Scrotal Swellings

 

1 – Testicular Cancer

• Incidence: 4 / 100,000 males / year.

• Most common men cancer < 35 yrs.

• 1/10 occur in undescended testis.

Symptoms

− Painless hard testicular lump.

− Signs of inflammation.

− Gynaecomastia.

− Back pain (in young man suspect metastatic testicular tumor).

Investigations

• Ultrasound.

• Tumor markers (alpha-feto protein, beta HCG and Alkaline Phosphatase).

• CT scan (? Metastasis).

• Inguinal exploration of testicle & frozen section if in doubt before formal surgery.

TNM Staging

To determine stage & extent of tumor spread.

– T Histological examination of the Tumor.

– N Extent of involvement of Lymph Nodes.

– M Metastasis.

Testicular Cancer : Staging

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Types of Testicular Cancer

 Germ Cells Tumor

i. Seminoma: from germinal epithelium which rarely metastasize.

ii. Non- Seminoma:

a) Embryonal carcinoma: from fetal yolk-sac.

• Teratocarcinoma:  A spectrum from most benign-looking adult tissues; e.g. cartilage & hair.

• Choriocarcimoma:  The worst & spread rapidly through bloodstream.

B. Non-Germ Cell Tumors

1.Leydig cell tumors: arise from Leydig cells between tubules& produces Testosterone Þ give rise to precocious puberty.

2.Sertoli cell tumors: very rare, seldom metastasize & cause gynaecomastia.

Treatment of testicular tumor

• Early stages :

− Inguinal Orchiectomy ± RPL.

− Radiotherapy.

− Chemotherapy.

• Late stages :

Inguinal Orchiectomy.

Mainly chemotherapy.

 

2 – Hydrocele

• Fluid accumulation in the cavity of tunica vaginalis due to obstruction to lymphatic drainage of testicle, heart failure edema or secondary effusion due to disease of testis or epididymis.

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• In neonate associated with hernia .

• Translumination ÞPositive

• Treatment: Hydrocelectomy.

 

3 – Varicocele

• Results from deficient valves in the deep venous drainage of the scrotal contents.

• Leads to dilatation and tortuosity of the veins.

• More common on the left side.

• Can cause infertility .

• Usually asymptomatic, occasionally dragging pain.

• Treatment: Varicocelectomy.

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4 – Spermatocele

• It is a retention cyst of the rete testis or head of the epididymis.

• It contains sperms.

• Treatment: Conservative, excision if symptomatic.

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5 – Haematocele

• Direct scrotal trauma may cause bleeding in cavity of tunica vaginalis Þsever tender scrotal swelling Þ pressure atrophy on testis.

• Translumination ÞNegative.

• Treatment: Exploration, clot evacuation& repair of tunica albuginea .

 

6 – Torsion

• Twist of the testis on it’s stalk.

• Types:

1. Intravaginal torsion.

2. Extravaginal torsion (rare).

• Symptoms & Signs:

1. Postpubertal period.

2. Pain: Sudden onset.

3. Nausea & Vomiting.

4. Testis lying transversely & high in position.

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7 – Inguinoscrotal Hernia

• Patent processus vaginalis.

• Translumination test —>  -ve

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