scrotum II

scrotum labs

urianalysis, WBC, AFP, hCG

_____ germ cell tumors often produce AFP, and both seminoma/non-seminoma can cause a rise in ____

non-seminoma, hCG

inguinal orchiectomy

surgical removal of testicle to confirm cancer type and to prevent seeding of cancerc cells

hydrocele, hematocele, and pyoceles all occur in between the _____ and _____ layers

visceral vaginalis, parietal vaginalis

pyocele may be noted after _____ or _____

trauma, surgery

hematocele often results from ____ but can also happen in advanced cases of epididymitis or _____

trauma, orchitis

scrotal _____ is associated with abscess, tumor, etc but when paired with ____, it suggests rupture

rupture, trauma hx

sono signs of rupture

focal alteration of testi parenchyma, interruption of albuginea, wall thickening, hematocele or pyocele

surgery within 72 hours of rupture

90% of testes can be saved

surgery after 72 hours of rupture

45% of testes can be saved

epididymitis

characterized by inflammation of the epididymis, often due to infection, STI, or trauma

orchitis

decreased arterial resistance and hyperemic flow with enlarged testicles

epididymo-orchitis

both epi and testis are infected, most commonly from lower UTI via the spermatic cord

most common cause for acute scrotal pain in adults

epididymo-orchitis and epididymitis

epididymo-orchitis symptoms

pain, fever, and urethral discharge

testicular infarction

decreased or absent flow, high resistance with little to no diastolic flow

reversed diastolic flow

threatened testicular infarction

scrotal absess

most commonly a complication of epididymo-orchitis and can be associated with Fournier gangrene

if air is present in scrotal abscess, _____with shadowing will be present as well

ring down artifact

fournier gangrene

rare life threatening bacterial infection of scrotum/ penis that worsens quickly

torsion AKA

intravaginal testicular torsion AKA

up to ____ of torsion cases have an ____ on both sides

60%, anatomic anomaly

undescended testicles are _____ more likely to be affected by torsion

10 times

in torsion, ____ is affected first, then arterial flow is obstructed and _____ follows

venous flow, ischemia

bell-clapper deformity

congenital abnormality where there is a lack of tnormal posterior fixation of testis and epi to scrotal wall and is the most common cause for torsion

first 6 hours after onset of pain-torsion

100% salvage rate

6-12 hours after onset of pain-torsion

70% salvage rate

12-24 hours after onset of piain-torsion

20% salvage rate

acute testicular torsion

most common cause of acute scrotal pain in adolescents including testicular, lower abdomen, and inguinal pain

cremasteric reflex

reflex that elevates testicle when inner thigh is stroked

whirlpool sign of _____ is a sono finding of _____

spermatic cord, acute testicular torsion

spontaneous detorsion AKA

torsion detorsion syndrome or intermittent testicular torsion AKA

RI of ____ can be associated with partial/complete _____

>0.75, torsion

extra-vaginal testicular torsion AKA

prenatal torsion AKA

in _____ torsion the testis is usually _____ and must be surgically removed

extra-vaginal, necrotic

chronic testicular torsion

>10 days

scrotal cysts

can be in epi or tunica albuginea

spermatocele

cystic dilations of efferent ductules, always in epi head

____ fluid and ____ are present in scrotal cysts, which can occur post-vasectomy

proteinaceous, spermatazoa

adenamatoid tumor

most common extra-testicular mass, common in 20-50 yr olds, and most common at tail of epi

epidermoid cyst AKA

keratocysts AKA

epidermoid cyst is a _____ of ____ origin

benign teratoma, germ-cell

a keratocyst is of slightly higher prevalence on _____ and has an____ appearance

right side, onion-ring

varicocele

abnormal dilation of the veins of the pampiniform plexus and most common correctable cause of infertility

non-compressible varicocele in men _____ can prompt a search for ____

>40 yrs, retroperitoneal mass

varicocele normal measurement

<2mm

scrotal hernia results from

indirect inguinal hernia

sperm granuloma

sperm leak that can be painful and results most commonly from a vasectomy

tubular ectasia of rete testis

uncommon benign result from partial/complete obliteration of efferent ducts

tubular ectasia of rete testis is associated with _____, epi/testes cyst, and _____

spermatocele, epi obstruction

tubular ectasia o the rete testis is often ____ and common in men aged ____

bilateral, >55 yrs

microlith

associated with malignancy

scrotal pearl AKA

scrotolith AKA

testicular cancer is the mot common cancer in men _____ and most frequently men aged ____

15-35 yrs, 20-34 yrs

undescended testicles are ____ more at risk for ____, but is is one of the most curable forms

2.5-8x, testicular cancer

extra-testicular masses are more likely to be _____, while intra-testicular masses are more likely to be ____

benign, malignant

risk factors for testicular cancer

infertility, kleinfelter, down syndrome, smoking

klinefelter

extra copy of x chromosome

germ cell tumors

seminomas and non-seminomas, malignant, and the most common tumors

germ cell tumor labs

elevated AFP and hCG

non-germ cell tumors

typically benign

non-seminoma types

include embryonal carcinoma, teratoma, choriocarcinoma, and yolk sac tumor

non-germ cell tumor types

Leydig cell, Sertoli cell, and granulosa cell tumors

seminoma

most common type pure germ cell tumor, occurring in the 4/5th decade of life

seminoma labs

AFP normal, hCG elevated

embryonal carcinoma

2nd most common testiclar tumor, more aggressive

embryonal carcinoma labs

elevated AFP and hCG

teratoma

2nd most common testicular neoplasm in children

teratoma labs

AFP and hCG elevated sometimes

choriocarcinoma labs

hCG is elevated

choriocarcinoma

worst prognosis, death writhing a year from diagnosis and very rare, <1%

yolk sac tumor AKA

endodermal sinus tumor AKA

yolk sac tumor

most common testicular tumor in infants and young children. most occur <2 yrs old

yolk sac tumor labs

AFP elevated

mets to testis may originate from _____ or _____

prostate, kidneys

malignant lymphoma

most common bilateral secondary testicular neoplasm affecting men >60 yrs and makes up 1-7% of testicular tumors

leukemic involvement

second most common secondary testicular neoplasm, most often occurring in children

leydig ce tumor

most common non-germ cell tumor occurring in 5-10 yr olds and 30-60 yr olds

leydig cell tumors produce ____ and may also secrete ____

testosterone, estrogen

leydig cell tumor labs

AFP and hCG normal

sertoli cell tumors

<1% of all testicular tumors and are usually very small <1 cm

sertoli cell tumor risk factors

i descended testis, patients with feminization, kleinfelter, or peutz-jeghers

peutz-jeghers

lesions along GI tract

granulosa cell tumors AKA

granuloma-theca cell tumors AKA