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Scrotum > pathology > Flashcards

pathology Flashcards

1
Q

goal of the exam

A
  • evaluate size, echogenicity, and structure of each testis.
  • determine whether testicular parenchyma appears uniform with an equal echogenicity between sides
  • document masses
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2
Q

evaluation of the scrotum

A
  • is epididymis normal? is scrotal skin thickened?
  • turn on color Doppler to assess flow. is there an absence of flow in testis or is it hyperemic? how does color Doppler compare between sides?
  • check flow in each epididymis
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3
Q

trauma may be result of

A
  • MVA
  • athletic injury
  • direct blow to scrotum
  • straddle injury
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4
Q

ultrasound of scrotal trauma presents challenge due to

A

edema and pain

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5
Q

if surgery is performed within 72 hours following injury,

A

up to 90% of testes can be saved but only 45% can be saved after 72 hours

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6
Q

potential complications of trauma

A
  • testicular rupture
  • hematocele
  • hematoma
  • hydrocele
  • epididymitis
  • orchitis
  • torsion
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7
Q

determine if rupture is present

A
  • focal alteration of testicular parenchymal pattern
  • interruption of tunica albuginea
  • irregular testicular contour
  • scrotal wall thickening hematocele
  • blood flow disruption across surface of testis indicates rupture
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8
Q

hematocele

A

blood collected within the layers of the tunica vaginalis

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9
Q

hematocele sonographic appearance

A

varies with age

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10
Q

acute hematocele sonographically is

A

echogenic with numerous highly visible echoes that can be seen to float or move in real time

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11
Q

with time hematocele sonographically show

A

low-level echoes and develop fluid-filled levels or septations

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12
Q

presence of hematocele does not confirm

A

rupture

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13
Q

hematomas may involve

A

testis or epididymis or they can be contained within scrotal wall

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14
Q

hematomas appear as

A

heterogenous areas within scrotum which becomes more complex with time, developing cystic components

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15
Q

hematoma may be

A

large and cause displacement of the associated testis

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16
Q

epididym-orchitis

A

infection of both epididymis and testis

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17
Q

epididymitis and/or orchitis may result from

A

trauma

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18
Q

epididym-orchitis most commonly results from

A

spread of lower urinary tract infection

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19
Q

color Doppler imaging with epididymo-orchitis can be used to identify associated

A

increased vascularity

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20
Q

epididym-orchitis most common cause of

A

acute scrotal pain in adults

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21
Q

sonographic epididymitis appears

A

enlarged, hypoechoic gland and increase vascularity

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22
Q

sonographic findings of epididymo-orchitis with color Doppler

A

hyperemic flow confirmed

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23
Q

hyperemic flow with epididymo-orchitis seen in epididymis and testis when both involved but

A

is restricted to epididymis if testis is normal

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24
Q

orchitis

A

inflammation in the testis

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25
Q

hydrocele

A

contain serous fluid within the cavity of the tunica vaginalis

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26
Q

hydrocele most common cause of

A

painless scrotal swelling, acute or chronic

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27
Q

hydrocele may be

A

idiopathic but commonly associated with epididymo-orchitis and torsion

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28
Q

hydrocele are much more common than

A

hematoceles and pyoceles

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29
Q

pyocele is

A

a collection of pus

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30
Q

pyocele occur with

A

untreated infection or when an abscess ruptures into space between layers of tunica vaginalis

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31
Q

torsion

A

testis and epididymis twist within scrotum, cutting off vascular supply within spermatic cord

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32
Q

torsion comprised blood flow to

A

testis, epididymis, and intrascrotal portion of spermatic cord

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33
Q

torsion first affects

A

venous flow cause swelling of scrotal structures on affected side

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34
Q

if torsion continues

A

arterial flow obstructed, and testicular ischemia follows

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35
Q

torsion within 5 to 6 hours of onset pain

A

80% to 100% of testes can be salvaged

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36
Q

torsion 6-12 hour salvage rate is

A

70%

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37
Q

torsion after 12 hours only

A

20% will be saved

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38
Q

clinical symptoms of torsion

A
  • presents with sudden onset of scrotal pain with swelling on affected side
  • severe pain causes nausea and vomiting in many patients
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39
Q

torsion can occur at

A

any age

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40
Q

torsion most common in

A

adolescents/ young adults, peak age 14

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41
Q

undescended testes are

A

10 times more likely than normal testes to be affected by torsion

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42
Q

bell clapper deformity occurs when

A

the gubernaculum ligament absent that tunica vaginalis completely surrounds testis, epididymis, distal spermatic cord, allowing them to move and rotate freely within scrotum

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43
Q

gubernaculum ligament

A

which helps to hold testis in place

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44
Q

extratesticular masses

A
  • epididymal (head) cysts
  • tunica albuginea cysts
  • tunica vaginalis cysts
  • varicocele
  • scrotal hernia
  • sperm granuloma
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45
Q

epididymal cysts, tunica albuginea/ vaginalis cysts, and spermatoceles are generally

A

asymptomatic but often palpable

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46
Q

epididymal (head) cyst

A

are clear cysts containing serous fluid located within the epididymis

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47
Q

epididymal cyst typically

A

small but can grow large

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48
Q

epididymal cyst occur most often

A

in the epididymal head

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49
Q

spermatocele

A

is a large cyst at the epididymis head

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50
Q

varicocele

A

abnormal dilation of veins of pampiniform plexus and/ or of peritesticular veins

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51
Q

varicocele most common cause of

A

male infertility

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52
Q

varicocele most common on

A

left

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53
Q

varicocele is seen

A

40% of left testicular and 23% of right

54
Q

varicocele could be

A

primary or secondary

55
Q

primary varicoceles usually caused by

A

incompetent venous valves within scrotal veins

56
Q

secondary varicoceles are caused by

A

increased pressure on testicular vein

57
Q

varicocele may be result of

A

renal hydronephrosis, abdominal mass, or liver cirrhosis

58
Q

varicocele sonographic appearance

A
  • numerous tortuous tubes of varying sizes within spermatic cord near epididymal head or adjacent to testis
  • > 2cm A-P
  • tubes may contain echoes that move with real-time imaging
  • increased flow upon Valsalva maneuver
59
Q

scrotal hernia occurs when

A

bowel or omentum herniate into scrotum

60
Q

scrotal hernia clinical diagnosis usually

A

sufficient, sonography helpful in cases of equivocal findings

61
Q

most herniated structure

A

bowel followed by omentum

62
Q

peristalsis of bowel seen with

A

real-time imaging, confirms the diagnosis of a scrotal hernia

63
Q

inguinal hernia is confined to

A

the inguinal canal

64
Q

sperm granulomas occur as

A

focal chronic inflammatory reactions to extravasation of spermatozoa

65
Q

sperm granuloma most frequently seen in

A

patients with history of vasectomy

66
Q

sperm granuloma may be located

A

anywhere within epidiymis or vas deferens

67
Q

benign testicular masses

A
  • tubular ectasia of the rete testis
  • cyst
  • epidermoid cyst
  • microlithiasis
68
Q

tubular ectasia of the rete testis

A

dilation of rete testis, uncommon, benign

69
Q

tubular ectasia of the rete testis associated with

A

presence of a spermatocele, epididymal or testicular cyst or other epididymal obstruction on same side as the dilated tubules

70
Q

testicular cyst more common in men

A

over 40

71
Q

testicular cyst associated with

A

extratesticular spermatoceles (epididymal cysts)

72
Q

testicular cyst located

A

near mediastinum

73
Q

testicular cyst can be

A

single or multiple and of varying size

74
Q

epidermoid cyst

A

composed of keratin

75
Q

epidermoid cyst presentation can be like

A

that of a malignant tumors

76
Q

epidermoid cyst sonographic appearance

A
  • variable
  • may demonstrate an onion skin or target appearance
  • no color flow
77
Q

microlithiasis

A

multiple calcifications

78
Q

microlithiasis measure

A

< 3mm

79
Q

microlithiasis are usually

A

bilateral

80
Q

microlithiasis reported to have association with

A

testicular malignancy, exact nature unknown

81
Q

microlithiasis associated with

A
  • cryptorchidism
  • Klinefelter’s syndrome
  • infertility
  • varicoceles
  • testicular atrophy
  • male pseudohermaphroditism
82
Q

extratesticular masses usually

A

benign

83
Q

intratesticular masses more likely to be

A

malignant

84
Q

testicular masses are categorized as either

A

germ cell (malignant) or non-germ cell (usually benign)

85
Q

germ cell tumors elevated

A

HCG and AFP

86
Q

germ cells approximately

A

95% of all testicular tumors are of germ cell type

87
Q

most common type of germ call tumors is

A
  • seminoma
  • followed by mixed embroyonal cell tumors and teratocarcinomas
88
Q

non-germ cells tumors are generally

A

benign

89
Q

non-germ cell tumors sonographically

A

tumors appear as focal, hypervascular, hypechoic, or heterogenous masses

90
Q

testicular cancer is

A

rare (1% of male cancers)

91
Q

testicular cancers usually occur

A

in males between the ages of 20-34

92
Q

testicular cancer is one of the most

A

curable types of cancer

93
Q

testicular cancer symptoms

A
  • painless lump
  • testicular enlargement
  • vague discomfort in scrotum
94
Q

seminoma is

A

germ cell tumor

95
Q

seminoma most common primary

A

testicular tumor

96
Q

seminomas tend to be

A

homogenous, hypoechoic masses with a smooth border

97
Q

seminoma do not often contain

A

calcification or cystic components

98
Q

embryonal cell carcinoma is

A

more aggressive than seminomas

99
Q

embryonal cell sonography

A
  • heterogenous
  • calcifications present
100
Q

germ cell tumors

A
  • seminoma
  • embryonal cell carcinoma
  • leydig cell tumors
  • teratocarcinomas
  • choriocarcinoma
101
Q

leydig cells make

A

testosterone

102
Q

leydig cell tumors are

A

rare, making up less then 5% of testis cancer

103
Q

leydig cell tumors have an

A

excellent prognosis if surgically resected

104
Q

teratocarcinomas form of

A

malignant teratoma occurring especially in the testis

105
Q

teratocarcinomas made of

A

different tissues such as hair, muscle or bone

106
Q

choriocarcinoma

A

has varied sonographic appearances because of mixed cell types

107
Q

metastasis to testicle

A

is rare, normally occurring later in life

108
Q

with metastasis primary tumor may originate from

A

prostate or kidneys

109
Q

with metastasis less common sites

A
  • lung
  • pancreas
  • bladder
  • colon
  • thyroid
  • melanoma
110
Q

sonographic findings of metastasis

A
  • solid hypo or hyperechoic mass
  • mixture of both
111
Q

lymphoma most common

A

bilateral secondary testicular neoplasm affecting men >60 years

112
Q

leukemia next common

A

secondary testicular neoplasm, most often found in children

113
Q

cryptorchidism

A

undecended testis(es)

114
Q

cryptorchidism may be located in

A
  • abdomen
  • inguinal canal
  • other ectopic location
115
Q

cryptorchidism associated with

A

infertility and increased risk of cancer

116
Q

cryptorchidism sonographic findings

A
  • smaller and less echogenic than normal testis
  • mediastinum rarely seen
117
Q

cryptorchidism is

A

bilateral 10% to 25% of cases

118
Q

testicular ectopia

A

very rare condition

119
Q

ectopic testicle cannot be

A

manipulated into correct path of descent

120
Q

testicular ectopia most commonly

A

in inguinal canal

121
Q

testicular ectopia other sites include

A
  • perineum
  • femoral canal
  • suprapubic area
  • penis
  • diaphragm
  • other hemiscrotum
122
Q

anorchia

A

rare condition

123
Q

unilateral anorchia or monorchidism found

A

in 4% of patients with nonpalpable testis

124
Q

anorchia most common on

A

left side

125
Q

anorchia caused by

A

intrauterine testicular torsion or other forms of decreased vascular supply to testicle in utero

126
Q

polyorchidism

A

very rare disorder

127
Q

polyorchidism more common on

A

left side

128
Q

polyorchidism usually found in

A

scrotum, has also been found in inguinal canal or retroperitoneum

129
Q

polyorchidism increased risk of

A
  • malignancy
  • cryptorchidism
  • inguinal hernia
  • torsion
130
Q

polyorchidism duplicated

A

testis, usually small, efferent spermatic system completely absent

Scrotum (2 decks)

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