Scrotal Cysts Flashcards by Nya Sanchez-Fernandez

What is a spermatocele

Fluid-filled sac that grows in the head of the epididymis

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Spermatoceles contain

Thick milky fluid

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What is in the thick milky fluid in spermatoceles

Spermatozoa
Lymphocytes
Cellular debris

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What are the sonographic findings of spermatoceles

Anechoic/hypoechoic
Head of epididymis
Posterior acoustic enhancement
Low-level echoes

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What are differentials of spermatoceles

Varicocele
Hydrocele
Epididymal cyst

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Varicocele is engorged

Spermatic cord veins

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What does an epididymal cyst contain

Clear serous fluid

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Spermatocele is difficult to differentiate form an epididymal cyst except for ____ since

Aspiration since a spermatocele contains milky-appearing sperm

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Testicular cysts may be caused by

Cancer
Fibrosis
Epididymal cysts

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What are the symptoms of testicular cysts

Swelling
Lesions
Inflammations
Probelms during ejaculation

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What are the sonographic findings of a testicular cyst

Criteria for simple cyst
(Anechoic, thin walled, posterior enhancement)

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What are the differentials of a testicular cyst

Mature cystic teratoma
Tubular ectasia of Rete Testis
Intratesticular Abscess

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What is tubular ectasia/Rete testis

Partial or complete obliteration of efferent ducts

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What is a intratesticular abscess secondary to

Epididymyo-orchitis

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Tubular ectasia or rete testis occurs in patients ___
Occurs ____ (Bilateral or unilateral)

55+ years old
Bilateral

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Where are simple scrotal cysts usually located

Common in mediastinum testis

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What is an epididymal cyst contain

Serous liquid

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Where is the most common place for an epididymal cyst

Mostly over head of epididymis

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Epididymal cysts are lined with ____ and contains

Epithelium
Contains clear serous fluid

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What is an epidermoid cyst

Noncancerous small bumps beneath the skin

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Where are the most common places for epidermoid cysts

Face
Neck
Trunk
Scrotum

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What are the sonographic findings of an epidermoid cyst

“Target/Bull’s Eye” pattern
Confined to tunica albuginea
“Onion skin”

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What are the differentials of an epidermoid cyst

Tunica albuginea cyst
Germ cell tumor
Testicular granuloma

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What is scrotoliths

Scrotal pearls
Benign macro-calcifications (Stones in scrotum)

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T or F: In scrotoliths there is clinical significance

False Usually no clinical significance

What are the main causes of microlithiasis

Unknown but sometimes associated with testicular cancer

In microlithiasis there is multiple small

Calcifications

What are the sonographic findings for microlithiasis

Discrete, small, echogenic foci within testicle 1-3mm No posterior shadowing

What are the differentials for microlithiasis

Scrotal pearls Large-cell calcifying sertoli cell tumor Testicular granuloma

Varicoceles is dilated veins in the It is due to

Pampiniform plexus of spermatic cord Due to venous reflux

Varicoceles is due to retrograde flow in

Internal spermatic vein

Varicocele happens most commonly on the ___(Right or Left) side

Left

What is the most common sign of varicoceles

Infertility

What is the most common reversible cause of male infertility

Varicoceles

What are the sonographic findings of varicoceles

Scanned upright and supine Multiple hypoechoic, serpiginous tubular structures Superior and lateral to testis

Sonographically the diameter of the plexus veins in varioceles is approx.

>2-3 mm

What is the rule fo 3's

3 veins>3mm

In varicoceles there's the enlargement of veins with

Valsalva maneuver

In varicoceles there is retrograde color with

Valsalva

What are the differentials of varicoceles

Tubular ectasia/Rete testis Testicular torsion Epididymitis

T or F: Flow does not change with valsalva in epididymitis

True

95% of testicular tumors are

Malignant germ cell tumors

Testicular carcinomas originate from

Reproductive (Sperm producing) tissue

What are the types of germ cell tumors

Nonseminomatous germ cell tumor Seminoma

T or F: Nonseminomatous germ cell tumors are less aggressive than seminoma

False Is more aggressive

What is the most common type of germ cell tumor

Seminoma

What is a seminoma

Malignant germ cell tumor

A seminoma most commonly involves the ___ Less frequently in

Common - Testicle Less - Mediastinum, retroperitoneum, extra-gonadal sites

Seminoma is ____ growth, ___ invasion, and ___ prognosis

Slow growth, late invasion, good prognosis

Embryonal carcinomas usually happen in what decades

2nd & 3rd decade

Choriocarcinoma usually happen in what decades

2nd & 3rd decade

What is the least common testicular carinoma

Choriocarcinoma

Choriocarcinoma is a ___ growth, ____ invasion, and ___ prognosis

Rapid growth, rapid invasion, bad prognosis

Choriocarcinomas may produce

Human chorionic gonadotropin and gynecomastia

What is a teratoma

Epidermoid cyst

Teratomas are ____ (Malignant or Benign), ____ childhood (Early or late), to ___ decade

Benign, early childhood, 3rd decade

Seminomas are malignant tumors of the

Testis

What is the most common testicular tumor

Seminoma

What are the types of seminoma

Classic Typical Spermatocystic

Seminoma is a counterpart of dysgerminoma of the _____

Ovary

What are the clinical findings of seminoma

Elevated beta - hCG, AFP Palpable mass Painless

What are the sonographic findings of a seminoma

Well-defined Hypoechoic Solid No calcifications or tunica invasion

What is a teratoma/teratocarcinoma

Type of testicular cancer affecting the germ cells of sperm

What are the sonographic findings of a teratoma/teratocarcinoma

Well-defined Anechoic/Complex hetergenous mass Cystic areas, calcifications

What are embryonal cell carcinomas What do they give a rise to

Malignant growth made up of epithelial cell Rise to metastases

Embryonal cell carcinomas are a form of cancer that makes up the majority of the cases of malignancy in

Breast Uterus Intestinal tract Skin Tongue

Embryonal cell carcinoma is a _____ (Common or uncommon) type of germ cell tumors that occurs in

Uncommon In ovaries and testes

What is the average age of diagnosis of embryonal cell carcinomas

Embryonal cell carcinomas are ____ (Nonaggressive or Aggressive) germ cell tumors

Aggressive

For embryonal cell carcinoma the peak incidence occurs in people of what age

30 years

What are more common sites for metastasis

Retoperitoneum Lung Liver

What are the sonographic findings of an embryonal cell carcinoma

Heterogenous Perdominately solid Mixed echogenicity Poorly marginated Coarse calcifications Invase TA & distort testicular contour

Uncommon form of germ cell tumor Usually about _-_% of tumors

Choriocarcinoma 1-3%

Choriocarcinoma peak at what age

Young adult males

What are the lab values for choriocarcinoma

Elevated serum beta hCG

What is clincal findings of a choriocarcinoma

Patients with history of cryptorchidism have increased risk of testicular cancer

What are the sonographic findings of a choriocarcinoma

Complex echo pattern Hemorrhage Necrosis Calcifications

What are the differentials of a choriocarcinoma

Epidermoid cyst Lymphoma Subacute hematoma

Gonadal stromal tumors also known as non-germ cell, interstitial or sex cord tumors

Stromal tumors

Gonadal germ cell tumor ___ & ___ in repro organs

Start & stays

Stromal tumors originate in

Intersititial cells

What is the most common form of stromal tumors

Leydig

What are the 4 types of stromal tumors

Leydig Sertoli Granulosa cell Gonadoblastoma

Sertoil stromal tumors aise from

Cells lining seminiferous tubules

What are granulosa cells

Rare benign tumor

Gonadoblastoma contains both

Stromal and germ cell elements

What is a Leydig cell tumor

Type of testicular cancer affecting the stromal cells of the testis

What are Leydig cells

Structral and hormone producing cells of the testis

What are stromal cells

Connective tissue or any organ

Leydig cell tumor has decreased ____, ____, ____

Libido Gynecomastia Impotence

Painless testicular enlargement

Leydig cell tumor

__% of Leydig cell tumors are ______ (Malignant or Benign)

90% Benign

What are the sonographic findings of Leydig cell tumors

Small solid hypoechoic intratesticular mass

What are sertoli cell tumors

Sex cord-gonadal stromal tumor of sertoli cells

Sertoli cell tumors occur in the

Testes or ovary

Sertoli cell tumors are very ____ (Common or rare) and are usually between what ages

35-50

What are the sonographic findings of sertoli cell tumor

Small hypoechoic mass

Metastatic tumor is the same type of cancer as the _____ tumor

Primary

What are the most common sites of metastasis in testicular cancer

Lymph nodes in lungs and abdomen

In metastatic testicular tumors more ____ (Rarely or Commonly) the cancer spreads to the

Rarely Bone, Liver, and Brain

T or F: All testicular masses should be considered malignant until proven otherwise

True

Most malignancies are ____ (Hyperechoic or Hypoechoic) to normal testis

Hypoechoic

Surgical removal of the skin covering the tip of the penis

Circumcision

What are the health benefits of circumcision

Easy hygiene Decreased risk of UTI's, STI's, & penile cancer Prevent penile probelms

Circumcision is not recommended if

Blood-clotting disorders Premature babies Babies born with abnormalities of the penis

What are the risk of circumcision

Bleeding & Infection Side affects related to anesthesia Foreskin may be cut too short or long