Scrotal mass overview: Difference between revisions
(→Biopsy) |
|||
| (113 intermediate revisions by 4 users not shown) | |||
| Line 1: | Line 1: | ||
__NOTOC__ | __NOTOC__ | ||
{{Scrotal mass}} | {{Scrotal mass}} | ||
{{CMG}}{{AE}}{{SR}} | {{CMG}}{{AE}}{{NE}}{{SR}} | ||
==Overview== | ==Overview== | ||
[[Scrotal examination|Scrotal]] mass may be classified into two subtypes: testicular and extratesticular.[[Scrotal swelling|Scrotal]] masses may be differentiated according to clinical features, laboratory findings, imaging features, [[histological]] features, and genetic studies from other diseases that cause testicular mass with discomfort, [[back pain]], [[abdominal discomfort]], or [[abdominal mass]]. If there is an acutely painful scrotum,there should be a strong suspicion for [[Testicular torsion (patient information)|testicular torsion]], which is an emergency condition, and emergent surgical referral should be strongly considered.[[Sonography]] may be performed if [[Testicular torsion (patient information)|testicular torsion]] is not suspected to confirm the diagnosis. According to the [[TNM classification]] and stage groupings, there are 3 stages of testicular cancer based on the size and extent of the primary tumor, number and location of any regional [[lymph nodes]] (abdominal [[retroperitoneal]]) infiltrated by tumor cells, distant metastasis, and [[Tumor marker|serum tumor marker]] levels.Symptoms related with scrotal mass will vary, depending on the cause of the mass, which include [[scrotum|enlarged scrotum]], [[testicle|painless or painful testicle lump]], and [[scrotum|feeling of heaviness in the scrotum]]. Common physical examination findings of [[Scrotal Swelling|scrotal]] mass include a tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral [[inguinal lymph nodes]] may be enlarged or tender.The laboratory findings related with [[Scrotal cyst|scrotal]] mass may vary, depending on the cause of the mass.Laboratory findings consistent with the diagnosis of testicular tumors, may include elevated serum tumor markers such as [[AFP]], [[LDH]], or [[HCG]]. Imaging studies for [[Scrotal Swelling|scrotal]] mass include [[ultrasound|scrotal ultrasound]], [[MRI]], and [[X ray|chest x-ray]].[[Biopsy]] should be performed in patients with [[Scrotal Swelling|scrotal]] skin lesions to rule out skin cancer. | |||
==Historical percpective== | |||
[[Reinforcement]] of the [[Electrocardiogram|anterior wall]] of the [[inguinal canal]] and tightening of the [[External Genital Warts|external]] [[inguinal ring]] was first discovered by Stromayr in 1559. In 1871, new use of carbolized catgut ligature was developed by Marcy to treat [[Inguinal hernia (patient information)|inguinal hernia]]. [[Twisted ovarian cyst|Twisted]] and [[Suture (anatomical)|suture-transfixed]] the [[Secondary peritonitis|peritoneal sac]] in the lateral [[muscles]] through the [[external ring]] was developed by Kocher to treat [[inguinal hernia]].[[Laparoscopic surgery|Laparoscopic]] approaches first used to treat [[Inguinal hernia|inguinal hernias]] in 1992.There is a limited information about the historical perspective of [[Testicular tumor|testicular tumors]]. [[Leydig cells]] were first discovered by Franz Leydig who was a German [[anatomist]] in 1870. | |||
==Classification== | ==Classification== | ||
Scrotal | [[Scrotal masses|Scrotal]] masses are divided to two main group:[[Testicular cancer (patient information)|Extra testicular]] and [[Testicular Feminization Syndrome|Testicular]].Also scrotal masses may be pain full or not painfull.The other [[Calcaneal paratendintis|classification]] is based on [[Neoplastic meningitis|neoplastic]] or [[Non-necrotising cellulitis|non-neoplastic]] masses. | ||
==Pathophysiology== | |||
Deponds on the causes [[P-type ATPase|phatophysiology]] is different. | |||
Inadequate [[Fixation (visual)|fixation]] of the [[Lower gastrointestinal bleeding resident survival guide|lower pole]] of the [[testis]] to the [[tunica vaginalis]] causes testicular tortion . If [[fixation]] is absent , the testis may torse (twist) on the [[Spermatic cord|spermatic cord,]] lead to produce[[ischemia]] from reduced [[Arterial insufficiency|arterial inflow]] and [[venous]] [[Outflow tract VT|outflow]] [[obstruction]] . [[Testicular torsion (patient information)|Testicular torsion]] etiology include (eg, [[trauma]], vigorous physical activity) or spontaneously. Acquired [[Hernia|hernias]] due loss of mechanical integrity of the abdominal wall muscles and tendons . primary [[hernia]] due [[Genetic]] or systemic [[extracellular matrix]] disorders and defective wound healing after [[laparotomy]] and [[hernia]] repairs may predispose to [[Incisional hernia MRI|incisional hernias]]. | |||
==Causes== | ==Causes== | ||
Scrotal mass may be caused by [[ | [[Scrotal mass|Scrotal masses]] may be caused by [[tumors]],injury,[[Trab domain containing 2b|truma]],infection.Also the causes deponds on [[Anatomical Therapeutic Chemical Classification System|anatomical origin]]. | ||
== | ==Differentiating scrotal masses from Other Diseases== | ||
==Epidemiology and | [[Scrotal mass|Scrotal masses]] must be differentiated from other diseases that cause [[Scrotal swelling CT|scrotal swelling]],[[Scrotal masses|scrota]]<nowiki/>l pain,such as [[Testicular cancer|testicular tortion]] ,[[Epidemic abscess|epididimitis,]]<nowiki/>[[Testicular cancer|testicular tumors]],[[Inguinal canal|inguinal herniation]] and many other diseases. | ||
==Epidemiology and Dermographics== | |||
[[Testicle|Testicula]]<nowiki/>r cancer is a rare type [[Cancer (medicine)|cancer]] accounting about 0.5% of all new [[Cancer (medicine)|cancer]] cases in U.S. In 2018, the estimate [[prevalence]] of [[testicular]] cancer is approximately 9,310 new cases of [[Androgen insensitivity syndrome|testicular]] cancers in the United States. The [[incidence]] of [[testicular]] cancer is approximately 5.7 per 100,000 [[men]] per year based on 2011-2015 report in the United States. The majority of cases are reported in New Zealand. [[Testicular]] cancer commonly affects more white [[males]] than any other races and black [[males]] are less affected by it. [[Testicular]] cancer is commonly affects [[men]] [[Age|aged]] 20-44 years old and [[median]] [[age]] is 33 years old. | |||
==Risk Factors== | |||
Depends on the causes of [[Scrotal masses (patient information)|scrotal masses]], [[risk factors]] are different,for example in [[Androgen insensitivity syndrome|testicular tortion]] the most potent [[Risk stratification tools|risk]] [[Factor 10a|factor]] is [[undescended testicle]] and [[Genetic Algorithm for Rule-set Prediction|genetic]] [[Structural Marxism|structural defects]]. | |||
==Screening== | ==Screening== | ||
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for testicular cancer. | According to the the [[United States Agency for International Development|U.S. Preventive Service Task Force]] [[United States Agency for International Development|(USPSTF)]], there is insufficient evidence to recommend routine [[screening]] for [[Testicular Cancer|testicular]] cancer. | ||
==Natural History,Complications,and Prognosis== | |||
===Complications=== | |||
Common complication of [[Testicular torsion differential diagnosis|testicular tortion]] include,[[Testicular]] [[Ischemia-modified albumin (IMA)|ischemia]]:[[Twisted ovarian cyst|Twisting]] of the [[K+-transporting ATPase|spermatic cord]] during [[Torsion of testes|torsion]] causes [[testicular]] [[Vascular closure devices|vascular]] compromise, resulting in [[testicular]] injury. | |||
==Diagnosis== | ==Diagnosis== | ||
===Diagnosis Study of Choice=== | |||
If there is an acutely painful [[Sperm-associated antigen 11B|scrotum]],there should be a strong suspicion for [[testicular torsion]], which is an emergency condition, and [[Emergency bleeding control|emergent surgical]] referral should be strongly considered. [[Sonography]] may be performed if [[Testicular torsion case study one|testicular torsion]] is not suspected to confirm the [[Diagnosis-related group|diagnosis]],althogh [[Color Blindness|color doppler ultrasound]] is preffered for initial diagnosis test. | |||
[[Testicular torsion (patient information)|Testicular torsion]] is primrily [[Diagnosis (artificial intelligence)|diagnosed]] base on the [[Clinical management system|clinical presentation.]] | |||
=== | ===History and Symptoms=== | ||
Symptoms related with [[Scrotal Swelling|scrotal]] mass will vary, depending on the cause of the mass, which include [[scrotum|enlarged scrotum]], [[testicle|painless or painful testicle lump]], and [[scrotum|feeling of heaviness in the scrotum]].Other symptoms are edema and erythem of [[Scratch|scrotom]] in [[Epasmir 5|epididimitis]] and [[Phentermine|tortion]], | |||
fever,[[Dysuria MRI|dysuria]] and [[urgency]] in [[Epididymal head cyst|epididimitis]].Low back pain and [[Lower end of tibia|lower extremitis edema]] are the other presentations in [[Scrotoplasty|scrotomal]] tumors. | |||
===Physical Examination=== | |||
[[Physical culture|physical]] [[Ex-Lax Chocolated|examination]] of scrotal masses depends on causes.common [[Physical Examination|physical]] [[Physical examination|examinations]] in [[Testicular cancer|testicular tortion]] is an elevated ,[[Hoarding disorder|horizontlly]] aligned testicle. | |||
Also they have severe [[tenderness]] and [[Firmacort|firm]] in palpation.[[Cremasteric reflex|Cremastic reflex]] and [[Phrenic|phren sign]] are absent.In [[testicular]] [[Apalutamide|apendix]] [[Tortilla Wall|tortion]] ,[[Phacetoperane|phathognomonic sign]] is [[Blubber|Blue dot]],which is a [[Nodule (medicine)|nodule]] with [[Blue|blue discoloration]].In [[Hydrocele MRI|hydrocele]] [[transillumination]] test will be positive. | |||
=== | ===Laboratory Findings=== | ||
The [[L(+)-tartrate dehydratase|laboratory]] findings related with [[Scrotal mass (patient information)|scrotal mass]] may vary, depending on the cause of the mass. [[Laboratory animal suppliers in the United Kingdom|Laboratory]] findings consistent with the diagnosis of [[testicular]] [[tumors]], may include elevated serum [[Tumor marker|tumor markers]] such as [[AFP]], [[LDH]], or [[HCG]][[Creatinine clearance|.CRP]] level up to 24mg /L is highly [[S-(+)-methamphetamine|specific]] and [[Sensitive Skin|sensitive]] for [[epididymitis]] and [[Orchitis|orchitis.]] | |||
=== | ===Electrocardiogram=== | ||
There is no [[Erythromycin|ECG]] findings associated with [[Scrotal masses (patient information)|scrotal masses]]. | |||
===X-ray=== | |||
There are no [[X-Prep|x-ray]] findings associated with [[Scrotal cyst|scrotal masses]]. | |||
===Echocardiography and Ultrasound=== | |||
[[Ulceprax|Ultrasound]] findings associated with [[Scrotal masses causes|scrotal masses]].It can differentiated [[Extra-pyramidal|extratsticular]] masses from [[Intra-amniotic infection|intratesticular]] masses.By using [[Doppler study|Doppler-colored ultrasound]] ,[[Specific Pathogen Free|specifity]] and [[Sensitivity (test)|sensitivity]] for [[Testicular Cancer|testicular tortion]] will be increased. | |||
===CT scan=== | |||
[[Ctenophores|CT scan]] may be helpfull in the [[Diagnosis-related group|diagnosis]] of [[testicular]] [[Carcinoma in situ|carcinoma]] and also for [[Staging (pathology)|staging]] [[Testicular tumor|testicular tumors]]. | |||
===MRI=== | |||
[[K-10|MRI]] may be helpfull in the [[Diagnosis-related group|diagnosis]] of [[testicular carcinoma]] and also for [[Staging (pathology)|staging testicular tumors.]] | |||
===Other Imaging Findings=== | |||
[[Radioactive iodine|Radionuclide]] Imaging may be helpfull in [[Testicular Cancer|testicular tortion]] [[Diagnosis (artificial intelligence)|diagnosis]] but because it takes time,usually is not used. | |||
=== | ===Other Diagnostic Studies=== | ||
There are no other [[Diagnosis WikiDoc Main Page|diagnostic]] studies associated with [[Scrotal Swelling|scrotal masses]]. | |||
=== | ==Treatment== | ||
===Medical Therapy=== | |||
[[Scrotal masses (patient information)|Scrotal masses]] presented with acute pain ,should be treated [[Emergency bleeding control|emergently]].Patients with [[Testicular Cancer|testicular tortion]] are treated with immidiate [[Male genital examination|scrotal exploration]],[[De-Sone LA|detortion]] and [[Orchid Trust|orchidopexy,]]<nowiki/>whereas treatment of [[To Do List/to do|tortion]] of [[Testicular Cancer|testicular apendage]] is [[Conservation genetics|conservative]].[[pharmacologic]] [[Medical therapy for lower extremity peripheral arterial disease|medical therapy]] is recommended among patients with [[Epamin|Epididimytis]]. In [[Testicular torsion case study one|testicular tumors]] the first line treatment is [[Radical behaviorism|radical orchiectomy]] after determining the [[Diagnosis WikiDoc Main Page|diagnosis]], treatment depends on [[Tumor-suppressor gene|tumor]] [[Type-2 Gumbel distribution|type]] and available options are [[Chemotherapy agent|chemotherapy]] and [[Radiation enteropathy|radiation]]. | |||
=== | ===Surgery=== | ||
[[Scrotal masses (patient information)|Scrotal masses]] presented with acute pain ,should be treated [[Emergency bleeding control|emergently]].Patients with [[Testicular Cancer|testicular tortion]] are treated with immidiate [[Male genital examination|scrotal exploration]],[[De-Sone LA|detortion]] and [[Orchid Trust|orchidopexy,]]<nowiki/>In [[Testicular torsion case study one|testicular tumors]] the first line treatment is [[Radical behaviorism|radical orchiectomy]]. | |||
=== | ===Primary Prevention=== | ||
[[ | There are no established measures for the [[Primal therapy|primary prevention]] of [[Scream therapy|scrotal masses]],but by decreasing some of the [[risk factors]] we can [[Prevention (medical)|prevent]] some of the causes. | ||
[[ | |||
==Refrences== | |||
<references /> | |||
Latest revision as of 16:30, 28 October 2019
|
Scrotal Mass Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Scrotal mass overview On the Web |
|
American Roentgen Ray Society Images of Scrotal mass overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2]Sujit Routray, M.D. [3]
Overview
Scrotal mass may be classified into two subtypes: testicular and extratesticular.Scrotal masses may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies from other diseases that cause testicular mass with discomfort, back pain, abdominal discomfort, or abdominal mass. If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered.Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis. According to the TNM classification and stage groupings, there are 3 stages of testicular cancer based on the size and extent of the primary tumor, number and location of any regional lymph nodes (abdominal retroperitoneal) infiltrated by tumor cells, distant metastasis, and serum tumor marker levels.Symptoms related with scrotal mass will vary, depending on the cause of the mass, which include enlarged scrotum, painless or painful testicle lump, and feeling of heaviness in the scrotum. Common physical examination findings of scrotal mass include a tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral inguinal lymph nodes may be enlarged or tender.The laboratory findings related with scrotal mass may vary, depending on the cause of the mass.Laboratory findings consistent with the diagnosis of testicular tumors, may include elevated serum tumor markers such as AFP, LDH, or HCG. Imaging studies for scrotal mass include scrotal ultrasound, MRI, and chest x-ray.Biopsy should be performed in patients with scrotal skin lesions to rule out skin cancer.
Historical percpective
Reinforcement of the anterior wall of the inguinal canal and tightening of the external inguinal ring was first discovered by Stromayr in 1559. In 1871, new use of carbolized catgut ligature was developed by Marcy to treat inguinal hernia. Twisted and suture-transfixed the peritoneal sac in the lateral muscles through the external ring was developed by Kocher to treat inguinal hernia.Laparoscopic approaches first used to treat inguinal hernias in 1992.There is a limited information about the historical perspective of testicular tumors. Leydig cells were first discovered by Franz Leydig who was a German anatomist in 1870.
Classification
Scrotal masses are divided to two main group:Extra testicular and Testicular.Also scrotal masses may be pain full or not painfull.The other classification is based on neoplastic or non-neoplastic masses.
Pathophysiology
Deponds on the causes phatophysiology is different. Inadequate fixation of the lower pole of the testis to the tunica vaginalis causes testicular tortion . If fixation is absent , the testis may torse (twist) on the spermatic cord, lead to produceischemia from reduced arterial inflow and venous outflow obstruction . Testicular torsion etiology include (eg, trauma, vigorous physical activity) or spontaneously. Acquired hernias due loss of mechanical integrity of the abdominal wall muscles and tendons . primary hernia due Genetic or systemic extracellular matrix disorders and defective wound healing after laparotomy and hernia repairs may predispose to incisional hernias.
Causes
Scrotal masses may be caused by tumors,injury,truma,infection.Also the causes deponds on anatomical origin.
Differentiating scrotal masses from 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.
Epidemiology and Dermographics
Testicular cancer is a rare type cancer accounting about 0.5% of all new cancer cases in U.S. In 2018, the estimate prevalence of testicular cancer is approximately 9,310 new cases of testicular cancers in the United States. The incidence of testicular cancer is approximately 5.7 per 100,000 men per year based on 2011-2015 report in the United States. The majority of cases are reported in New Zealand. Testicular cancer commonly affects more white males than any other races and black males are less affected by it. Testicular cancer is commonly affects men aged 20-44 years old and median age is 33 years old.
Risk Factors
Depends on the causes of scrotal masses, risk factors are different,for example in testicular tortion the most potent risk factor is undescended testicle and genetic structural defects.
Screening
According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for testicular cancer.
Natural History,Complications,and Prognosis
Complications
Common complication of testicular tortion include,Testicular ischemia:Twisting of the spermatic cord during torsion causes testicular vascular compromise, resulting in testicular injury.
Diagnosis
Diagnosis Study of Choice
If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered. Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis,althogh color doppler ultrasound is preffered for initial diagnosis test. Testicular torsion is primrily diagnosed base on the clinical presentation.
History and Symptoms
Symptoms related with scrotal mass will vary, depending on the cause of the mass, which include enlarged scrotum, painless or painful testicle lump, and feeling of heaviness in the scrotum.Other symptoms are edema and erythem of scrotom in epididimitis and tortion, fever,dysuria and urgency in epididimitis.Low back pain and lower extremitis edema are the other presentations in scrotomal tumors.
Physical Examination
physical examination of scrotal masses depends on causes.common physical examinations in testicular tortion is an elevated ,horizontlly aligned testicle. Also they have severe tenderness and firm in palpation.Cremastic reflex and phren sign are absent.In testicular apendix tortion ,phathognomonic sign is Blue dot,which is a nodule with blue discoloration.In hydrocele transillumination test will be positive.
Laboratory Findings
The laboratory findings related with scrotal mass may vary, depending on the cause of the mass. Laboratory findings consistent with the diagnosis of testicular tumors, may include elevated serum tumor markers such as AFP, LDH, or HCG.CRP level up to 24mg /L is highly specific and sensitive for epididymitis and orchitis.
Electrocardiogram
There is no ECG findings associated with scrotal masses.
X-ray
There are no x-ray findings associated with scrotal masses.
Echocardiography and Ultrasound
Ultrasound findings associated with scrotal masses.It can differentiated extratsticular masses from intratesticular masses.By using Doppler-colored ultrasound ,specifity and sensitivity for testicular tortion will be increased.
CT scan
CT scan may be helpfull in the diagnosis of testicular carcinoma and also for staging testicular tumors.
MRI
MRI may be helpfull in the diagnosis of testicular carcinoma and also for staging testicular tumors.
Other Imaging Findings
Radionuclide Imaging may be helpfull in testicular tortion diagnosis but because it takes time,usually is not used.
Other Diagnostic Studies
There are no other diagnostic studies associated with scrotal masses.
Treatment
Medical Therapy
Scrotal masses presented with acute pain ,should be treated emergently.Patients with testicular tortion are treated with immidiate scrotal exploration,detortion and orchidopexy,whereas treatment of tortion of testicular apendage is conservative.pharmacologic medical therapy is recommended among patients with Epididimytis. In testicular tumors the first line treatment is radical orchiectomy after determining the diagnosis, treatment depends on tumor type and available options are chemotherapy and radiation.
Surgery
Scrotal masses presented with acute pain ,should be treated emergently.Patients with testicular tortion are treated with immidiate scrotal exploration,detortion and orchidopexy,In testicular tumors the first line treatment is radical orchiectomy.
Primary Prevention
There are no established measures for the primary prevention of scrotal masses,but by decreasing some of the risk factors we can prevent some of the causes.