Scrotal mass differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Scrotal mass}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Scrotal_mass]]
{{CMG}}{{AE}}{{SR}}
{{CMG}};{{AE}}{{NE}}{{Preeti}}


==Overview==
==Overview==
Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.


==Differential Diagnosis==
==Differentiating Scrotal masses from the other Diseases==
{| class="wikitable"
 
! Disease Name
[[Scrotal mass|Scrotal masses]] must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as [[Testicular cancer|testicular tortion]] ,[[Epidemic abscess|epididimitis,]]<nowiki/>testicular tumors,[[Inguinal canal|inguinal herniation]] and many other diseases.
! History & Symptoms
*The table below summarizes the findings that differentiates [[Scrotal mass (patient information)|scrotal mass]] according to the clinical features, laboratory findings, imaging features, [[Histological section|histological features]], and [[genetic]] studies.
! Physical Exam
 
! Lab Findings
{|
! Imaging Findings
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! Gross and Histologic Findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! Genetic Studies / Immunohistochemistry
| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
!
! colspan="4" 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'''
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated
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| Germs Cell Tumors
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| Seminoma
| • Most common• 30-50 year-old with painless unilateral testicular mass or mild discomfort
| • Palpable, nontender unilateral testicular mass• Usually homogeneous enlargement
| • Elevated serum placental ALP (PALP)
| • 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
| • 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
| • Stains positively for ALP, c-KIT, CD30, EMA, and glycogen
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| Embryonal cell carcinoma
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| • Young adults• Painful testicular mass• Manifests with early mestastasis (bone, lung, CNS)
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
| • Often unremarkable (small primary tumor)
| • Elevated serum hCG• Elevated serum AFP when mixed
| • Variable echogenicity (usually hypoechoic ono ultrasound)• No differentiating features on imaging• Commonly invade the surrounding structures (tunica albuginea)• Irregular calcifications
| • Pale-grey mass with areas of hemorrhagic and necrosis• Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
| • Stains positively for CD30 and hCG stain• May stain positively for AFP when mixed
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| Yolk salk tumor(endodermal sinus tumor, infantila embryonal carcinoma, or orchidoblastoma)
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
| • Most common testicular cancer in children less than 3 years of age• Rapidly growing unilateral mass in an infant or a young child
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Past Medical History
| • Palpable, nontender unilateral testicular mass• Usually heterogeneous enlargement
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
| • Elevated serum AFP
|-
| • Diffuse enlargement of the testis with a heterogeneous appearance on ultrasound• Areas of hemorrhage and necrosis on MRI
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Unilateral /Bilateral swelling
| • Yellow, mucinous, non-encapsulated, heterogeneous mass with areas of necrosis and hemorrhagePatterns that resemble embryonal structures (yolk sac, allantois) with reticular, papillary, or elongated forms• Schiller-Duval bodies (perivascular structures)
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Onset
| • Stains positively for AFP, alpha-1-antitrypsin, PAS diastase
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary symptoms
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tender<br>-ness
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Erythema
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! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Discharge
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inguinal Lymphadenopathy
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cremasteric Reflex
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood/Urine Analysis
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S
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| Teratoma
! colspan="16" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Painful
| • Bimodal distribution of age (infants and middle aged adults)• Painless tumor• History of congenital disease (Down syndrome, klinefelter, spina bifida)
| • Palpable, nontender unilateral testicular mass• Usually heterogeneous enlargement
| • Elevated serum hCG• Elevated serum AFP
| • Heterogeneous, cystic appearance with mucinous or sebaceous depositions• Variable echogenicity on ultrasound• Calcifications usually irregular
| • Large, heterogeneous appearance with solid, cystic, mucoid, and/or cartilageanous components• Presence of at least 2 germ layers
| • Chromosome 12p mutations• Stains positively for cytokeratin. hCG, and AFP
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| Teratocarcinoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymoorchitis|Epididymitis]]<ref name="pmid22483426">{{cite journal |vauthors=Yu KJ, Wang TM, Chen HW, Wang HH |title=The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis |journal=Chang Gung Med J |volume=35 |issue=1 |pages=38–45 |date=2012 |pmid=22483426 |doi= |url=}}</ref><ref name="pmid15949072">{{cite journal |vauthors=Manavi K, Turner K, Scott GR, Stewart LH |title=Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh |journal=Int J STD AIDS |volume=16 |issue=5 |pages=386–7 |date=May 2005 |pmid=15949072 |doi=10.1258/0956462053888853 |url=}}</ref><br><ref name="pmid29668706">{{cite journal |vauthors=Lee YS, Kim SW, Han SW |title=Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis |journal=PLoS ONE |volume=13 |issue=4 |pages=e0194761 |date=2018 |pmid=29668706 |pmc=5905873 |doi=10.1371/journal.pone.0194761 |url=}}</ref><ref name="pmid2161009">{{cite journal |vauthors=Ralls PW, Jensen MC, Lee KP, Mayekawa DS, Johnson MB, Halls JM |title=Color Doppler sonography in acute epididymitis and orchitis |journal=J Clin Ultrasound |volume=18 |issue=5 |pages=383–6 |date=June 1990 |pmid=2161009 |doi= |url=}}</ref><ref name="pmid26112484">{{cite journal |vauthors=Michel V, Pilatz A, Hedger MP, Meinhardt A |title=Epididymitis: revelations at the convergence of clinical and basic sciences |journal=Asian J. Androl. |volume=17 |issue=5 |pages=756–63 |date=2015 |pmid=26112484 |pmc=4577585 |doi=10.4103/1008-682X.155770 |url=}}</ref><ref name="pmid19002691">{{cite journal |vauthors=Tracy CR, Costabile RA |title=The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed? |journal=World J Urol |volume=27 |issue=2 |pages=259–63 |date=April 2009 |pmid=19002691 |doi=10.1007/s00345-008-0338-0 |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref><ref name="pmid18336454">{{cite journal |vauthors=Ludwig M |title=Diagnosis and therapy of acute prostatitis, epididymitis and orchitis |journal=Andrologia |volume=40 |issue=2 |pages=76–80 |date=April 2008 |pmid=18336454 |doi=10.1111/j.1439-0272.2007.00823.x |url=}}</ref>
| • Middle aged adult with painless testicular mass of mild discomfort• May manifest with features of metastasis
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| • Palpable, nontender unilateral testicular mass• Usually heterogeneous enlargement
| style="background: #F5F5F5; padding: 5px;" |Gradual
| • Elevated serum hCG• Elevated serum AFP
| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
| • Variable echogenicity on ultrasound
| style="background: #F5F5F5; padding: 5px;" |Dysuria, frequency, and/or urgency
| • 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
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| • Stains positively for cytokeratin. hCG, AFP, and CD30
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px;" | +
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(Pyuria
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Bacteriuria)
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| style="background: #F5F5F5; padding: 5px;" |Painful local lymphadenopathy
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px;" |
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* CBC-[[Leukocytosis]]
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* Urine culture (pre-pubertal and elderly)
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* NAAT
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* Immunofluorescent antibody testing
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| style="background: #F5F5F5; padding: 5px;" |
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* Decreased epididymal blood flow
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| style="background: #F5F5F5; padding: 5px;" |
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* Enlarged (>17 mm) [[epididymis]] with a hypoechoic, hyperechoic, or [[heterogeneous]] echotexture, increased blood flow
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| style="background: #F5F5F5; padding: 5px;" |
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* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
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* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]].
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| style="background: #F5F5F5; padding: 5px;" |
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* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
| style="background: #F5F5F5; padding: 5px;" |
* [[Hydrocele]]
* [[Urinary tract infection]]
* Gonococcal infection
* chlamydia infection
* Phen sign +ve
|-
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| Choriocarcinoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Orchitis]]
| • 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)
[[Orchitis|(]][[Mumps]])<ref name="pmid20070300">{{cite journal |vauthors=Davis NF, McGuire BB, Mahon JA, Smyth AE, O'Malley KJ, Fitzpatrick JM |title=The increasing incidence of mumps orchitis: a comprehensive review |journal=BJU Int. |volume=105 |issue=8 |pages=1060–5 |date=April 2010 |pmid=20070300 |doi=10.1111/j.1464-410X.2009.09148.x |url=}}</ref><ref name="pmid18873054">{{cite journal |vauthors=CHARNY CW, MERANZE DR |title=Pathology of mumps orchitis |journal=J. Urol. |volume=60 |issue=1 |pages=140–6 |date=July 1948 |pmid=18873054 |doi= |url=}}</ref><ref name="pmid4580293">{{cite journal |vauthors=Bjorvatn B |title=Mumps virus recovered from testicles by fine-needle aspiration biopsy in cases of mumps orchitis |journal=Scand. J. Infect. Dis. |volume=5 |issue=1 |pages=3–5 |date=1973 |pmid=4580293 |doi= |url=}}</ref><ref name="pmid609284">{{cite journal |vauthors=Beard CM, Benson RC, Kelalis PP, Elveback LR, Kurland LT |title=The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974 |journal=Mayo Clin. Proc. |volume=52 |issue=1 |pages=3–7 |date=January 1977 |pmid=609284 |doi= |url=}}</ref><br><ref name="pmid19970951">{{cite journal |vauthors=Gall EA |title=The Histopathology of Acute Mumps Orchitis |journal=Am. J. Pathol. |volume=23 |issue=4 |pages=637–51 |date=July 1947 |pmid=19970951 |pmc=1934294 |doi= |url=}}</ref><ref name="pmid18336454">{{cite journal |vauthors=Ludwig M |title=Diagnosis and therapy of acute prostatitis, epididymitis and orchitis |journal=Andrologia |volume=40 |issue=2 |pages=76–80 |date=April 2008 |pmid=18336454 |doi=10.1111/j.1439-0272.2007.00823.x |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref><ref name="pmid10823460">{{cite journal |vauthors=Başekim CC, Kizilkaya E, Pekkafali Z, Baykal KV, Karsli AF |title=Mumps epididymo-orchitis: sonography and color Doppler sonographic findings |journal=Abdom Imaging |volume=25 |issue=3 |pages=322–5 |date=2000 |pmid=10823460 |doi= |url=}}</ref>
| • Often unremarkable (small primary tumor)
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| • Elevated serum hCG
| style="background: #F5F5F5; padding: 5px;" |Abrupt
| • Variable echogenicity• No differentiating features on imaging• Commonly invade the surrounding structures (tunica albuginea)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
| • 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)
| style="background: #F5F5F5; padding: 5px;" |Dysuria
| • Stains positively for hCG
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | ±
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| style="background: #F5F5F5; padding: 5px;" |Painful local lymphadenopathy
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* CBC-[[Leukocytosis]]
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* raised CRP
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* Immunofluorescent antibody testing
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* Urine analysis and culture - normal
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| style="background: #F5F5F5; padding: 5px;" |
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* Increased blood flow in affected side.
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| style="background: #F5F5F5; padding: 5px;" |
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* [[Mumps]], [[Coxsackie virus|coxsackie]]<nowiki/>virus infection
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* Concurrent [[epididymitis]]
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* [[Congenital disorder|Congenital abnornmalities]]
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| style="background: #F5F5F5; padding: 5px;" |
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* Tubules are infiltration with neutrophiles, lymphocytes and cells resembling histiocytes
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* Microscopic destruction of  spermatogenic cells
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* RT‐PCR
* Serum immunofluorescence antibody<nowiki/> testing.
| style="background: #F5F5F5; padding: 5px;" |
* Phen sign +ve
* Testicular atrophy
* Infertility
|-
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| Diffuse embryoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion|Testicular Torsion]]<ref name="pmid29240370">{{cite journal |vauthors=Hazeltine M, Panza A, Ellsworth P |title=Testicular Torsion: Current Evaluation and Management |journal=Urol Nurs |volume=37 |issue=2 |pages=61–71, 93 |date=2017 |pmid=29240370 |doi= |url=}}</ref><ref name="pmid28714632">{{cite journal |vauthors=Estremadoyro V, Meyrat BJ, Birraux J, Vidal I, Sanchez O |title=[Diagnosis and management of testicular torsion in children] |language=French |journal=Rev Med Suisse |volume=13 |issue=550 |pages=406–410 |date=February 2017 |pmid=28714632 |doi= |url=}}</ref><ref name="pmid24364548">{{cite journal |vauthors=Sharp VJ, Kieran K, Arlen AM |title=Testicular torsion: diagnosis, evaluation, and management |journal=Am Fam Physician |volume=88 |issue=12 |pages=835–40 |date=December 2013 |pmid=24364548 |doi= |url=}}</ref><ref name="pmid3842075">{{cite journal |vauthors=Mikuz G |title=Testicular torsion: simple grading for histological evaluation of tissue damage |journal=Appl Pathol |volume=3 |issue=3 |pages=134–9 |date=1985 |pmid=3842075 |doi= |url=}}</ref><ref name="pmid16724203">{{cite journal |vauthors=Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL |title=Acute testicular torsion in children: the role of sonography in the diagnostic workup |journal=Eur Radiol |volume=16 |issue=11 |pages=2527–32 |date=November 2006 |pmid=16724203 |doi=10.1007/s00330-006-0287-1 |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref>
| • 20-25 yo man with painful testicular mass
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| • Tender testicular mass
| style="background: #F5F5F5; padding: 5px;" |Sudden
| • Elevated serum hCG• Elevated serum AFP
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Poorly-defined, heterogeneous hyperechoic mass on ultrasound
| style="background: #F5F5F5; padding: 5px;" |Absent
| • 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
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| • Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px;" | +
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Blood in semen may be present
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| style="background: #F5F5F5; padding: 5px;" |Absent
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px;" |
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* Normal
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* Absent or decreased arterial perfusion of the testis
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* Previous history of [[testicular torsion]]
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*<nowiki/>[[Family history]]<nowiki/> of [[testicular torsion]]
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* [[Prematurity]]
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*<nowiki/>[[Undescended testes]]
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* [[Low birth weight]]
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| style="background: #F5F5F5; padding: 5px;" |
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* In the first 4 hours: testicular parenchyma shows edema and and desquamation of the germ cells
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* 4-8 hours partial necrosis of germ cells.
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* >24 hrs: necrosis
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| style="background: #F5F5F5; padding: 5px;" |
* [[Doppler ultrasound]]> [[Computed tomography|CT scan]]
| style="background: #F5F5F5; padding: 5px;" |
* Phen sign +ve
|-
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| Polyembryoma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematocele]]<ref name="pmid25667770">{{cite journal |vauthors=Bowen DK, Gonzalez CM |title=Intratesticular hematoma after blunt scrotal trauma: a case series and algorithm-based approach to management |journal=Cent European J Urol |volume=67 |issue=4 |pages=427–9 |date=2014 |pmid=25667770 |pmc=4310892 |doi=10.5173/ceju.2014.04.art24 |url=}}</ref><ref name="pmid28609265">{{cite journal |vauthors=Askari R, Khouzam RN, Dishmon DA |title=Image Diagnosis: Rapidly Enlarging Scrotal Hematoma: A Complication of Femoral Access? |journal=Perm J |volume=21 |issue= |pages= |date=2017 |pmid=28609265 |pmc=5469436 |doi=10.7812/TPP/16-111 |url=}}</ref><br><ref name="pmid2048502">{{cite journal |vauthors=Mizutani Y, Miyakawa M |title=[A case of idiopathic chronic scrotal hematocele] |language=Japanese |journal=Hinyokika Kiyo |volume=37 |issue=2 |pages=199–201 |date=February 1991 |pmid=2048502 |doi= |url=}}</ref><ref name="pmid2681835">{{cite journal |vauthors=Kratzik C, Hainz A, Kuber W, Donner G, Lunglmayr G, Frick J, Schmoller HJ |title=Has ultrasound influenced the therapy concept of blunt scrotal trauma? |journal=J. Urol. |volume=142 |issue=5 |pages=1243–6 |date=November 1989 |pmid=2681835 |doi= |url=}}</ref><ref name="pmid23833421">{{cite journal |vauthors=Rao MS, Arjun K |title=Sonography of scrotal trauma |journal=Indian J Radiol Imaging |volume=22 |issue=4 |pages=293–7 |date=October 2012 |pmid=23833421 |pmc=3698892 |doi=10.4103/0971-3026.111482 |url=}}</ref>
| • 20-25 yo man with painful testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral or bilateral
| • Tender testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
| • Elevated serum AFP• Elevated serum hCG
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Poorly-defined, heterogeneous hyperechoic mass on ultrasound
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • Multiple discrete embyoid bodies (combination of both embyonal carcinoma and yolk sac components)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
| • Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
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| style="background: #F5F5F5; padding: 5px; " | +
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Blood in semen
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| style="background: #F5F5F5; padding: 5px; " |Absent
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |-
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* Urinalysis  may be the only indication of injury to urinary tract
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* [[Hematuria]].
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |Scrotal wall thickening and testicular hematoma
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |Testicular trauma related to:
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* Sports injuries.
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* Direct [[trauma]]
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* Motor vehicle accidents
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* [[Straddle injury|Straddle injuries]]
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* Increased destruction and fibrosis of the dartos fascia,.
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* Dense inflammatory cells, necrotic areas and destruction of the muscular layer.
|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Ultrasonography: to check for testicular rupture.
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
|-
|-
| Placental site trophoblastic tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Incarcerated Hernia]]<ref name="pmid18244999">{{cite journal |vauthors=Jenkins JT, O'Dwyer PJ |title=Inguinal hernias |journal=BMJ |volume=336 |issue=7638 |pages=269–72 |year=2008 |pmid=18244999 |pmc=2223000 |doi=10.1136/bmj.39450.428275.AD |url=}}</ref><ref name="pmid26987468">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref>
| • Infant or young adult • Painful small testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
| • Small nontender or minimally painful testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Sudden
| • Elevated serum hCG
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
| • Variable echogenicity• No differentiating features on imaging• May have vascular flow
| style="background: #F5F5F5; padding: 5px; text-align: left;" | Absent
| • 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)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| • Stains positively for hPL (diffuse), p63, cytokeratin, AFP, and hCG (patchy)• Negative p63 staining
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Normal
|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Normal
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
|
| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Groin ultrasound or CT scan show presence of bowel and omentum.
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Valsalva maneuvers performed while palpating the inguinal canal will push a hernia against the examiner's finger.
|  
|  
|
|  
|  
|
|-
|-
| Epithelioid trophoblastic tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brucellosis]]<ref name="pmid27331193">{{cite journal |vauthors=Kaya F, Kocyigit A, Kaya C, Turkcuer I, Serinken M, Karabulut N |title=Brucellar Testicular Abscess Presenting as a Testicular Mass: Can Color Doppler Sonography be used in Differentiation? |journal=Turk J Emerg Med |volume=15 |issue=1 |pages=43–6 |date=March 2015 |pmid=27331193 |pmc=4909939 |doi=10.5505/1304.7361.2014.82698 |url=}}</ref><ref name="pmid11698991">{{cite journal |vauthors=Navarro-Martínez A, Solera J, Corredoira J, Beato JL, Martínez-Alfaro E, Atiénzar M, Ariza J |title=Epididymoorchitis due to Brucella mellitensis: a retrospective study of 59 patients |journal=Clin. Infect. Dis. |volume=33 |issue=12 |pages=2017–22 |date=December 2001 |pmid=11698991 |doi=10.1086/324489 |url=}}</ref><ref name="pmid17141451">{{cite journal |vauthors=Colmenero JD, Muñoz-Roca NL, Bermudez P, Plata A, Villalobos A, Reguera JM |title=Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis |journal=Diagn. Microbiol. Infect. Dis. |volume=57 |issue=4 |pages=367–72 |date=April 2007 |pmid=17141451 |doi=10.1016/j.diagmicrobio.2006.09.008 |url=}}</ref><ref name="pmid2313817">{{cite journal |vauthors=Reisman EM, Colquitt LA, Childers J, Preminger GM |title=Brucella orchitis: a rare cause of testicular enlargement |journal=J. Urol. |volume=143 |issue=4 |pages=821–2 |date=April 1990 |pmid=2313817 |doi= |url=}}</ref>
| • Infant or young adult• Painful small testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
| • Small nontender or minimally painful testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
| • Elevated serum hCG
| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
| • Variable echogenicity• No differentiating features on imaging• May have vascular flow
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Dysuria
| • Solid yellowish mass that resembles uterine tissue• Less prominent foci of hemorrhage and ncerosis• Predominance of intermediate trophoblast cells (chorionic type) that invade surrounding blood vessels• Paucity of cytotrophoblast and syncytiotrophoblast cells (unlike choriocarcinoma)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| • Stain positively for p63 (diffuse), cytokeratin, AFP, and hCG (patchy)• Negative hPL staining
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Painful local lymphadenopathy
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* CBC-[[Leukocytosis]]
|  
* raised CRP
|  
* Immunofluorescent antibody testing
|  
* Urine analysis and culture - normal
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Increased blood flow in affected side
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
|  
* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]].
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|
* Culture of the organism from blood.
|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Antibodies are detected using:
|
* Serum agglutination (standard tube agglutination)
|
* Enzyme-linked immunosorbent assay
* Rose Bengal agglutination
* Coombs test
* Immunocapture agglutination (Brucellacapt)
* 2-mercaptoethanol agglutination
|-
|-
| Mixed germ cell tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Torsion of the appendix testis<ref name="pmid16569689">{{cite journal |vauthors=Rakha E, Puls F, Saidul I, Furness P |title=Torsion of the testicular appendix: importance of associated acute inflammation |journal=J. Clin. Pathol. |volume=59 |issue=8 |pages=831–4 |date=August 2006 |pmid=16569689 |pmc=1860437 |doi=10.1136/jcp.2005.034603 |url=}}</ref><ref name="pmid9651416">{{cite journal |vauthors=Kadish HA, Bolte RG |title=A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages |journal=Pediatrics |volume=102 |issue=1 Pt 1 |pages=73–6 |date=July 1998 |pmid=9651416 |doi= |url=}}</ref><ref name="pmid7967303">{{cite journal |vauthors=Okui N, Tomita K, Kimura A, Uekane K, Kawamura T, Teshima S |title=[Heterochronic occurrence of bilateral torsion of appendix testis a case report] |language=Japanese |journal=Nippon Hinyokika Gakkai Zasshi |volume=85 |issue=9 |pages=1395–8 |date=September 1994 |pmid=7967303 |doi= |url=}}</ref><ref name="pmid25704247">{{cite journal |vauthors=Lev M, Ramon J, Mor Y, Jacobson JM, Soudack M |title=Sonographic appearances of torsion of the appendix testis and appendix epididymis in children |journal=J Clin Ultrasound |volume=43 |issue=8 |pages=485–9 |date=October 2015 |pmid=25704247 |doi=10.1002/jcu.22265 |url=}}</ref>
| • Typical age at diagnosis and other clinical features based on underlying components
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
| • Physical exam findings based on underlying components
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
| • Elevated serum hCG, AFP, and/or PALP dependeing on the underlying compoenents
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Imaging findings based on underlying components
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • Histopathological findings based on underlying components• Variable proportion of choriocarcinoma, embryonal cell carcinoma, yolk sac tumor, seminoma, and/or teratoma tissue
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| • 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
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Normal
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Normal blood flow to the testis with an occasional increase on the affected side
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* In the first 4 hours: testicular appendages shows edema and and desquamation.
|  
* 4-8 hours partial necrosis of appendix cells.
|  
* >24 hrs: necrosis
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* scrotal ultrasound shows the torsed appendage as a lesion of low echogenicity with a central hypoechogenic area.
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|
* Scrotal wall mayshow the classical "blue dot" sign, which is due to infarction and necrosis of the appendix testis
|  
|  
|
|-
|-
| Carcinoid (pure neuroendocrine neplasm)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Henoch-Schönlein purpura|Henoch-Schonlein purpura]]<ref name="pmid10934812">{{cite journal |vauthors=Choong CS, Liew KL, Liu PN, Kuo TU, Su CM |title=Acute scrotum in Henoch-Schönlein purpura |journal=Zhonghua Yi Xue Za Zhi (Taipei) |volume=63 |issue=7 |pages=577–80 |date=July 2000 |pmid=10934812 |doi= |url=}}</ref><ref name="pmid27169017">{{cite journal |vauthors=Modi S, Mohan M, Jennings A |title=Acute Scrotal Swelling in Henoch-Schonlein Purpura: Case Report and Review of the Literature |journal=Urol Case Rep |volume=6 |issue= |pages=9–11 |date=May 2016 |pmid=27169017 |pmc=4855902 |doi=10.1016/j.eucr.2016.01.004 |url=}}</ref><ref name="pmid11702171">{{cite journal |vauthors=Dayanir YO, Akdilli A, Karaman CZ, Sönmez F, Karaman G |title=Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura |journal=Eur Radiol |volume=11 |issue=11 |pages=2267–9 |date=2001 |pmid=11702171 |doi=10.1007/s003300100843 |url=}}</ref><ref name="pmid22693978">{{cite journal |vauthors=Akgun C |title=A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schönlein vasculitis |journal=Bratisl Lek Listy |volume=113 |issue=6 |pages=382–3 |date=2012 |pmid=22693978 |doi= |url=}}</ref>
| • Middle-aged and elderly adult• Manifests as a minimally painful, rapidly growing mass• May manifest as carcinoid syndrome
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
| • Tender testicular mass• Hydrocele or cryptorchidism
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
| • Elevated serum and urine 5-HIAA if carcinoid syndrome present
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Unilateral, well-circumscribed mass without vascular invasion• Solid and cystic appearance• Mixed echogenicity on ultrasound• Irregular calcifications
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • 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
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| • Stains positively for cytokeratin, serotonin, chromogranin, synaptophysin, and CD56
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Serum IgA levels are elevated
|  
* Elevated ESR
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Sore throat 2-3 weeks back
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Light microscopy shows  leukocytoclastic vasculitis in postcapillary venules with IgA deposition
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Biopsy
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Palpable purpura
|  
* Age at onset is less than 20 years
|  
* Acute abdominal pain
|
|
|
|-
|-
| PNET (Ewing's tumor of the testes)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fourniers gangrene|Fournier's gangrene]]<ref name="pmid29146218">{{cite journal |vauthors=Voelzke BB, Hagedorn JC |title=Presentation and Diagnosis of Fournier Gangrene |journal=Urology |volume=114 |issue= |pages=8–13 |date=April 2018 |pmid=29146218 |doi=10.1016/j.urology.2017.10.031 |url=}}</ref><ref name="pmid28328332">{{cite journal |vauthors=Huang CS |title=Fournier's Gangrene |journal=N. Engl. J. Med. |volume=376 |issue=12 |pages=1158 |date=March 2017 |pmid=28328332 |doi=10.1056/NEJMicm1609306 |url=}}</ref><ref name="pmid29052826">{{cite journal |vauthors=Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S, Acar A, Baş G |title=Fournier's gangrene: A retrospective analysis of 25 patients |journal=Ulus Travma Acil Cerrahi Derg |volume=23 |issue=5 |pages=400–404 |date=September 2017 |pmid=29052826 |doi=10.5505/tjtes.2017.01678 |url=}}</ref><ref name="pmid26138056">{{cite journal |vauthors=Namkoong H, Ishii M, Koizumi M, Betsuyaku T |title=Fournier's gangrene: a surgical emergency |journal=Infection |volume=44 |issue=1 |pages=143–4 |date=February 2016 |pmid=26138056 |doi=10.1007/s15010-015-0816-4 |url=}}</ref>
| • 30-50 yo man with rapidly enlarging mass• Often metastatic at presentation
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral
| • Palpable, nontender unilateral testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
| • Unremarkable
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
| • No differentiating features on imaging• Vascular flow on Dopper
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • Greyish necrotic mass of immature neural tissue• Sheet-like / rosette distribution of small round blue tumor cells• Neurosecretory granules on electron microscopy
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
| • Stains positively for synaptophysin, NSE, chromogranin, CD99, GFAP, FLI1• Split of EWS gene on chromosome 22
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Leukocytosis
|  
* Acidosis
|  
* Elevated ESR and CRP
|  
* Blood cultures are positive in majority of patient for streptococcus.
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Computed tomography (CT) scan shows most useful finding is presence of gas in soft tissues.
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Patient show signs of  tense edema outside the involved skin, blisters, bullae, crepitus, and subcutaneous gas.
|  
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|  
!Diseases
|  
!Unilateral /Bilateral swelling
|  
!Onset
! colspan="1" rowspan="1" |Fever
!Urinary symptoms
!Tender<be>-ness
!Erythema
! colspan="1" rowspan="1" |Discharge
!Inguinal Lymphadenopathy
!Cremasteric Reflex
!Blood/Urine Analysis
!Doppler U/S
!Past Medical History
!Histopathology
|'''Gold standard'''
!Additional findings
|-
|-
| Sex-Chord Stromal Tumors
! colspan="16" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Painless
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|  
|-
|-
| Fibroma
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fragile X syndrome|Fragile X]]  [[Macroorchidism]]<ref name="pmid6348096">{{cite journal |vauthors=Hagerman RJ, McBogg P, Hagerman PJ |title=The fragile X syndrome: history, diagnosis, and treatment |journal=J Dev Behav Pediatr |volume=4 |issue=2 |pages=122–30 |date=June 1983 |pmid=6348096 |doi= |url=}}</ref><ref name="pmid9678703">{{cite journal |vauthors=de Vries BB, Halley DJ, Oostra BA, Niermeijer MF |title=The fragile X syndrome |journal=J. Med. Genet. |volume=35 |issue=7 |pages=579–89 |date=July 1998 |pmid=9678703 |pmc=1051369 |doi= |url=}}</ref><ref name="pmid8190590">{{cite journal |vauthors=Lachiewicz AM, Dawson DV |title=Do young boys with fragile X syndrome have macroorchidism? |journal=Pediatrics |volume=93 |issue=6 Pt 1 |pages=992–5 |date=June 1994 |pmid=8190590 |doi= |url=}}</ref><ref name="pmid25767309">{{cite journal |vauthors=Saldarriaga W, Tassone F, González-Teshima LY, Forero-Forero JV, Ayala-Zapata S, Hagerman R |title=Fragile X syndrome |journal=Colomb. Med. |volume=45 |issue=4 |pages=190–8 |date=2014 |pmid=25767309 |pmc=4350386 |doi= |url=}}</ref>
| • Middle-aged adult (range 20-70 years) with slowly-growing, painless testicular mass• History of nevoid basal cell carcinoma (Gorlin syndrome)
| style="background: #F5F5F5; padding: 5px;" |Bilateral
| • Palpable, nontender unilateral testicular mass
| style="background: #F5F5F5; padding: 5px;" |Gradual
| • Unremarkable
| style="background: #F5F5F5; padding: 5px;" | -
| • 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
| style="background: #F5F5F5; padding: 5px;" |Absent
| • 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
| style="background: #F5F5F5; padding: 5px;" | -
| • 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
| style="background: #F5F5F5; padding: 5px;" | -
|  
| style="background: #F5F5F5; padding: 5px;" | +
|  
| style="background: #F5F5F5; padding: 5px;" |Absent
|  
| style="background: #F5F5F5; padding: 5px;" | +
|  
| style="background: #F5F5F5; padding: 5px;" |
|  
* Normal
|  
| style="background: #F5F5F5; padding: 5px;" | -
|  
| style="background: #F5F5F5; padding: 5px;" | -
|  
| style="background: #F5F5F5; padding: 5px;" |Increased volume of testis
|  
| style="background: #F5F5F5; padding: 5px;" |
|  
* FMR1 DNA analysis
|  
| style="background: #F5F5F5; padding: 5px;" |
|  
* Long and narrow face with prominent forehead and chin (prognathism)
|  
* Large ears
|  
* Intellectual Disability
|  
|  
|
|
|
|-
|-
| Granulosa cell tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Tumors<ref name="pmid28967388">{{cite journal |vauthors=Shen J, Bi Y, Wang X, Lu L, Tang L, Liu Y, Chen H, Zhang B |title=Epidemiologic study of 230 cases of testicular/paratesticular tumors or masses: 15-year experience of a single center |journal=J. Pediatr. Surg. |volume=52 |issue=12 |pages=2056–2060 |date=December 2017 |pmid=28967388 |doi=10.1016/j.jpedsurg.2017.08.027 |url=}}</ref><ref name="pmid25096628">{{cite journal |vauthors=Hohšteter M, Artuković B, Severin K, Kurilj AG, Beck A, Šoštarić-Zuckermann IC, Grabarević Ž |title=Canine testicular tumors: two types of seminomas can be differentiated by immunohistochemistry |journal=BMC Vet. Res. |volume=10 |issue= |pages=169 |date=August 2014 |pmid=25096628 |pmc=4129470 |doi=10.1186/s12917-014-0169-8 |url=}}</ref><ref name="pmid22677786">{{cite journal |vauthors=McDonald MW, Reed AB, Tran PT, Evans LA |title=Testicular tumor ultrasound characteristics and association with histopathology |journal=Urol. Int. |volume=89 |issue=2 |pages=196–202 |date=2012 |pmid=22677786 |doi=10.1159/000338771 |url=}}</ref><ref name="pmid28549629">{{cite journal |vauthors=Naouar S, Braiek S, El Kamel R |title=Testicular tumors of adrenogenital syndrome: From physiopathology to therapy |journal=Presse Med |volume=46 |issue=6 Pt 1 |pages=572–578 |date=June 2017 |pmid=28549629 |doi=10.1016/j.lpm.2017.05.006 |url=}}</ref>
| • 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)
| style="background: #F5F5F5; padding: 5px;" |Unilateral or bilateral
| • Palpable, nontender unilateral testicular mass
| style="background: #F5F5F5; padding: 5px;" |Gradual
| • Unremarkable
| style="background: #F5F5F5; padding: 5px;" |±
| • Hypoechoic mass with solid and cystic appearance on ultrasound (swiss-cheese appearance)
| style="background: #F5F5F5; padding: 5px;" |Absent
| • 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
| style="background: #F5F5F5; padding: 5px;  text-align: center;" | ±
| • Stains positively for calretinin, inhibin, vimentin, actin, and MIC2
| style="background: #F5F5F5; padding: 5px;" |
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px;" |Present
|  
| style="background: #F5F5F5; padding: 5px;" | +
|  
| style="background: #F5F5F5; padding: 5px;" |
|  
* Increased serum beta-hCG or alpha fetoprotien (AFP)
|  
| style="background: #F5F5F5; padding: 5px;" | -
|  
| style="background: #F5F5F5; padding: 5px;" | -
|  
| style="background: #F5F5F5; padding: 5px;" |Seminoma  shows findings such as:
|  
* Large [[cells]] with watery [[cytoplasm]]
|  
* Fried egg [[appearance]]
|  
| style="background: #F5F5F5; padding: 5px;" |
|  
* Biopsy
|  
| style="background: #F5F5F5; padding: 5px;" |
|  
* Pain in the back or abdomen
|  
* [[Ascites]]
|
* [[Weight loss]]
|
* [[Gynecomastia]]
|
* Precocious Puberty
|
* [[Infertility]]
|-
|-
| Leydig (interstitial) cell tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid28551604">{{cite journal |vauthors=Costantino E, Ganesan GS, Plaire JC |title=Abdominoscrotal hydrocele in an infant boy |journal=BMJ Case Rep |volume=2017 |issue= |pages= |date=May 2017 |pmid=28551604 |doi=10.1136/bcr-2017-220370 |url=}}</ref><ref name="pmid26708803">{{cite journal |vauthors=Kaefer M, Agarwal D, Misseri R, Whittam B, Hubert K, Szymanski K, Rink R, Cain MP |title=Treatment of contralateral hydrocele in neonatal testicular torsion: Is less more? |journal=J Pediatr Urol |volume=12 |issue=5 |pages=306.e1–306.e4 |date=October 2016 |pmid=26708803 |doi=10.1016/j.jpurol.2015.07.009 |url=}}</ref><ref name="pmid174600034">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref><ref name="pmid28389795">{{cite journal |vauthors=Chen Y, Wang F, Zhong H, Zhao J, Li Y, Shi Z |title=A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele |journal=Surg Endosc |volume=31 |issue=12 |pages=4888–4901 |date=December 2017 |pmid=28389795 |doi=10.1007/s00464-017-5491-3 |url=}}</ref><ref name="pmid21592287">{{cite journal |vauthors=Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA |title=Adult hydrocele and spermatocele |journal=BJU Int. |volume=107 |issue=11 |pages=1852–64 |date=June 2011 |pmid=21592287 |doi=10.1111/j.1464-410X.2011.10353.x |url=}}</ref>
| • Bimodal age distribution• Slowly enlarging painless unilateral mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral
| • Palpable, nontender unilateral testicular mass• Signs of excess estradiol (e.g. gynecomastia)
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
| • Unremarkable
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Well-defined, hypoechoic solid mass on ultrasound• May have cystic component• Irregular calcifications
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • 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
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| • Mutation in fumarate hydratase• Stains positively for inhibin, cytokeratin, calretinin, synaptophysin, vimentin, Melan-A
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Normal
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* [[Ultrasound|Ultrasound:]] simple fluid collection
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Transillumination test is positive
|  
|  
|  
|  
|  
|  
|
|-
|-
| Sertoli hyperplasia (Sertoli adenoma, Pick's adenoma)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Varicocele]]<ref name="pmid28865534">{{cite journal |vauthors=Clavijo RI, Carrasquillo R, Ramasamy R |title=Varicoceles: prevalence and pathogenesis in adult men |journal=Fertil. Steril. |volume=108 |issue=3 |pages=364–369 |date=September 2017 |pmid=28865534 |doi=10.1016/j.fertnstert.2017.06.036 |url=}}</ref><ref name="pmid174600033">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref><ref name="pmid28851509">{{cite journal |vauthors=Locke JA, Noparast M, Afshar K |title=Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials |journal=J Pediatr Urol |volume=13 |issue=5 |pages=437–445 |date=October 2017 |pmid=28851509 |doi=10.1016/j.jpurol.2017.07.008 |url=}}</ref><ref name="pmid26806081">{{cite journal |vauthors=Shridharani A, Owen RC, Elkelany OO, Kim ED |title=The significance of clinical practice guidelines on adult varicocele detection and management |journal=Asian J. Androl. |volume=18 |issue=2 |pages=269–75 |date=2016 |pmid=26806081 |doi=10.4103/1008-682X.172641 |url=}}</ref>
| • Child or young adult with history of Peutz-Jegher syndrome, androgen insensitivity syndrome, or McCune Albright syndrome• Slowly enlarging painless bilateral masses
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
| • Palpable, nontender bilateral testicular masses• Signs of excess estradiol (e.g. gynecomastia)
(Mainly left)
| • Elevated serum estradiol • Elevated anti-Mullerian hormone and inhibin B• Reduced androgen concentration
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
| • Hyperechogenic nodules on ultrasound
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Local warmth
| • Well-demarcated yellowish nodules in the testis• Unencapsulated nodules composed of Sertoli cells
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
| • Stains positively for anti-Mullerian hormone, inhibin A, CK8, and CK18• Negative staining for AFP, hCG, and p53•
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Elevations in unstimulated luteinizing hormone and follicle stimulating hormone levels  may be seen in when associated with infertility in adults
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Thrombosis of Inferiror vena cava 
|
* Thrombosis of Right renal vein 
|
* Abdominal mass 
|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* [[Renal cancer]]
|  
* [[Nephrectomy]]
|  
* Nut-cracker syndrome
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Ultrasonography: [[tortuous]], [[tubular]], anechoic structures adjacent to the testis corresponding to dilated veins of the [[pampiniform plexus]] with calibers of 2–3 mm during the [[Valsalva maneuver]]
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|
* Infertility
|-
|-
| Large cell calcifying Sertoli cell tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]<ref name="pmid174600032">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref><ref name="pmid21592287">{{cite journal |vauthors=Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA |title=Adult hydrocele and spermatocele |journal=BJU Int. |volume=107 |issue=11 |pages=1852–64 |date=June 2011 |pmid=21592287 |doi=10.1111/j.1464-410X.2011.10353.x |url=}}</ref><ref name="pmid17606432">{{cite journal |vauthors=Yeh HC, Wang CJ, Liu CC, Wu WJ, Chou YH, Huang CH |title=Giant spermatocele mimicking hydrocele: a case report |journal=Kaohsiung J. Med. Sci. |volume=23 |issue=7 |pages=366–9 |date=July 2007 |pmid=17606432 |doi=10.1016/S1607-551X(09)70423-1 |url=}}</ref>
| • Young patient with history of Carney syndrome, Peutz-Jeghers syndrome, or tuberous sclerosis• Slowly enlarging painless unilateral/bilateral mass(es)
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
| • Palpable, nontender unilateral or bilateral testicular mass• Signs of excess estradiol (e.g. gynecomastia)
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
| • Elevated serum estradiol
| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
| • Diffuse and regular (smooth, rounded, large) calcifications• Variable appearance on ultrasound• Often multiple hyperechogenic regions with strong shadowing • Possible increased blood flow
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
| • 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
| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
| • Stains positively for inhibin, vimentin, calretinin, S100, and cytokeratin• Negative staining for laminin, PALP, AFP, and hCG
| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Falling snow, resulting from internal echoes moving away from the transducer
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Epididymitis
|
* Trauma
|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Epididymal scarring is seen
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|
* [[Ultrasonography]]: hypoechoic with posterior acoustic enhancement
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* Transillumination test is positive
|
|  
|  
|
|-
|-
| Sclerosing Sertoli cell tumor
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal edema<ref name="pmid28316300">{{cite journal |vauthors=Geffre M, Maki C, Maier S |title=Acute Scrotal Edema in Cirrhotic after Laparoscopic Cholecystectomy |journal=Am Surg |volume=83 |issue=3 |pages=e93–95 |date=March 2017 |pmid=28316300 |doi= |url=}}</ref><ref name="pmid28625172">{{cite journal |vauthors=Esposito F, Sanchez O, Siebert JN, Manzano S |title=Acute scrotal idiopathic edema: A misleading erythema |journal=CJEM |volume=20 |issue=S2 |pages=S37 |date=October 2018 |pmid=28625172 |doi=10.1017/cem.2017.343 |url=}}</ref>
| • Variable age at presentation (adolescence to elderly)• Slowly enlarging painless unilateral mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral and can extend to perineum
| • Palpable, nontender unilateral testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
| • Unremarkable
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Well-circumscribed hypoechogenic lesion on ultrasound
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • Well-circumscribed, yellowish-grey nodule• Absent hemorrhage or necrosis• Tubuules and cords of Sertoli cells surrounded by hypocellular collagenous strome (sclerosis)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| • Stains positively for calretinin, inhibin, and vimentin• Negative staining for cytokeratin, AFP, and hCG
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* [[Eosinophilia]]
|
* Hypoalbuminemia
|  
* Hyperlipidemia.
|  
* Proteinurea
|
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|
* Deep Vein Thrombosis
|
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Nephrotic Syndrome
|  
* Hepatic Cirrhosis
|  
* Insect Bite
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Kidney or Liver biopsy
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|
* Occurs between 4-12 years of age.
|-
|-
| Sertoli tumor, non-specific
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sebaceous cyst]]<ref name="pmid26400592">{{cite journal |vauthors=Solanki A, Narang S, Kathpalia R, Goel A |title=Scrotal calcinosis: pathogenetic link with epidermal cyst |journal=BMJ Case Rep |volume=2015 |issue= |pages= |date=September 2015 |pmid=26400592 |pmc=4593290 |doi=10.1136/bcr-2015-211163 |url=}}</ref><ref name="pmid25297369">{{cite journal |vauthors=Prasad KK, Manjunath RD |title=Multiple epidermal cysts of scrotum |journal=Indian J. Med. Res. |volume=140 |issue=2 |pages=318 |date=August 2014 |pmid=25297369 |pmc=4216510 |doi= |url=}}</ref><ref name="pmid25015622">{{cite journal |vauthors=Ząbkowski T, Wajszczuk M |title=Epidermoid cyst of the scrotum: a clinical case |journal=Urol J |volume=11 |issue=3 |pages=1706–9 |date=July 2014 |pmid=25015622 |doi= |url=}}</ref>
| • Bimodal age districution: either 40-50 year old man or infants with history of Carney syndrome or Peutz-Jegher syndrome• Slowly enlarging testicular mass
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
| • Palpable, nontender unilateral testicular mass• Signs of excess estradiol (e.g. gynecomastia)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
| • Often unremarkable• Elevated serum estradiol may be present, less common
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Well-circumscribed mass with variable echogenicity
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • 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
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Stains positively for vimentin, cytokeratin, inhibin, S100, chromogranin, synaptophysin, and CD99• Negative staining for hCG, AFP, and PLAP
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Normal
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* [[Fibrous tissues]] and fluids
|  
* A fatty,([[keratinous]]), substance that resembles cottage cheese,.
|
* A viscous, serosanguinous fluid (containing [[purulent]] and bloody material).
|
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|
* Histological examination
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Freely movable on palpation.
|
|  
|  
|
|-
|-
| Sertoli-Leydig cell tumor (SLCT)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scrotum Carcinoma|Carcinoma of the scrotum]]<ref name="pmid21791720">{{cite journal |vauthors=Casasola Chamorro J, Gutiérrez García S, de Blas Gómez V |title=Scrotal carcinoma |journal=Arch. Esp. Urol. |volume=64 |issue=6 |pages=541–3 |date=July 2011 |pmid=21791720 |doi= |url=}}</ref><ref name="pmid26113906">{{cite journal |vauthors=Halfya A, Elmortaji K, Redouane R, Fethi M, Rafik A, Mohamed E, Abdessamad C |title=[Squamous cell carcinomas of the scrotum: about 7 cases with review of the literature] |language=French |journal=Pan Afr Med J |volume=20 |issue= |pages=163 |date=2015 |pmid=26113906 |pmc=4469445 |doi=10.11604/pamj.2015.20.163.5991 |url=}}</ref><ref name="pmid26959967">{{cite journal |vauthors=Armas-Alvarez AL, Salinas-Sánchez AS, Atienzar-Tobarra M, Virseda-Rodríguez JA |title=Scrotal tumors |journal=Arch. Esp. Urol. |volume=69 |issue=2 |pages=86–9 |date=March 2016 |pmid=26959967 |doi= |url=}}</ref>
| • Young adult or phenotypic female with history of androgen insensitivity• Slowly enlarging painless unilateral mass•
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Palpable, nontender unilateral testicular mass• Signs of excess estradiol (e.g. gynecomastia)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
| • Often unremarkable• Elevated serum estradiol may be present, less common• Abrnomally elevated testosterone among pts with androgen insensitivity
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Well-circumscribed mass with variable echogenicity• Solid mass with intratumoral cysts may be present
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • 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)
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| • Stains positively for inhibin, melanA, and CD99• Negative staining for EMA, PLAP, and S100
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
|  
* Normal
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
|  
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|  
* keratinocytic dysplasia involving the full thickness of the epidermis without infiltration of atypical cells into the dermis.
|  
* The keratinocytes are pleomorphic with hyperchromatic nuclei
|  
* Numerous mitoses are present.
|  
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* Biopsy
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* Scaly patch or plaque is seen over the testis.
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| Testicular tumor of andrenogenital syndrome (testicular adrenal rest tumor)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[filariasis|Chylocele]] ([[Filariasis]])<ref name="pmid25989164">{{cite journal |vauthors=Otabil KB, Tenkorang SB |title=Filarial hydrocele: a neglected condition of a neglected tropical disease |journal=J Infect Dev Ctries |volume=9 |issue=5 |pages=456–62 |date=March 2015 |pmid=25989164 |doi=10.3855/jidc.5346 |url=}}</ref><ref name="pmid28507911">{{cite journal |vauthors=Janssen KM, Willis CJ, Anderson M, Gelnett MS, Wickersham EL, Brand TC |title=Filariasis Orchitis-Differential for Acute Scrotum Pathology |journal=Urol Case Rep |volume=13 |issue= |pages=117–119 |date=July 2017 |pmid=28507911 |pmc=5426035 |doi=10.1016/j.eucr.2017.04.002 |url=}}</ref><ref name="pmid21771446">{{cite journal |vauthors=Yagain K, Mathew M |title=Filariasis presenting as a scrotal nodule in a 2 year old child: a case report |journal=Asian Pac J Trop Med |volume=4 |issue=2 |pages=167–8 |date=February 2011 |pmid=21771446 |doi=10.1016/S1995-7645(11)60062-X |url=}}</ref>
| • Post-pubertal patient with history of congenital adrenal hyperplasia (CAH)• Often asymptomatic, detected during screening in patients with CAH
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
| • Unremarkable testicular exam• Other signs of congenital adrenal hyperplasia
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradually
| • Elevated 11-beta-hydroxylase activity• Reduced concentrations of AFP, LDH, and hCG
Rapidly
| • Uniform hypoechogenicity on ultrasound• Usually multifocal and bilateral lesions
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| • Hyperplasia, bilateral lesions in testicular hilum• Yellowish nodules• Cells resemble adrenocortical cells, no mitoses• Normal surrounding tissue• Absent Reinke crystals
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| • Stains positively for CD56, synaptophysin, and inhibin• Negative staining for androgen receptor protein•
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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* Circulating filarial antigen (CFA) assays are positve
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| style="background: #F5F5F5; padding: 5px; text-align: left;" |
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* Lymphatics containing worms can be differentiated from the blood vessels by irregular movement
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* CFA assay
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| style="background: #F5F5F5; padding: 5px; text-align: left;" |
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* Ultrasound demonstrates living worms which has been described as  "filarial dance" sign.
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| Other tumors
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotoliths<ref name="pmid21935341">{{cite journal |vauthors=Khallouk A, Yazami OE, Mellas S, Tazi MF, El Fassi J, Farih MH |title=Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment |journal=Rev Urol |volume=13 |issue=2 |pages=95–7 |date=2011 |pmid=21935341 |pmc=3176555 |doi= |url=}}</ref><ref name="pmid16836500">{{cite journal |vauthors=Noël B, Bron C, Künzle N, De Heller M, Panizzon RG |title=Multiple nodules of the scrotum: histopathological findings and surgical procedure. A study of five cases |journal=J Eur Acad Dermatol Venereol |volume=20 |issue=6 |pages=707–10 |date=July 2006 |pmid=16836500 |doi=10.1111/j.1468-3083.2006.01578.x |url=}}</ref><ref name="pmid8790314">{{cite journal |vauthors=Polk P, McCutchen WT, Phillips JG, Biggs PJ |title=Polypoid scrotal calcinosis: an uncommon variant of scrotal calcinosis |journal=South. Med. J. |volume=89 |issue=9 |pages=896–7 |date=September 1996 |pmid=8790314 |doi= |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* Normal
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* Trauma
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* Torsion of appendix
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| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
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* Ultrasound
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| style="background: #F5F5F5; padding: 5px; text-align: left;" |
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* Ultrasound shows  mobile hyperechoic extratesticular focus in the potential tunica space.
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| Lymphoma
| • Elderly patient (>60 years) with history of lymphoma (commonly diffuse large B cell lymphoma)• Unilateral or bilateral painless testicular mass
| • Palpable, nontender unilateral or bilateral testicular mass
| • Depends on lymphoma subtype
| • Diffuse infiltration• Hypoechoic solid masses on ultrasound• Hypervascularity on Doppler ultrasound
| • Whitish-tan colored mass• Large, pleomorphic malignant cells• Seminiferous tubules may be spared or undergo sclerosis• Vascular invasion
| • Stains positively for CD45• Depends mainly on lymphoma subtype• Usually negative staining for PLAP and SALL4
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| Angiosarcoma
| • Bimodal age distribution• Young man with history of teratoma or elderly man with history of radiation or chronic hydrocele• Painless/painful testicular mass
| • Tender or non-tender testicular mass• Low-grade fever• Scrotal swelling• Flank pain• Hydrocele
| • Often unremarkable
| • Hypervascularity on Doppler ultrasound
| • Solid vascular lesion• Classical pattern of proliferating anastomosing blood-filled channels• 2 patterns: solid (sheet proliferation without lumen) and primitive (small lumina filled withblood)
| • Stains positively for CD31, CD34, lectin, and factor VIII-related antigen• Negative staining for pancytokeratin, PLAP, CD45, CD68, CAM5.2, and AE1/AE3
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| Chondrosarcoma
| • Young or middle-aged adult with history of teratoma• Painless testicular mass
| • Palpable, non-tender, heterogeneous mass
| • Often unremarkable
| • Lobulated mass
| • Firm, grey mass with irregular lobulations• Cartilaginous (chondroid) matrix surrounded by fibrovascular bands• Most have non-cartilagenous components (rarely pure)
| • Stains positively for S100
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| Hemangioma
| • Painless testicular mass among pts of any age
| • Palpable, non-tender, homogeneous mass
| • Often unremarkable
| • Homogeneous hypoechoic mass• Hypervascularity on Doppler ultrasound
| • Well-defined hemorrhagic mass• Red blood cells in tubules
| • Stains positively for CD31, CD34, FLI1, and factor VIII-related antigen• Negative staining for pancytokeratin, AE, keratin, PLAP, and EMA
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| Mesothelioma
| • Middle aged man with painless testicular mass and history of hydrocele or exposure to asbestos
| • Palpable, non-tender testicular mass• Scrotal swelling
| • Often unremarkable
| • Thickening of tunica vaginais• Solid paratesticular mass• Hydrocele
| • May be benign or malignant• Papillary patterns of uniform epithelioid cells with fibrovacular core• Polygonal cells with microvilli on electron microscopy• Psammoma bodies
| • 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
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| Plasmacytoma
| • Adult (of any age) with concurrent or history of plasma cell neoplasia (commonly multiple myeloma)• Symptoms of multiple myeloma (e.g. fatigue, back pain)
| • Testicular exam unremarkable
| • Lab findings of plasmacytosis (e.g. anemia, elevated creatinine, hypercalcemia)• No specific lab finding for testicular involvement
| • Poorly circumscribed hypoechoic lesions on ultrasound• Hypervascularity on Doppler ultrasound
| • Large, tan-yellow mass• Areas of hemorrahgeAtypical plasma cellsTubule effacement in the center and tubule sparing in the periphery
| • Positive staining for EMA, CD45, CD79am CD138, kappa or lambda light chains, and other plasma cell markers
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| Non-neoplasic lesions
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| Adrenal cortical rest
| • Usually asymptomatic (incidental finding)• Young man with scrotal swelling and dull pain• History of congenital adrenal hyperplasia (hydroxylase deficiency)
| • Scrotal swelling
| • May be unremarkable• If secretory, elevated concentration of adrenal hormone
| • Heterogeneous, well-circumscribed hypoechoic mass on ultrasound• No or minimal vascularity on Doppler• No distinguishing features
| • Well-circumscribed, small, round, orange-yellow nodule• Adrenal cortical tissue with absence of adrenal medullary tissue
| • Positive staining for  markers of cortical adrenal tissue
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| Chylocele
| • Scrotal swelling in a man with history of filariasis / elephantiasis
| • Scrotal swelling• Negative trans-illumination test
| • Unremarkable
| • Fluid collection surrounding the testes
| • Milky chylous fluid (not waterry) on aspiration• Usually no evidence of microfliariae in chylous fluid• Abundant leukocytes
| N/A
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| Cystic dysplasia
| • Young child with history of renal agenesis / dysplasia• May be unilateral or bilateral, painless testicular mass•
| • Palpable, non-tender testicular mass
| • Unremarkable
| • Irregular cystic spaces witht varying sizes• Absence of solid or vascular components•
| • Varying cystic spaces• Formation of incomplete connective tissue septa• Cells resembling the normal adult rete testes
| N/A
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| Dermoid cyst
| • Young or middle aged adult with slowly growing painless mass• Ruptured cyst may manifest with scrotal swelling, erythema, and pain
| • Palpable, nontender unilateral testicular mass• Usually heterogeneous enlargement
| • Unremarkable
| • Onioin-skin appearance on ultrasound• Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound• No vacular flow on Doppler
| • 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
| • Absence of any mutation (normal 12p)• Stains positively for cytokeratin
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| Epidermoid cyst (keratocyst)
| • 10-40 yo • Painless slowly growing testicular mass• Ruptured cyst may manifest with scrotal swelling, erythema, and pain
| • Palpable, non-tender testicular mass• Usually heterogeneous enlargement
| • Unremarkable
| • Onioin-skin appearance on ultrasound• Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound• No vacular flow on Doppler
| • 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
| • Absence of any mutation (normal 12p)
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| Granulomatous orchitis
| • 40-60 yo man with sudden-onset testicular tenderness and mass formation• History of infection, sarcoidosis, or testicular trauma
| • Tender testicular mass• Fever
| • Unremarkable
| • Solid hypoechoic mass
| • Solid nodule• Lymphocytic infiltration and formation of giant cells and macrophages • Not true granuloma
| N/A
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| Hematocele
| • Scrotal mass in patients with history of testicular trauma, torsion, or increased bleeding tendency
| • Scrotal swelling• Negative trans-illumination test
| • Unremarkable
| • Fluid collection surrounding the testes
| • Bloody fluid on aspiration
| N/A
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| Hydrocele
| • Scrotal mass in patients with history of testicular trauma or epidymitis
| • Scrotal swelling• Positive trans-illumination test
| • Unremarkable
| • Fluid collection surrounding the testes
| • Clear fluid on aspiration
| N/A
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| Macroorchidism
| • History of fragile X syndrome, FSH secreting adenoma
| • Large testicle (the testicle itself is large)• Signs of underlying disease•
| • May have elevated hormone concentration (e.g. FSH) if secretory adenoma
| • Large testicle, but normal architecture
| Normal testicular findings
| N/A
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| Malakoplakia
| • Young man with long-standing symptoms of orchi-epididymitis (pain, scrotal swelling) • History of immunosuppression
| • Palpable, tender testicular mass• Scrotal swelling• Erythema
| • Positive culture results for bacterial infection (chronic inflammation)
| • Hypoechogenic mass on ultrasound• Increased vascularity on Doppler
| • 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)
| N/A
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| Meconium periorchitis
| • Neonate or infant (delayed diagnosis) with history of meconium peritonitis (leakage from patent processus vaginalis to scrotum)
| • Palpable, non-tender testicular mass
| • Unremarkable
| • Hypoechogenic mass  with shadowing calcifications• Normal testicle with normal blood flow
| • Greenish-yellowish masss with dystrophic calcifications (meconium converts to fibrous solid mass)• Calcifications either fibroadhesive or cystic• Hemosiderin laden macrophages• Lanugo hairs, bile pigments, cholesterol, mucin, and other components normally present in meconium• Myxoid stroma
| N/A
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| Testicular Vasculitis
| • Middle aged man with history of polyarteritis nodosa (less commonly granulomatosis with polyangiomatosis, Henoch-Schonlein purpura, or giant cell arteritis)• History of HBV or HIVPainful testicular mass with intra-testicular hemorrhage• Symptoms of underlying vasculitis
| • Signs of underlying vasculitis• Palpable, tender testicular mass• Scrotal swelling if vasculitis includes extratesticular structures
| • Unremarkable
| • Heterogeneous, hypoechogenic lesion on ultrasound• Inreased intralesional vascularity on Doppler
| • Soft, dark red lesion with areas of hemorrhage• Fibrinoid necrosis• Vascular wall fibrosis
| N/A
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| Fibrous proliferation (paratesticular fibrous pseudotumor)
| • Patients of all ages (peak during young adulthood)• Slowly growing painless unilateral scrotal masss• History of genitourinary infection or trauma
| • Palpable, non-tender scrotal mass
| • Unremarkable
| • Paratesticular mass between tunica layers• Hypoechogenic solid mass on ultrasound• No vascularity on Doppler
| • Whitish mass with multinoduular thickening• Collagen-rich fibrous tissue with increased fibroblasts• Dystrophic calcifications• No hemorrhage or necrosis
| • Stains positiively for actin and keratin• Negative staining for ALK-1, beta-catenin
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| Polyorchism (supranumerary testes)
| • Often asymptomatic (incidental finding)• Young patient with scrotal pain, swelling, hydrocele, varicocele • Patients may present with testicular torsion
| • Palpable, non-tender scrotal mass• Scrotal swelling• Testicular torsion manifests with excruciating testicular or pelvic pain, erythema, and swelling
| • Unremarkable
| • Isoechogenic scrotal mass
| • Normal testicular tissue
| N/A
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| Spermatocele
| • Young or middle aged adult with painless testicular or scrotal mass
| • Homogeneous palpable non-tender testicular or scrotal mass
| • Unremarkable
| • Well-defined cystic dilation of the rete testis or head of the epididymis
| • Cuboidal / flat and ciliated epithelium• Presence of numerous spermatozoa•
| N/A
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| Splenogodal fusion syndrome (ectopic scrotal spleen)
| • Child or adolescent with painless, left scrotal mass (not right) and history of perimelia (continuous subtype) or cardiac defect (discontinuous subtype)
| • Homogeneous palpable non-tender scrotal mass
| • Unremarkable
| • Well-defined, homogeneous,, hypoechoic mass on ultrasound• Increased vascular flow on Doppler
| • Splenic tissue (red with clear boundaries)• Occasional calcification, thrombi, or fibrosis
| N/A
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| Varicocele
| • Often asymptomatic• Dull or sharp testicular pain that increases with standing or physical activity and improves when lying down• History of infertility
| • Scrotal mass and swelling• Often left-sided• Dilated, tortuous veins • "Bag of worms" sensation upon palpation
| • Unremarkable
| • 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
| • Testicular atrophy in advanced cases
| N/A
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| Testicular torsion
| • Excruciating, acute, sharp testicular pain that radiates to the pelvis and abdomen• Testicular swelling and pain
| • Scrotal swelling and tenderness• •
| • Unremarkable
| • Focal/diffuse hypoechogenicity on ultrasound• No blood flow on Doppler (vs. increased flow in infections)• Scrotal wall thickening
| • • •
| N/A
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| Scrotal
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| AIDS-related testicular tumor
| • Commonly testicular lymphoma or germ cell tumor• Patient with history of AIDS presents with testicular swelling or pain• Systemic manifestations of underlying malignancy
| • Palpable testicular mass that may be tender or non-tender
| • Depends on underlying malignancy
| • Depends on underlying malignancy
| • Depends on underlying malignancy
| • Depends on underlying malignancy
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| Brucellosis
| • 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
| • Tender testicular mass• Fever• Hydrocele
| • Elevated WBC count• Positive serum STA test for brucellosis• Elevated Brucella IgM and IgG antibodies• Urine PCR positive for Brucella spp.
| • Focal/diffuse heterogeneous, hypoechoic intratesticular mass on ultrasound• Focal/diffuse increased blood flow on Doppler• Scrotal wall thickening
| • Abscess formation at diagnosis is common• Grey-white mass suggestive of testicular atrophy• Granulomatous inflammation with lymphocytic infiltration
| N/A
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| Gonorrhea infection
| • Patient with history of unprotected sexual intercourse presents with unilaterla testicular pain, swelling, and fever• May be either acute or chronic
| • Tender testicular mass• Fever• Hydrocele
| • Elevated WBC count• Gram-negative diplococci on urethral Gram stain• Urine PCR positive for Gonorrhea
| • Focal/diffuse hypoechogenicity on ultrasound• Focal/diffusre increased blood flow on Doppler• Scrotal wall thickening
| • Granulomatous inflammation with lymphocytic infiltration
| • Urethral Gram stain demonstrates Gram-negative diplococci
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| Histoplasma infection
| • Chronic testicular enlargement• Patients may have systemic manifestations of histoplasmosis•
| • Tender/non-tender testicular mass
| • Elevated WBC count and eosinophilia may be present (may be normal in chronic cases)
| • Focal/diffuse hypoechogenicity on ultrasound• Focal/diffusre increased blood flow on Doppler• Scrotal wall thickening
| • Caseating granuloma with giant cells
| • Yeast observed on silver stain
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| Mumps
| • Post-pubertal man with recent manifestations of mumps (e.g. parotiditis, pancreatitis, arthritis, myocarditis, meningoencephalitis) presents with acute, unilateral painful testicular mass
| • Tender testicular mass• Hydrocele• Fever• Parotiditis• Rash
| • Elevated WBC• Elevated paramyxovirus IgM and IgG• Urine PCR positive for paramyxovirus
| • Focal/diffuse hypoechogenicity on ultrasound• Focal/diffusre increased blood flow on Doppler• Scrotal wall thickening
| • Non-specific interstitial edema, degenerative changes, vascular dilation • Lymphocytic infiltration
| N/A
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| Pyogenic epididymo-orchitis
| • Patient with history of unprotected sexual intercourse presents with acute scrotal swelling and pain
| • Tender testicular mass• Fever• Hydrocele
| • Elevated WBC• Bacterial growth on urethral swab specimin (usually E. coli)• Urine PCR positive for offending bacterial agent
| • Focal/diffuse hypoechogenicity on ultrasound• Focal/diffusre increased blood flow on Doppler• Scrotal wall thickening
| • Abscess formation in advanced cases• Non-specific interstitial edema, degenerative changes, vascular dilation • Lymphocytic infiltration• Grey-white mass suggestive of testicular atrophy
| N/A
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| Syphilis
| • 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
| • Irregular tender testicular mass• Thickened epididymis• Hydrocele
| • Positive syphilis serology (suggest latent syphilis)• VDRL may be either positiive or negative • Positive dark field microscopy from lesion content
| • Heterogeneous hypoechogenicity on ultrasound• Solid and cystic appearance with areas of necrosis• May have increased blood flow on Doppler
| • 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
| • May stain positively for silver-based methods (Warthin-Starry stain, Wright stain, Levaditi stain)• •
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| Tuberculosis
| • 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)
| • Irregular testicular mass• May be tender or non-tender• Thickened scrotal skin• Hydrocele
| • Ejaculum may demonstrate positive acid fast bacilli (AFB) staining
| • Heterogeneous hypoechogenicity on ultrasound• No/minimal blood flow on Doppler• Hypointense lesion on T1WI MRI and hyperintense on T2WI MRI
| • Possible abscess formation • Caseating necrosis• Epithelioid cells and lymphocytic infiltration with presence of multinucleated giant cells
| • Positive acid fast bacilli staining
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[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Oncology]]


==References==
==References==
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[[Category:Oncology]]
[[Category:Oncology]]


{{WS}}
[[Category:Up-To-Date]]
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[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Urology]]

Latest revision as of 15:16, 23 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2] Preeti Singh, M.B.B.S.[3]

Overview

Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.

Differentiating Scrotal masses from the other Diseases

Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.

Diseases Clinical manifestations Para-clinical findings Gold standard Associated
Symptoms Physical examination
Lab Findings Past Medical History Histopathology
Unilateral /Bilateral swelling Onset Fever Urinary symptoms Tender
-ness 		Erythema Discharge Inguinal Lymphadenopathy Cremasteric Reflex Blood/Urine Analysis Doppler U/S
Painful
Epididymitis[1][2]
[3][4][5][6][7][8] 		Unilateral Gradual ± Dysuria, frequency, and/or urgency + - +

(Pyuria Bacteriuria)

Painful local lymphadenopathy +
  • CBC-Leukocytosis
  • Urine culture (pre-pubertal and elderly)
  • NAAT
  • Immunofluorescent antibody testing
  • Decreased epididymal blood flow
Orchitis

(Mumps)[9][10][11][12]
[13][8][7][14]

Bilateral Abrupt ± Dysuria + - ± Painful local lymphadenopathy +
  • CBC-Leukocytosis
  • raised CRP
  • Immunofluorescent antibody testing
  • Urine analysis and culture - normal
  • Increased blood flow in affected side.
  • Tubules are infiltration with neutrophiles, lymphocytes and cells resembling histiocytes
  • Microscopic destruction of spermatogenic cells
  • RT‐PCR
  • Serum immunofluorescence antibody testing.
  • Phen sign +ve
  • Testicular atrophy
  • Infertility
Testicular Torsion[15][16][17][18][19][7] Unilateral Sudden - Absent + + +

Blood in semen may be present

Absent -
  • Normal
  • Absent or decreased arterial perfusion of the testis
  • In the first 4 hours: testicular parenchyma shows edema and and desquamation of the germ cells
  • 4-8 hours partial necrosis of germ cells.
  • >24 hrs: necrosis
  • Phen sign +ve
Hematocele[20][21]
[22][23][24] 		Unilateral or bilateral Sudden - Absent + + +

Blood in semen

Absent -
  • Urinalysis may be the only indication of injury to urinary tract
  • Hematuria.
 Scrotal wall thickening and testicular hematoma Testicular trauma related to:
  • Increased destruction and fibrosis of the dartos fascia,.
  • Dense inflammatory cells, necrotic areas and destruction of the muscular layer.
  • Ultrasonography: to check for testicular rupture.
 _
Incarcerated Hernia[25][26] Unilateral Sudden + Absent + + - Absent +
  • Normal
  • Normal
 - -
  • Groin ultrasound or CT scan show presence of bowel and omentum.
  • Valsalva maneuvers performed while palpating the inguinal canal will push a hernia against the examiner's finger.
Brucellosis[27][28][29][30] Unilateral or Bilateral Sudden ± Dysuria - - ± Painful local lymphadenopathy +
  • CBC-Leukocytosis
  • raised CRP
  • Immunofluorescent antibody testing
  • Urine analysis and culture - normal
  • Increased blood flow in affected side
 -
  • Culture of the organism from blood.
 Antibodies are detected using:
  • Serum agglutination (standard tube agglutination)
  • Enzyme-linked immunosorbent assay
  • Rose Bengal agglutination
  • Coombs test
  • Immunocapture agglutination (Brucellacapt)
  • 2-mercaptoethanol agglutination
Torsion of the appendix testis[31][32][33][34] Unilateral or Bilateral Sudden - Absent + - - Absent +
  • Normal
  • Normal blood flow to the testis with an occasional increase on the affected side
 -
  • In the first 4 hours: testicular appendages shows edema and and desquamation.
  • 4-8 hours partial necrosis of appendix cells.
  • >24 hrs: necrosis
  • scrotal ultrasound shows the torsed appendage as a lesion of low echogenicity with a central hypoechogenic area.
  • Scrotal wall mayshow the classical "blue dot" sign, which is due to infarction and necrosis of the appendix testis
Henoch-Schonlein purpura[35][36][37][38] Unilateral Sudden - Absent + + - - -
  • Serum IgA levels are elevated
  • Elevated ESR
 -
  • Sore throat 2-3 weeks back
  • Light microscopy shows leukocytoclastic vasculitis in postcapillary venules with IgA deposition
 Biopsy
  • Palpable purpura
  • Age at onset is less than 20 years
  • Acute abdominal pain
Fournier's gangrene[39][40][41][42] Bilateral Sudden + Absent + + - - +
  • Leukocytosis
  • Acidosis
  • Elevated ESR and CRP
  • Blood cultures are positive in majority of patient for streptococcus.
 - - -
  • Computed tomography (CT) scan shows most useful finding is presence of gas in soft tissues.
  • Patient show signs of tense edema outside the involved skin, blisters, bullae, crepitus, and subcutaneous gas.
Diseases Unilateral /Bilateral swelling Onset Fever Urinary symptoms Tender<be>-ness Erythema Discharge Inguinal Lymphadenopathy Cremasteric Reflex Blood/Urine Analysis Doppler U/S Past Medical History Histopathology Gold standard Additional findings
Painless
Fragile X Macroorchidism[43][44][45][46] Bilateral Gradual - Absent - - + Absent +
  • Normal
 - - Increased volume of testis
  • FMR1 DNA analysis
  • Long and narrow face with prominent forehead and chin (prognathism)
  • Large ears
  • Intellectual Disability
Testicular Tumors[47][48][49][50] Unilateral or bilateral Gradual ± Absent ± + Present +
  • Increased serum beta-hCG or alpha fetoprotien (AFP)
 - - Seminoma shows findings such as:
  • Biopsy
Hydrocele[51][52][53][54][55] Bilateral Gradual - Absent - - - Absent + -
  • Normal
 - -
  • Transillumination test is positive
Varicocele[56][57][58][59] Unilateral

(Mainly left)

Gradual Local warmth Absent - ± - Absent +
  • Elevations in unstimulated luteinizing hormone and follicle stimulating hormone levels may be seen in when associated with infertility in adults
  • Thrombosis of Inferiror vena cava
  • Thrombosis of Right renal vein
  • Abdominal mass
 -
  • Infertility
Spermatocele[60][55][61] Unilateral Gradual - Absent - - - Absent + -
  • Falling snow, resulting from internal echoes moving away from the transducer
  • Epididymitis
  • Trauma
  • Epididymal scarring is seen
  • Transillumination test is positive
Scrotal edema[62][63] Bilateral and can extend to perineum Gradual - Absent - - - Absent +
  • Deep Vein Thrombosis
  • Nephrotic Syndrome
  • Hepatic Cirrhosis
  • Insect Bite
 -
  • Kidney or Liver biopsy
  • Occurs between 4-12 years of age.
Sebaceous cyst[64][65][66] Unilateral Gradual - Absent - - - Absent + -
  • Normal
 -
  • Fibrous tissues and fluids
  • A fatty,(keratinous), substance that resembles cottage cheese,.
  • A viscous, serosanguinous fluid (containing purulent and bloody material).
  • Histological examination
  • Freely movable on palpation.
Carcinoma of the scrotum[67][68][69] - Gradual - Absent - - - Absent + -
  • Normal
 -
  • keratinocytic dysplasia involving the full thickness of the epidermis without infiltration of atypical cells into the dermis.
  • The keratinocytes are pleomorphic with hyperchromatic nuclei
  • Numerous mitoses are present.
  • Biopsy
  • Scaly patch or plaque is seen over the testis.
Chylocele (Filariasis)[70][71][72] Unilateral or Bilateral Gradually

Rapidly

+ Absent - - - Absent +
  • Circulating filarial antigen (CFA) assays are positve
  • Lymphatics containing worms can be differentiated from the blood vessels by irregular movement
 - -
  • CFA assay
  • Ultrasound demonstrates living worms which has been described as "filarial dance" sign.
Scrotoliths[73][74][75] Unilateral Gradual - Absent - - - Absent + -
  • Normal
  • Trauma
  • Torsion of appendix
 -
  • Ultrasound
  • Ultrasound shows mobile hyperechoic extratesticular focus in the potential tunica space.

References

  1. ↑ Yu KJ, Wang TM, Chen HW, Wang HH (2012). "The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis". Chang Gung Med J. 35 (1): 38–45. PMID 22483426.
  2. ↑ Manavi K, Turner K, Scott GR, Stewart LH (May 2005). "Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh". Int J STD AIDS. 16 (5): 386–7. doi:10.1258/0956462053888853. PMID 15949072.
  3. ↑ Lee YS, Kim SW, Han SW (2018). "Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis". PLoS ONE. 13 (4): e0194761. doi:10.1371/journal.pone.0194761. PMC 5905873. PMID 29668706.
  4. ↑ Ralls PW, Jensen MC, Lee KP, Mayekawa DS, Johnson MB, Halls JM (June 1990). "Color Doppler sonography in acute epididymitis and orchitis". J Clin Ultrasound. 18 (5): 383–6. PMID 2161009.
  5. ↑ Michel V, Pilatz A, Hedger MP, Meinhardt A (2015). "Epididymitis: revelations at the convergence of clinical and basic sciences". Asian J. Androl. 17 (5): 756–63. doi:10.4103/1008-682X.155770. PMC 4577585. PMID 26112484.
  6. ↑ Tracy CR, Costabile RA (April 2009). "The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed?". World J Urol. 27 (2): 259–63. doi:10.1007/s00345-008-0338-0. PMID 19002691.
  7. ↑ 7.0 7.1 7.2 Pepe P, Panella P, Pennisi M, Aragona F (October 2006). "Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?". Eur J Radiol. 60 (1): 120–4. doi:10.1016/j.ejrad.2006.04.016. PMID 16730939.
  8. ↑ 8.0 8.1 Ludwig M (April 2008). "Diagnosis and therapy of acute prostatitis, epididymitis and orchitis". Andrologia. 40 (2): 76–80. doi:10.1111/j.1439-0272.2007.00823.x. PMID 18336454.
  9. ↑ Davis NF, McGuire BB, Mahon JA, Smyth AE, O'Malley KJ, Fitzpatrick JM (April 2010). "The increasing incidence of mumps orchitis: a comprehensive review". BJU Int. 105 (8): 1060–5. doi:10.1111/j.1464-410X.2009.09148.x. PMID 20070300.
  10. ↑ CHARNY CW, MERANZE DR (July 1948). "Pathology of mumps orchitis". J. Urol. 60 (1): 140–6. PMID 18873054.
  11. ↑ Bjorvatn B (1973). "Mumps virus recovered from testicles by fine-needle aspiration biopsy in cases of mumps orchitis". Scand. J. Infect. Dis. 5 (1): 3–5. PMID 4580293.
  12. ↑ Beard CM, Benson RC, Kelalis PP, Elveback LR, Kurland LT (January 1977). "The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974". Mayo Clin. Proc. 52 (1): 3–7. PMID 609284.
  13. ↑ Gall EA (July 1947). "The Histopathology of Acute Mumps Orchitis". Am. J. Pathol. 23 (4): 637–51. PMC 1934294. PMID 19970951.
  14. ↑ Başekim CC, Kizilkaya E, Pekkafali Z, Baykal KV, Karsli AF (2000). "Mumps epididymo-orchitis: sonography and color Doppler sonographic findings". Abdom Imaging. 25 (3): 322–5. PMID 10823460.
  15. ↑ Hazeltine M, Panza A, Ellsworth P (2017). "Testicular Torsion: Current Evaluation and Management". Urol Nurs. 37 (2): 61–71, 93. PMID 29240370.
  16. ↑ Estremadoyro V, Meyrat BJ, Birraux J, Vidal I, Sanchez O (February 2017). "[Diagnosis and management of testicular torsion in children]". Rev Med Suisse (in French). 13 (550): 406–410. PMID 28714632.
  17. ↑ Sharp VJ, Kieran K, Arlen AM (December 2013). "Testicular torsion: diagnosis, evaluation, and management". Am Fam Physician. 88 (12): 835–40. PMID 24364548.
  18. ↑ Mikuz G (1985). "Testicular torsion: simple grading for histological evaluation of tissue damage". Appl Pathol. 3 (3): 134–9. PMID 3842075.
  19. ↑ Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL (November 2006). "Acute testicular torsion in children: the role of sonography in the diagnostic workup". Eur Radiol. 16 (11): 2527–32. doi:10.1007/s00330-006-0287-1. PMID 16724203.
  20. ↑ Bowen DK, Gonzalez CM (2014). "Intratesticular hematoma after blunt scrotal trauma: a case series and algorithm-based approach to management". Cent European J Urol. 67 (4): 427–9. doi:10.5173/ceju.2014.04.art24. PMC 4310892. PMID 25667770.
  21. ↑ Askari R, Khouzam RN, Dishmon DA (2017). "Image Diagnosis: Rapidly Enlarging Scrotal Hematoma: A Complication of Femoral Access?". Perm J. 21. doi:10.7812/TPP/16-111. PMC 5469436. PMID 28609265.
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  25. ↑ Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  26. ↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
  27. ↑ Kaya F, Kocyigit A, Kaya C, Turkcuer I, Serinken M, Karabulut N (March 2015). "Brucellar Testicular Abscess Presenting as a Testicular Mass: Can Color Doppler Sonography be used in Differentiation?". Turk J Emerg Med. 15 (1): 43–6. doi:10.5505/1304.7361.2014.82698. PMC 4909939. PMID 27331193.
  28. ↑ Navarro-Martínez A, Solera J, Corredoira J, Beato JL, Martínez-Alfaro E, Atiénzar M, Ariza J (December 2001). "Epididymoorchitis due to Brucella mellitensis: a retrospective study of 59 patients". Clin. Infect. Dis. 33 (12): 2017–22. doi:10.1086/324489. PMID 11698991.
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  32. ↑ Kadish HA, Bolte RG (July 1998). "A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages". Pediatrics. 102 (1 Pt 1): 73–6. PMID 9651416.
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  34. ↑ Lev M, Ramon J, Mor Y, Jacobson JM, Soudack M (October 2015). "Sonographic appearances of torsion of the appendix testis and appendix epididymis in children". J Clin Ultrasound. 43 (8): 485–9. doi:10.1002/jcu.22265. PMID 25704247.
  35. ↑ Choong CS, Liew KL, Liu PN, Kuo TU, Su CM (July 2000). "Acute scrotum in Henoch-Schönlein purpura". Zhonghua Yi Xue Za Zhi (Taipei). 63 (7): 577–80. PMID 10934812.
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  37. ↑ Dayanir YO, Akdilli A, Karaman CZ, Sönmez F, Karaman G (2001). "Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura". Eur Radiol. 11 (11): 2267–9. doi:10.1007/s003300100843. PMID 11702171.
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  39. ↑ Voelzke BB, Hagedorn JC (April 2018). "Presentation and Diagnosis of Fournier Gangrene". Urology. 114: 8–13. doi:10.1016/j.urology.2017.10.031. PMID 29146218.
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  41. ↑ Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S, Acar A, Baş G (September 2017). "Fournier's gangrene: A retrospective analysis of 25 patients". Ulus Travma Acil Cerrahi Derg. 23 (5): 400–404. doi:10.5505/tjtes.2017.01678. PMID 29052826.
  42. ↑ Namkoong H, Ishii M, Koizumi M, Betsuyaku T (February 2016). "Fournier's gangrene: a surgical emergency". Infection. 44 (1): 143–4. doi:10.1007/s15010-015-0816-4. PMID 26138056.
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  44. ↑ de Vries BB, Halley DJ, Oostra BA, Niermeijer MF (July 1998). "The fragile X syndrome". J. Med. Genet. 35 (7): 579–89. PMC 1051369. PMID 9678703.
  45. ↑ Lachiewicz AM, Dawson DV (June 1994). "Do young boys with fragile X syndrome have macroorchidism?". Pediatrics. 93 (6 Pt 1): 992–5. PMID 8190590.
  46. ↑ Saldarriaga W, Tassone F, González-Teshima LY, Forero-Forero JV, Ayala-Zapata S, Hagerman R (2014). "Fragile X syndrome". Colomb. Med. 45 (4): 190–8. PMC 4350386. PMID 25767309.
  47. ↑ Shen J, Bi Y, Wang X, Lu L, Tang L, Liu Y, Chen H, Zhang B (December 2017). "Epidemiologic study of 230 cases of testicular/paratesticular tumors or masses: 15-year experience of a single center". J. Pediatr. Surg. 52 (12): 2056–2060. doi:10.1016/j.jpedsurg.2017.08.027. PMID 28967388.
  48. ↑ Hohšteter M, Artuković B, Severin K, Kurilj AG, Beck A, Šoštarić-Zuckermann IC, Grabarević Ž (August 2014). "Canine testicular tumors: two types of seminomas can be differentiated by immunohistochemistry". BMC Vet. Res. 10: 169. doi:10.1186/s12917-014-0169-8. PMC 4129470. PMID 25096628.
  49. ↑ McDonald MW, Reed AB, Tran PT, Evans LA (2012). "Testicular tumor ultrasound characteristics and association with histopathology". Urol. Int. 89 (2): 196–202. doi:10.1159/000338771. PMID 22677786.
  50. ↑ Naouar S, Braiek S, El Kamel R (June 2017). "Testicular tumors of adrenogenital syndrome: From physiopathology to therapy". Presse Med. 46 (6 Pt 1): 572–578. doi:10.1016/j.lpm.2017.05.006. PMID 28549629.
  51. ↑ Costantino E, Ganesan GS, Plaire JC (May 2017). "Abdominoscrotal hydrocele in an infant boy". BMJ Case Rep. 2017. doi:10.1136/bcr-2017-220370. PMID 28551604.
  52. ↑ Kaefer M, Agarwal D, Misseri R, Whittam B, Hubert K, Szymanski K, Rink R, Cain MP (October 2016). "Treatment of contralateral hydrocele in neonatal testicular torsion: Is less more?". J Pediatr Urol. 12 (5): 306.e1–306.e4. doi:10.1016/j.jpurol.2015.07.009. PMID 26708803.
  53. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
  54. ↑ Chen Y, Wang F, Zhong H, Zhao J, Li Y, Shi Z (December 2017). "A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele". Surg Endosc. 31 (12): 4888–4901. doi:10.1007/s00464-017-5491-3. PMID 28389795.
  55. ↑ 55.0 55.1 Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA (June 2011). "Adult hydrocele and spermatocele". BJU Int. 107 (11): 1852–64. doi:10.1111/j.1464-410X.2011.10353.x. PMID 21592287.
  56. ↑ Clavijo RI, Carrasquillo R, Ramasamy R (September 2017). "Varicoceles: prevalence and pathogenesis in adult men". Fertil. Steril. 108 (3): 364–369. doi:10.1016/j.fertnstert.2017.06.036. PMID 28865534.
  57. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
  58. ↑ Locke JA, Noparast M, Afshar K (October 2017). "Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials". J Pediatr Urol. 13 (5): 437–445. doi:10.1016/j.jpurol.2017.07.008. PMID 28851509.
  59. ↑ Shridharani A, Owen RC, Elkelany OO, Kim ED (2016). "The significance of clinical practice guidelines on adult varicocele detection and management". Asian J. Androl. 18 (2): 269–75. doi:10.4103/1008-682X.172641. PMID 26806081.
  60. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
  61. ↑ Yeh HC, Wang CJ, Liu CC, Wu WJ, Chou YH, Huang CH (July 2007). "Giant spermatocele mimicking hydrocele: a case report". Kaohsiung J. Med. Sci. 23 (7): 366–9. doi:10.1016/S1607-551X(09)70423-1. PMID 17606432.
  62. ↑ Geffre M, Maki C, Maier S (March 2017). "Acute Scrotal Edema in Cirrhotic after Laparoscopic Cholecystectomy". Am Surg. 83 (3): e93–95. PMID 28316300.
  63. ↑ Esposito F, Sanchez O, Siebert JN, Manzano S (October 2018). "Acute scrotal idiopathic edema: A misleading erythema". CJEM. 20 (S2): S37. doi:10.1017/cem.2017.343. PMID 28625172.
  64. ↑ Solanki A, Narang S, Kathpalia R, Goel A (September 2015). "Scrotal calcinosis: pathogenetic link with epidermal cyst". BMJ Case Rep. 2015. doi:10.1136/bcr-2015-211163. PMC 4593290. PMID 26400592.
  65. ↑ Prasad KK, Manjunath RD (August 2014). "Multiple epidermal cysts of scrotum". Indian J. Med. Res. 140 (2): 318. PMC 4216510. PMID 25297369.
  66. ↑ Ząbkowski T, Wajszczuk M (July 2014). "Epidermoid cyst of the scrotum: a clinical case". Urol J. 11 (3): 1706–9. PMID 25015622.
  67. ↑ Casasola Chamorro J, Gutiérrez García S, de Blas Gómez V (July 2011). "Scrotal carcinoma". Arch. Esp. Urol. 64 (6): 541–3. PMID 21791720.
  68. ↑ Halfya A, Elmortaji K, Redouane R, Fethi M, Rafik A, Mohamed E, Abdessamad C (2015). "[Squamous cell carcinomas of the scrotum: about 7 cases with review of the literature]". Pan Afr Med J (in French). 20: 163. doi:10.11604/pamj.2015.20.163.5991. PMC 4469445. PMID 26113906.
  69. ↑ Armas-Alvarez AL, Salinas-Sánchez AS, Atienzar-Tobarra M, Virseda-Rodríguez JA (March 2016). "Scrotal tumors". Arch. Esp. Urol. 69 (2): 86–9. PMID 26959967.
  70. ↑ Otabil KB, Tenkorang SB (March 2015). "Filarial hydrocele: a neglected condition of a neglected tropical disease". J Infect Dev Ctries. 9 (5): 456–62. doi:10.3855/jidc.5346. PMID 25989164.
  71. ↑ Janssen KM, Willis CJ, Anderson M, Gelnett MS, Wickersham EL, Brand TC (July 2017). "Filariasis Orchitis-Differential for Acute Scrotum Pathology". Urol Case Rep. 13: 117–119. doi:10.1016/j.eucr.2017.04.002. PMC 5426035. PMID 28507911.
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  73. ↑ Khallouk A, Yazami OE, Mellas S, Tazi MF, El Fassi J, Farih MH (2011). "Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment". Rev Urol. 13 (2): 95–7. PMC 3176555. PMID 21935341.
  74. ↑ Noël B, Bron C, Künzle N, De Heller M, Panizzon RG (July 2006). "Multiple nodules of the scrotum: histopathological findings and surgical procedure. A study of five cases". J Eur Acad Dermatol Venereol. 20 (6): 707–10. doi:10.1111/j.1468-3083.2006.01578.x. PMID 16836500.
  75. ↑ Polk P, McCutchen WT, Phillips JG, Biggs PJ (September 1996). "Polypoid scrotal calcinosis: an uncommon variant of scrotal calcinosis". South. Med. J. 89 (9): 896–7. PMID 8790314.
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