Scrotal mass differential diagnosis: Difference between revisions

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{{CMG}};{{AE}}{{Preeti}}
{{CMG}};{{AE}}{{Preeti}}
==Overview==
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]]. Common differential diagnoses include [[yolk sac tumor]], [[teratoma]], [[choriocarcinoma]], [[embryonal cell carcinoma]], [[seminoma]], and [[lymphoma|testicular lymphoma]] (usually [[non-Hodgkin lymphoma]]).


==Differential Diagnosis==
==Differential Diagnosis==

Revision as of 17:05, 18 October 2019

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

Differential Diagnosis

The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.

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.
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  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.
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  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.
  29. ↑ Colmenero JD, Muñoz-Roca NL, Bermudez P, Plata A, Villalobos A, Reguera JM (April 2007). "Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis". Diagn. Microbiol. Infect. Dis. 57 (4): 367–72. doi:10.1016/j.diagmicrobio.2006.09.008. PMID 17141451.
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  33. ↑ Okui N, Tomita K, Kimura A, Uekane K, Kawamura T, Teshima S (September 1994). "[Heterochronic occurrence of bilateral torsion of appendix testis a case report]". Nippon Hinyokika Gakkai Zasshi (in Japanese). 85 (9): 1395–8. PMID 7967303.
  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.
  43. ↑ Hagerman RJ, McBogg P, Hagerman PJ (June 1983). "The fragile X syndrome: history, diagnosis, and treatment". J Dev Behav Pediatr. 4 (2): 122–30. PMID 6348096.
  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.
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  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.
  72. ↑ Yagain K, Mathew M (February 2011). "Filariasis presenting as a scrotal nodule in a 2 year old child: a case report". Asian Pac J Trop Med. 4 (2): 167–8. doi:10.1016/S1995-7645(11)60062-X. PMID 21771446.
  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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