Scrotum Flashcards
What is the testicle surrounded by?
Tunica albuginea
What do the multiple septations in the tunica albuginea form?
Mediastinum testis
What is a Rete testis?
Anastomosing network of delicate tubules located in the hilum of the testicle (mediastinum testis) that carries sperm to the epididymis.
What are the sections of the epididymis?
Head, Body, Tail
Where is the Epididymis in relation to the testicle?
- Parallel to testicle
- Head is adjacent to superior pole of teste ( largest portion of epi.)
What is an appendix teste?
Remnant of Mullerian ducts
- small ovoid structure beneath the head of epi.
- torsion may occur known as “Blue dot sign”
What is the tunica vaginalis?
- saccular extension of the peritoneum into the scrotal layers
What are the layers of the tunica vaginalis?
- Visceral layer (Inner): Covers testes and Epi
- Parietal layer ( outer): Lines scrotal chamber
What is the blood flow to the testes?
- deferential artery
- Cremasteric (external spermatic) artery
- Testicular artery
What does the testicular artery divide into?
- capsular
- centripetal (intratesticular) branches
What does the spermatic cord consist of?
- vas deferens
- cremasteric, deferential, testicular arteries
- pampiniform plexus of veins
- lymphatics
- nerves
Know about testicular masses…
- most extratesticular masses are benign, majority of intratesticular lesions are malignant
What is a Seminoma?
- Most common germ cell type found in both pure seminoma and mixed germ cell testicular masses
- ** Cryptorchidism
- Spread through draining lymph nodes in the retroperitoneum
What labs are associated with tumor markers?
- Beta HCG
- AFP
- LDH
What is a nonseminoma?
- masses that are not “pure seminomas” and consist of other cell types: Embryonal carcinomas, teratomas, yolk sac tumors, choriocarcinoma
What type of lab is associated with nonseminomas?
Alpha fetoprotein
What lab will you see in both seminomas and nonseminomas?
Serum beta HCG
What is the most common testicular tumor in infants and young children?
Yolk sac tumors
- high AFP
What is a Leydig Cell tumor?
- rare stromal testicular tumor
- always benign in children, malignant variants in adults
- Tumor produces testosterone resulting in Precocious puberty
- Labs are normal in Leydig cell
What are the two types of benign cysts?
- cysts of tunica albuginea
- Intratesticular cysts
- ——-normally located near the mediastinum testis and probably originate from the rete testis
What is an Epidermoid cysts?
- benign tumor of germ cell origin
- lie beneath the tunica albuginea
- “Bow tie” central echogenic pattern
What is a Testicular Abscess?
- complication of epididymo-orchitis
- enlarged testicle seen with fluid filled mass
What are scrotal calcifications?
Calcs (“Scrotal Pearls”) may be located within the testicle or between the layers of the tunica vaginalis
- AKA: Microlithiasis
- a definite but minimal risk of testicular germ cell tumor
What is a testicular infarct?
present as a triangular-shaped avascular intratesticular lesion
- can produce a focal or diffuse hypoechoic testicle
What is a hydrocele?
Serous fluid that accumulates within the tunica vaginalis or between the layers of the tunica vaginalis (parietal or visceral layer)
What are hydroceles caused by?
Failed closure of the vaginalis at the internal ring
What is a hematocele?
blood fills the scrotal chamber from trauma
What is a varicocele?
- dilatation of the pampiniform venous plexus of the testicular veins which drain the testicle
- 90% of varicoceles are on the LEFT side
What is the most common cause for male infertility?
Varicoceles
What is the technique we use to diagnose a varicocele?
Valsalva
What is a scrotal hernia?
bowel protruding through the inguinal canal into the tunica vaginalis of the scrotum
- ** presence of peristalsis confirms diagnosis
What is the most common extratesticular tumor?
adenomatoid tumor
What is a Spermatocele?
- AKA: Epididymal cyst
- cystic masses of the epididymis that result from dilatation of the epididymal tubules
What is the difference between spermatocele and epididymal cyst?
- Spermatocele: filled with thick milky fluid containing spermatozoa
- Epididymal cyst: Clear fluid
What are the main causes for acute scrotal pain?
- Torsion
- Epididymitis / Orchitis
What is the most common condition that causes acute scrotal pain?
Epididymitis
- usually caused by sexually transmitted organisms
- can cause infection to testicle causing orchitis
What testicular torsion?
without attachment to the tunica vaginalis, the testicle can rotate freely on the spermatic cord (Bell clapper deformity)
- venous and arterial occlusion
- becomes enlarged and hypoechoic
What is Cryptorchidism?
- Hidden testicle
- AKA Undescended testicle
- infertility and cancer are complications
- Patients who has cryptorchidism have increased risk of developing malignancy
What is the most common location for undescended testis?
Inguinal canal
