valign=top|
*Normal testicular findings 
|valign=top|
*N/A
|-
|align=center|
'''[[Malakoplakia]]'''
|valign=top|
*Young man with long-standing symptoms of orchi-epididymitis (pain, scrotal swelling)
*History of immunosuppression 
|valign=top|
*Palpable, tender testicular mass
*Scrotal swelling
*Erythema 
|valign=top|
*Positive culture results for bacterial infection (chronic inflammation) 
|valign=top|
*Hypoechogenic mass on ultrasound
*Increased vascularity on Doppler 
|valign=top|
*Soft yellow friable plaques (malakos=soft | plakos=plaques)
*Von Hansemann cells (large cells with abundant eosinophilic cytoplasm) and Michaelis-Gutmann bodies (intracytoplasmic inclusion bodies with owl eyes appearance)
|valign=top|
*N/A
|-
|align=center|
'''[[vasculitis|Testicular vasculitits]]'''
|valign=top|
*Middle aged man with history of polyarteritis nodosa (less commonly granulomatosis with polyangiomatosis, Henoch-Schonlein purpura, or giant cell arteritis)
*History of HBV or HIV
Painful testicular mass with intra-testicular hemorrhage
*Symptoms of underlying vasculitis 
|valign=top|
*Signs of underlying vasculitis
*Palpable, tender testicular mass
*Scrotal swelling if vasculitis includes extratesticular structures 
|valign=top|
*Unremarkable 
|valign=top|
*Heterogeneous, hypoechogenic lesion on ultrasound
*Inreased intralesional vascularity on Doppler 
|valign=top|
*Soft, dark red lesion with areas of hemorrhage
*Fibrinoid necrosis
*Vascular wall fibrosis 
|valign=top|
*N/A 
|-
|align=center|
'''[[Fibrous connective tissue|Fibrous proliferation<br>(paratesticular fibrous pseudotumor)]]'''
|valign=top|
*Patients of all ages (peak during young adulthood)
*Slowly growing painless unilateral scrotal masss
*History of genitourinary infection or trauma
|valign=top|
*Palpable, non-tender scrotal mass 
|valign=top|
*Unremarkable
|valign=top|
*Paratesticular mass between tunica layers
*Hypoechogenic solid mass on ultrasound
*No vascularity on Doppler 
|valign=top|
*Whitish mass with multinoduular thickening
*Collagen-rich fibrous tissue with increased fibroblasts
*Dystrophic calcifications
*No hemorrhage or necrosis 
|valign=top|
*Stains positiively for actin and keratin
*Negative staining for ALK-1, beta-catenin
|-
|align=center|
'''[[testis|Polyorchism<br>(supranumerary testes)]]'''
|valign=top|
*Often asymptomatic (incidental finding)
*Young patient with scrotal pain, swelling, hydrocele, varicocele
*Patients may present with testicular torsion 
|valign=top|
*Palpable, non-tender scrotal mass
*Scrotal swelling
*Testicular torsion manifests with excruciating testicular or pelvic pain, erythema, and swelling
|valign=top|
*Unremarkable 
|valign=top|
*Isoechogenic scrotal mass 
|valign=top|
*Normal testicular tissue 
|valign=top|
*N/A
|-
|align=center|
'''[[Spermatocele]]'''
|valign=top|
*Young or middle aged adult with painless testicular or scrotal mass 
|valign=top|
*Homogeneous palpable non-tender testicular or scrotal mass
|valign=top|
*Unremarkable 
|valign=top|
*Well-defined, homogeneous,, hypoechoic mass on ultrasound
*Increased vascular flow on Doppler 
|valign=top|
*Splenic tissue (red with clear boundaries)
*Occasional calcification, thrombi, or fibrosis 
|valign=top|
*N/A
|-
|align=center|
'''[[spleen|Splenogodal fusion syndrome<br>(ectopic scrotal spleen)]]'''
|valign=top|
*Child or adolescent with painless, left scrotal mass (not right) and history of perimelia (continuous subtype) or cardiac defect (discontinuous subtype) 
|valign=top|
*Homogeneous palpable non-tender scrotal mass 
|valign=top|
*Unremarkable
|valign=top|
*Well-defined, homogeneous,, hypoechoic mass on ultrasound
*Increased vascular flow on Doppler 
|valign=top|
*Splenic tissue (red with clear boundaries)
*Occasional calcification, thrombi, or fibrosis 
|valign=top|
*N/A
|-
|align=center|
'''[[Varicocele]]'''
|valign=top|
*Often asymptomatic
*Dull or sharp testicular pain that increases with standing or physical activity and improves when lying down
*History of infertility 
|valign=top|
*Scrotal mass and swelling
*Often left-sided
*Dilated, tortuous veins
*"Bag of worms" sensation upon palpation 
|valign=top|
*Unremarkable
|valign=top|
*On ultrasound, CT/MRI, and venography, apperance of dilated pampiniform plexus veins with serpentine appearance is diagnostic
*Flow reversal (reflux) with Valsalva maneuver on Doppler
*Enhancement following administration of gadolinium on MRI 
|valign=top|
*Testicular atrophy in advanced cases 
|valign=top|
*N/A
|-
|align=center|
'''[[Testicular torsion]]'''
|valign=top|
*Excruciating, acute, sharp testicular pain that radiates to the pelvis and abdomen
*Testicular swelling and pain 
|valign=top|
*Scrotal swelling and tenderness 
|valign=top|
*Unremarkable 
|valign=top|
*Focal/diffuse hypoechogenicity on ultrasound
*No blood flow on Doppler (vs. increased flow in infections)
*Scrotal wall thickening 
|align=center|--- 
|valign=top|
*N/A 
|-
| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Scrotal'''}}
|-
|align=center|
'''[[Brucellosis]]'''
|valign=top|
*Patient with history of exposure to cattle/sheep/goat/swine or animal products (milk, meat, cheese) presents with acute scrotal pain and swelling
*Undulant fever and night sweats (characteristic wet hay odor)
*Relapses common with similar symptoms 
|valign=top|
*Tender testicular mass
*Fever
*Hydrocele 
|valign=top|
*Elevated WBC count
*Positive serum STA test for brucellosis
*Elevated Brucella IgM and IgG antibodies
*Urine PCR positive for Brucella 
|valign=top|
*Focal/diffuse hypoechogenicity on ultrasound
*Focal/diffusre increased blood flow on Doppler
*Scrotal wall thickening 
|valign=top|
*Granulomatous inflammation with lymphocytic infiltration 
|valign=top|
*Urethral Gram stain demonstrates Gram-negative diplococci
|-
|align=center|
'''[[Brucellosis]]'''
|valign=top|
*Patient with history of exposure to cattle/sheep/goat/swine or animal products (milk, meat, cheese) presents with acute scrotal pain and swelling
Undulant fever and night sweats (characteristic wet hay odor)
*Relapses common with similar symptoms 
|valign=top|
*Tender testicular mass
*Fever
*Hydrocele 
|valign=top|
*Elevated WBC count
*Positive serum STA test for brucellosis
*Elevated Brucella IgM and IgG antibodies
*Urine PCR positive for Brucella spp. 
|valign=top|
*Focal/diffuse heterogeneous, hypoechoic intratesticular mass on ultrasound
*Focal/diffuse increased blood flow on Doppler
*Scrotal wall thickening 
|valign=top|
*Abscess formation at diagnosis is common
*Grey-white mass suggestive of testicular atrophy
*Granulomatous inflammation with lymphocytic infiltration 
|valign=top|
*N/A
|-
|align=center|
'''[[Gonorrhea|Gonorrhea infection]]'''
|valign=top|
*Patient with history of unprotected sexual intercourse presents with unilaterla testicular pain, swelling, and fever
*May be either acute or chronic 
|valign=top|
*Tender testicular mass
*Fever
*Hydrocele
|valign=top|
*Elevated WBC count
*Gram-negative diplococci on urethral Gram stain
*Urine PCR positive for Gonorrhea 
|valign=top|
*Focal/diffuse hypoechogenicity on ultrasound
*Focal/diffusre increased blood flow on Doppler
*Scrotal wall thickening 
|valign=top|
*Granulomatous inflammation with lymphocytic infiltration 
|valign=top|
*Urethral Gram stain demonstrates Gram-negative diplococci
|-
|align=center|
'''[[Histoplasmosis|Histoplasma infection]]'''
|valign=top|
*Chronic testicular enlargement
*Patients may have systemic manifestations of histoplasmosis
|valign=top|
*Tender/non-tender testicular mass 
|valign=top|
*Elevated WBC count and eosinophilia may be present (may be normal in chronic cases)
|valign=top|
*Focal/diffuse hypoechogenicity on ultrasound
*Focal/diffusre increased blood flow on Doppler
*Scrotal wall thickening 
|valign=top|
*Caseating granuloma with giant cells 
|valign=top|
*Yeast observed on silver stain
|-
|align=center|
'''[[Mumps]]'''
|valign=top|
*Post-pubertal man with recent manifestations of mumps (e.g. parotiditis, pancreatitis, arthritis, myocarditis, meningoencephalitis) presents with acute, unilateral painful testicular mass 
|valign=top|
*Tender testicular mass
*Hydrocele
*Fever
*Parotiditis
*Rash 
|valign=top|
*Elevated WBC
*Elevated paramyxovirus IgM and IgG
*Urine PCR positive for paramyxovirus 
|valign=top|
*Focal/diffuse hypoechogenicity on ultrasound
*Focal/diffusre increased blood flow on Doppler
*Scrotal wall thickening 
|valign=top|
*Non-specific interstitial edema, degenerative changes, vascular dilation
*Lymphocytic infiltration
|valign=top|
*N/A 
|-
|align=center|
'''[[epididymo-orchitis|Pyogenic epididymo-orchitis]]
|valign=top|
*Patient with history of unprotected sexual intercourse presents with acute scrotal swelling and pain 
|valign=top|
*Tender testicular mass
*Fever
*Hydrocele 
|valign=top|
*Elevated WBC
*Bacterial growth on urethral swab specimin (usually E. coli)
*Urine PCR positive for offending bacterial agent
|valign=top|
*Focal/diffuse hypoechogenicity on ultrasound
*Focal/diffusre increased blood flow on Doppler
*Scrotal wall thickening 
|valign=top|
*Abscess formation in advanced cases
*Non-specific interstitial edema, degenerative changes, vascular dilation
*Lymphocytic infiltration
*Grey-white mass suggestive of testicular atrophy
|valign=top|
*N/A
|-
|align=center|
'''[[Syphilis]]'''
|valign=top|
*Patient with long history of unprotected sexual intercourse presents with painful testicular swelling (tertiary syphilis)
*Often manifests as epidimo-orchitis that is resistant to conventional antibiotic therapy
*May have other systemic symptoms of tertiary syphilis 
|valign=top|
*Irregular tender testicular mass
*Thickened epididymis
*Hydrocele 
|valign=top|
*Positive syphilis serology (suggest latent syphilis)
*VDRL may be either positiive or negative
*Positive dark field microscopy from lesion content 
|valign=top|
*Heterogeneous hypoechogenicity on ultrasound
*Solid and cystic appearance with areas of necrosis
*May have increased blood flow on Doppler 
|valign=top|
*Discrete gummas on gross pathology
*Microscopic features of gumma (interstitial inflammation, lymphocytic and plasma cell infiltration, obliterative endorteritis (endoarteritis obliterans), perivascular cuffing)
*Spirochetes may occasionally be observed 
|valign=top|
*May stain positively for silver-based methods (Warthin-Starry stain, Wright stain, Levaditi stain) 
|-
|align=center|
'''[[Tuberculosis]]'''
|valign=top|
*Patient with history of tuberculosis presents with painless mass or chronically dull testicular discomfort
*Positive constitutional symptoms (weight loss, malaise)
*May be isolated or may be associated with other systemic symptoms of tuberculosis (e.g. lymphadenopathy, pulmonary lesions, renal involvement)
*May have concomitant involvement of other GU organs (e.g. prostate, seminal vesicles) 
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*Irregular testicular mass
*May be tender or non-tender
*Thickened scrotal skin
*Hydrocele
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*Ejaculum may demonstrate positive acid fast bacilli (AFB) staining 
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*Heterogeneous hypoechogenicity on ultrasound
*No/minimal blood flow on Doppler
*Hypointense lesion on T1WI MRI and hyperintense on T2WI MRI
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*Possible abscess formation
*Caseating necrosis
*Epithelioid cells and lymphocytic infiltration with presence of multinucleated giant cells
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*Positive acid fast bacilli staining
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Latest revision as of 16:32, 8 March 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Preeti Singh, M.B.B.S.[2]


References

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