Calcinosis escrotal: ¿una entidad idiopática? / Scrotal Calcinosis: an Idiopathic Entity?

La calcinosis escrotal es una enfermedad benigna e infrecuente que se presenta en adultos de mediana edad, con múltiples nódulos asintomáticos a nivel de la piel del escroto. Algunos autores vinculan la aparición de estas lesiones a la calcificación secundaria de quistes epidérmicos o ecrinos. Cuando no se encuentra relacionada con dichas entidades ni con alteraciones del metabolismo fosfocálcico, el cuadro se considera idiopático. El tratamiento de elección es quirúrgico, en caso de impacto en la calidad de vida o relevancia estética para el paciente. (AU)

Scrotal calcinosis is a rare, benign disease that presents in middle-aged adults with multiple asymptomatic nodules on the skin of the scrotum. Some authors link the appearance of these lesions to the secondary calcification of epidermal or eccrine cysts. When it is not related to these entities or to alterations in phosphocalcic metabolism, the condition is considered idiopathic. The treatment of choice is surgical, in case of impact on the quality of life or aesthetic relevance for the patient. (AU)

Paratesticular Dermoid Cyst Mimicking a Torsed Supernumerary Testis: A Case Report.

BACKGROUND Paratesticular tumors are rare causes of scrotal masses; most are benign and arise from the spermatic cord. We present the case of a dermoid cyst, a rare benign paratesticular tumor mimicking a torsed supernumerary testis. CASE REPORT An 8-year-old male presented to the Emergency Department with intense pain and swelling in the left hemiscrotum. He reported severe stabbing pain in his left hemiscrotum, quantified as 10/10, and demonstrating no improvement with change in position. Ultrasonography of the scrotum showed an oval-shaped heterogeneous, predominantly hypoechoic structure observed immediately inferior and lateral to the left testicle, showing no internal vascularity. The right hemiscrotum showed no testicular structure. Based on the sonographic observations, the possibility of 2 adjacent testicles in the left hemiscrotum was raised; the one without vascularity and with hypoechoic texture suggested the presence of ischemic changes due to torsion. The differential diagnosis of a paratesticular mass includes a paratesticular tumor, mimicking of paratesticular neoplasms (i.e. polyorchidism and splenogonadal fusion) and metastases. Surgical exploration of the left hemiscrotum revealed a normal untorsed left testis with an adherent paratesticular mass. An intraoperative frozen biopsy of the mass offered the preliminary diagnosis of an epidermoid cyst. CONCLUSIONS Paratesticular tumors can clinically present variably as a mass, which can be painful. Dermoid cysts can present as a painful mass and the sonographic appearance varies from anechoic to hyperechoic according to the cyst contents. A dermoid cyst as the differential diagnosis of a painful paratesticular mass in boys is important along with the possibility of a torsed supernumerary testicle.

Inguinoscrotal stage of testicular descent: analysis in 217 human fetuses.

BACKGROUND: Testicular descent is a complex process of relevant importance for the comprehension of cryptorchidism. Studies about the inguinoscrotal stage of testicular migration correlating the testicular position with fetal parameters are rare in the literature. Our hypothesis is that the transition of the testis by the inguinal canal is a very fast process and occurs at the end of the third gestational trimester. AIM: To analyze the inguinoscrotal stage of testicular descent during the human fetal period. STUDY DESIGN: This is an observational study in human fetuses. We studied 217 human male fetuses ranging from 10 to 35 weeks postconception (WPC). The fetuses were well preserved and evaluated regarding crown-rump length (CRL) and body weight before dissection. Testicular position was classified as: a) abdominal, when the testis was proximal to the internal ring; b) inguinal, when it was found between the internal and external inguinal rings; and c) scrotal, when being inside the scrotum. Means were statistically compared using the unpaired t-test (P < 0.05). RESULTS: Of the 434 testes, 329 (75.8%) were abdominal, 48 (11.05%) were inguinal, and 57 (13.13%) were scrotal. The first case of inguinal testis was observed in a fetus with 17 WPC, 203 g, and 15 cm CRL. The 48 inguinal testes were observed in 29 fetuses (13.36%), aged between 17 and 29 WPC, weighing between 203 and 1220 g, and with CRL between 15 and 27.5 cm. Of the 29 fetuses with inguinal testes, 23 (79.32%) were aged between 20 and 26 WPC; 3 (10.34%) had 17 WPC; and 3 (10.34%) had more than 26 WPC. All the fetuses with more than 30 WPC had testes in the scrotum. We did not observe fetuses less than 17 WPC with the testes in the canal. DISCUSSION: We found that all fetuses with more than 30 WPC had the testes located in the scrotum and that in fetuses between 17 WPC and 25 WPC, 38 testes (8.7% of the sample) were situated in the canal and only 1 testis in a fetus with 25 WPC was located in the scrotum, showing that the second stage of testicular migration through the inguinal canal rarely occurs before the 20th WPC. CONCLUSION: The inguinoscrotal stage of testicular descent is a fast process, observed only in 13% of the fetuses and occurring with more intensity between 20 and 26 WPC.

Characterization of scrotal involvement in children and adolescents with IgA vasculitis.

OBJECTIVE: To characterize scrotal involvement in children and adolescents with IgA vasculitis. METHODS: A cross-sectional retrospective study included 296 IgA vasculitis (EULAR/PRINTO/PRES criteria) patients, 150/296 (51%) were males and assessed by demographic/clinical/laboratory and treatments. Scrotal involvement was defined by the presence of scrotal edema and/or pain/tenderness in physical examination and/or testicular Doppler ultrasound abnormalities. RESULTS: Scrotal involvement was observed in 28/150 (19%) IgA vasculitis patients. This complication was evidenced at IgA vasculitis diagnosis in 27/28 (96%). Acute recurrent scrotal involvement was observed in 2/150 (1%) and none had chronic subtype. Further analysis of patients with scrotal involvement at first episode (n = 27) compared to those without this complication (n = 122) revealed that the median age at diagnosis [4.0 (2.0-12) vs. 6 (1.3-13) years, p = 0.249] was similar in both groups. The frequency of elevated serum IgA was significantly lower in IgA vasculitis patients with scrotal involvement versus without this manifestation (18% vs. 57%, p = 0.017), whereas glucocorticoid (93% vs. 49%, p < 0.0001) and ranitidine use (63% vs. 30%, p = 0.003) were significantly higher in the former group. CONCLUSIONS: The scrotal involvement occurred in almost one fifth of IgA vasculitis patients and was commonly evidenced as acute subtype at diagnosis. Scrotal signs/symptoms improved after a prompt use of glucocorticoid and was associated with low frequency of elevated IgA serum levels.

Infrared thermography as a noninvasive method to assess scrotal insulation on sperm production in beef bulls.

This study evaluated the thermoregulation and spermatogenic changes by scrotal temperature gradient using infrared thermography in testicular compromised bulls. Bulls were insulated (n = 6) for 72 hr and control animals (n = 3) remained without insulation during all the experimental period. Seminal evaluation was performed prior, at insult removal and once per week for 13 consecutive weeks. Mean temperature gradient in insulated animals was lower at the time of insulation removal compared to the week prior and after the insult (p < .05). Two weeks after insult, sperm motility was lower in insulated compared to control animals (p < .01) and spermatozoa total defects were higher in insulated compared to control animals (p < .05). Two and seven weeks after insult, the major defects were higher in insulated compared to control animals (p < .05). Scrotal temperature gradient showed a positive correlation with sperm mass motion (p < .01) and a negative correlation with ocular globe temperature (p < .01) in insulated animals. The infrared thermography can be used to evaluate ocular globe temperature in bulls; however, it is only effective to detect changes in scrotal temperature gradient at the insult removal.

Achados citopatológicos e ultrassonográficos de mastocitoma na bolsa escrotal em cão / Cytopathological and ultrasonographic findings of mastocytoma in a scrotal pouch in a dog

Mast cell tumors are the most common skin cancer in dogs. They are characterized by excessive proliferation of neoplastic mast cells. The areas of higher incidence are posterior region of the animal body, scrotum and flank. The diagnosis of mastocytoma is may have the aid of imaging tests such as ultrasonography, but it is essentially based on cytology. A dog was admitted to VETCLINIC for ultrasonographic and cytological examination of the scrotal region, because it was enlarged after orchiectomy procedure. Ultrasonographic examination revealed a heterogeneous echogenic image measuring 3.93 cm by 2.76 cm, showing regular and defined contours and with evident internal vascularity in Doppler mode suggestive of inflammatory process. In cytology, the sample of low cellularity consists of individualized round cells. Round to oval nucleus presenting coarse chromatin and sometimes evident nucleoli (1-2). Moderate to large cytoplasm with intense presence of granules of pink coloration. Intense anisocytosis and anisocariasis. Background of hemorrhagic blade with marked presence of granules, being the suggestive report, being the findings compatible with mastocytoma.

Achados citopatológicos e ultrassonográficos de mastocitoma na bolsa escrotal em cão / Cytopathological and ultrasonographic findings of mastocytoma in a scrotal pouch in a dog

Mast cell tumors are the most common skin cancer in dogs. They are characterized by excessive proliferation of neoplastic mast cells. The areas of higher incidence are posterior region of the animal body, scrotum and flank. The diagnosis of mastocytoma is may have the aid of imaging tests such as ultrasonography, but it is essentially based on cytology. A dog was admitted to VETCLINIC for ultrasonographic and cytological examination of the scrotal region, because it was enlarged after orchiectomy procedure. Ultrasonographic examination revealed a heterogeneous echogenic image measuring 3.93 cm by 2.76 cm, showing regular and defined contours and with evident internal vascularity in Doppler mode suggestive of inflammatory process. In cytology, the sample of low cellularity consists of individualized round cells. Round to oval nucleus presenting coarse chromatin and sometimes evident nucleoli (1-2). Moderate to large cytoplasm with intense presence of granules of pink coloration. Intense anisocytosis and anisocariasis. Background of hemorrhagic blade with marked presence of granules, being the suggestive report, being the findings compatible with mastocytoma.(AU)

A 26-Year-Old Man From Mexico With Headaches, Dysuria, and a Right Scrotal Mass.

CASE PRESENTATION: A 26-year-old man with no medical history was admitted to the hospital for evaluation of his change in mental status. He was noted to be agitated at work and had difficulty walking for 2 days before being brought in to the ED by his family. According to his uncle, the patient had been complaining of a headache and pain with urination for approximately 1 week. He was born in Guerrero, Mexico (a small farm town), and moved to Los Angeles, California, in 2008.

Avaliação Por Ressonância Magnética Das Principais Estruturas Do Escroto De Búfalos Em Desenvolvimento / Magnetic Resonance Evaluation Of The Main Structures Of The Sculpture Of Buffalo Development / Evaluación Por Resonancia Magnética De Las Principales Estructuras Del Escrito De Búfalos En Desarrollo

O objetivo deste estudo foi relatar o uso da ressonância magnética (RM) para avaliar os principais componentes do escroto de búfalos, bem como sua relação com a idade, peso corporal (PC) e níveis plasmáticos de testosterona. Foram avaliados o parênquima testicular (PT), mediastino (MD), cabeça (CE), corpo (CP) e cauda do epidídimo (CD), plexo pampiniforme (PP) e a túnica albugínea (TA) de dez peças anatômicas de búfalos com média de idade de 20,20 meses e peso corporal (PC) de 564kg, obtidas de frigorífico. Os exames de RM foram realizados utilizando um equipamento de baixo campo magnético de 0,25 Tesla e quatro bobinas de radiofrequência. Realizaram-se as sequências: Spin eco T1 (SE-T1), Short TI Inversion-Recovery (STIR), Fast Spin eco T2 (FSE-T2), Gradiente eco T1 (GE-T1), Gradiente eco T2 (GE-T2) e Turbo 3D-T1. Realizou-se a colheita de sangue, durante a sangria dos animais, para avaliação da concentração plasmática de testosterona (ng/mL). Determinou-se o grau de similaridade (%) para avaliação da equiparidade das imagens com a idade, concentração plasmática de testosterona e PC. Para o PT, a maior similaridade foi encontrada entre a idade, a concentração plasmática de testosterona (77,31%) com a GE-T2 e o PC teve maior similaridade (71,07%) com a GE-T1.

The objective of this study was to report the use of magnetic resonance imaging (MRI) to evaluate the main components of the buffalo scrotum, as well as its relation with age, body weight (BW) and plasma testosterone levels. The testicular parenchyma (PT) was evaluated; Mediastinum (MD); (CP) and the tail of the epididymis (CD), pampiniform plexus (PP) and the tunica albuginea (TA) of ten anatomical pieces of buffalo with a mean age of 20,20 months and body weight (CP) Of 564kg, obtained from refrigerator. MRI scans were performed using a 0.25 Tesla low magnetic field equipment and four radiofrequency coils. The following sequences were performed: Spin echo T1 (SE-T1), Short TI Inversion-Recovery (STIR), Fast Spin echo T2 (FSE-T2), E2 gradient (GE-T2), E2 gradient (GE-T1) and Turbo 3D-T1. Blood sampling was also performed during bleeding of the animals to evaluate the plasma concentration of testosterone (ng/mL). The degree of similarity (%) was determined for the evaluation of the image equivalence with age, plasma testosterone concentration and CP. For PT, the highest similarity was found between age and plasma testosterone concentration (77.31%) with GE T2 and PC had greater similarity (71.07%) with GE-T1.

El objetivo de este estudio fue relatar el uso de la resonancia magnética (RM) para evaluar los principales componentes del escroto de búfalos, así como su relación con la edad, peso corporal (PC) y niveles plasmáticos de testosterona. Se evaluó el parénquima testicular (PT), Mediastino (MD), (PP) y la túnica albugínea (TA) de diez piezas anatómicas de búfalos con una media de edad de 20,20 meses y peso corporal (PC). De 564kg, obtenidas de nevera. Los exámenes de RM se realizaron utilizando un equipo de bajo campo magnético de 0,25 Tesla y cuatro bobinas de radiofrecuencia. Se realizaron las secuencias: Spin eco T1 (SE-T1), Short TI Inversion-Recovery (STIR), Fast Spin eco T2 (FSE-T2), Gradiente eco T2 (GE-T1), Gradiente eco T2 (GE-T2) y Turbo 3D-T1. Se realizó también la toma de sangre durante la sangría de los animales para evaluar la concentración plasmática de testosterona (ng/ml). Se determinó el grado de similitud (%) para evaluar la equiparidad de las imágenes con la edad, concentración plasmática de testosterona y PC. Para el PT la mayor similitud fue encontrada entre la edad y la concentración plasmática de testosterona (77,31%) con la GE-T2 y el PC tuvo mayor similitud (71,07%) con la GE-T1. El MD presentó una similitud de 93,70% entre la edad y la concentración plasmática de testosterona con la FSE-T2 y STIR y en relación al PC, el nivel de similitud fue superior en la GE-T2 y el FSE-T2 (60,10%).

Avaliação Por Ressonância Magnética Das Principais Estruturas Do Escroto De Búfalos Em Desenvolvimento / Magnetic Resonance Evaluation Of The Main Structures Of The Sculpture Of Buffalo Development / Evaluación Por Resonancia Magnética De Las Principales Estructuras Del Escrito De Búfalos En Desarrollo

O objetivo deste estudo foi relatar o uso da ressonância magnética (RM) para avaliar os principais componentes do escroto de búfalos, bem como sua relação com a idade, peso corporal (PC) e níveis plasmáticos de testosterona. Foram avaliados o parênquima testicular (PT), mediastino (MD), cabeça (CE), corpo (CP) e cauda do epidídimo (CD), plexo pampiniforme (PP) e a túnica albugínea (TA) de dez peças anatômicas de búfalos com média de idade de 20,20 meses e peso corporal (PC) de 564kg, obtidas de frigorífico. Os exames de RM foram realizados utilizando um equipamento de baixo campo magnético de 0,25 Tesla e quatro bobinas de radiofrequência. Realizaram-se as sequências: Spin eco T1 (SE-T1), Short TI Inversion-Recovery (STIR), Fast Spin eco T2 (FSE-T2), Gradiente eco T1 (GE-T1), Gradiente eco T2 (GE-T2) e Turbo 3D-T1. Realizou-se a colheita de sangue, durante a sangria dos animais, para avaliação da concentração plasmática de testosterona (ng/mL). Determinou-se o grau de similaridade (%) para avaliação da equiparidade das imagens com a idade, concentração plasmática de testosterona e PC. Para o PT, a maior similaridade foi encontrada entre a idade, a concentração plasmática de testosterona (77,31%) com a GE-T2 e o PC teve maior similaridade (71,07%) com a GE-T1. (AU)

The objective of this study was to report the use of magnetic resonance imaging (MRI) to evaluate the main components of the buffalo scrotum, as well as its relation with age, body weight (BW) and plasma testosterone levels. The testicular parenchyma (PT) was evaluated; Mediastinum (MD); (CP) and the tail of the epididymis (CD), pampiniform plexus (PP) and the tunica albuginea (TA) of ten anatomical pieces of buffalo with a mean age of 20,20 months and body weight (CP) Of 564kg, obtained from refrigerator. MRI scans were performed using a 0.25 Tesla low magnetic field equipment and four radiofrequency coils. The following sequences were performed: Spin echo T1 (SE-T1), Short TI Inversion-Recovery (STIR), Fast Spin echo T2 (FSE-T2), E2 gradient (GE-T2), E2 gradient (GE-T1) and Turbo 3D-T1. Blood sampling was also performed during bleeding of the animals to evaluate the plasma concentration of testosterone (ng/mL). The degree of similarity (%) was determined for the evaluation of the image equivalence with age, plasma testosterone concentration and CP. For PT, the highest similarity was found between age and plasma testosterone concentration (77.31%) with GE T2 and PC had greater similarity (71.07%) with GE-T1.(AU)

El objetivo de este estudio fue relatar el uso de la resonancia magnética (RM) para evaluar los principales componentes del escroto de búfalos, así como su relación con la edad, peso corporal (PC) y niveles plasmáticos de testosterona. Se evaluó el parénquima testicular (PT), Mediastino (MD), (PP) y la túnica albugínea (TA) de diez piezas anatómicas de búfalos con una media de edad de 20,20 meses y peso corporal (PC). De 564kg, obtenidas de nevera. Los exámenes de RM se realizaron utilizando un equipo de bajo campo magnético de 0,25 Tesla y cuatro bobinas de radiofrecuencia. Se realizaron las secuencias: Spin eco T1 (SE-T1), Short TI Inversion-Recovery (STIR), Fast Spin eco T2 (FSE-T2), Gradiente eco T2 (GE-T1), Gradiente eco T2 (GE-T2) y Turbo 3D-T1. Se realizó también la toma de sangre durante la sangría de los animales para evaluar la concentración plasmática de testosterona (ng/ml). Se determinó el grado de similitud (%) para evaluar la equiparidad de las imágenes con la edad, concentración plasmática de testosterona y PC. Para el PT la mayor similitud fue encontrada entre la edad y la concentración plasmática de testosterona (77,31%) con la GE-T2 y el PC tuvo mayor similitud (71,07%) con la GE-T1. El MD presentó una similitud de 93,70% entre la edad y la concentración plasmática de testosterona con la FSE-T2 y STIR y en relación al PC, el nivel de similitud fue superior en la GE-T2 y el FSE-T2 (60,10%).(AU)

Tumor germinal mixto maligno de testículo de inicio súbito: presentación de un caso / Testicle´s malignant mixed germ tumor of sudden onset: a case presenting

Los tumores germinales mixtos representan el 40-60% de las neoplasias testiculares, pueden presentarse en testículos descendidos o no, y en sitios extratesticulares. Están asociados a condiciones como criptorquidia, atrofia testicular y hernia inguinal. Pueden debutar con síntomas que incluyen aumento unilateral del volumen escrotal, con o sin dolor. Microscópicamente se observan varias combinaciones de componentes histológicos germinales, es indispensable la determinación del porcentaje de cada uno de ellos, y la medición de marcadores tumorales, por sus implicaciones pronósticas. El tratamiento principal está basado en la orquiectomía radical y dependiendo del estadio la quimioterapia y o radioterapia complementaria. En los pacientes adecuadamente tratados, la sobrevida es muy buena, aun en estadios avanzados de la enfermedad. Se presenta masculino de 20 años con dolor de inicio súbito y sensación de masa en testículo derecho. Ecografía revela lesión sólida que compromete parénquima testicular. Se realiza orquiectomía radical. Estudio anatomopatológico muestra tumor maligno con áreas sólidas y quísticas, tipo tumor germinal mixto con componente de carcinoma embrionario, teratoma maduro, y tumor de seno endodérmico, sin componente seminomatoso.

Mixed germ cell tumors represent 40-60% of testicular tumors, they can occur in undescended testicles or not, and Extratesticular sites. They are associated with conditions such as cryptorchidism, testicular atrophy and inguinal hernia. They may present with symptoms including unilateral scrotal volume increase, with or without pain. Microscopically various combinations of components observed histological germ is indispensable determining the percentage of each, and measurement of tumor markers for prognostic implications. Treatment is based on surgical resection plus chemotherapy and / or adjuvant radiotherapy. In treated patients, survival is good, even in advanced stages of the disease. Male 20 years presents with sudden onset of pain and sensation of mass in the right testicle. Ultrasound reveals solid lesion that compromises testicular parenchyma. Radical orchiectomy is done. Pathological study shows malignant tumor with solid and cystic areas, with mixed germ cell tumor type component of embryonic carcinoma, teratoma, endodermal sinus tumor and without seminoma component.