Malignant mesenchymoma in the scrotum. A case report

A 67-year-old man visited our hospital with the chief complaint of painless swelling of the left scrotal content. An elastic hard mass was palpable in the left scrotum. Resection of the tumor, including the left scrotal skin, was performed. The tumor originated from the scrotal wall and did not communicate with the testis, the epididymis or spermatic cord. Histologically, the tumor was diagnosed as a malignant mesenchymoma composed of liposarcoma, chondrosacoma and osteosarcoma. Malignant mesenchymoma is very rare, especially in the scrotum. Our case that originated from the scrotal wall is the first one reported in Japan.     

Epidermoid cyst of the scrotum: a case report

A 52-year-old male visited our department for a painless swelling from the right side of the anus to the right scrotum that he first noticed 5 years earlier. Palpation revealed a small fist-sized elastic solid mass with a smooth surface from the central area to the inferior pole of the right scrotum. This mass was clearly demarcated from the contents of the scrotum and not adherent to the scrotal skin. A diagnosis of a tumorous lesion in the scrotum was made, and the tumor was resected. Histopathological examination demonstrated a scrotal epidermoid cyst. To our knowledge, this is the 17th case reported in Japan.     

Cavernous hemangioma of the scrotum: a case report

A 19-year-old male consulted our department, complaining of a painful scrotal mass. On palpation, the mass was discriminated from testis, epididymis, and spermatic cord in the left scrotum. He underwent total excision of the mass. Pathologic examination revealed cavernous hemangioma. Scrotal hemangioma is a relatively rare lesion and this is the 37th case reported in Japan.     

Changes in pain sensitivity during neurosis in rats]

OBJECTIVE: Few cases of verrucous carcinoma of the penis with foci of invasive squamous cell carcinoma have been reported and denominated "hybrid tumors". The accuracy of this term is discussed in this paper. METHODS/RESULTS: A huge penile mass in a patient that had undergone three previous operations for lesions diagnosed as verrucous carcinoma is reported. Partial penectomy was performed. Histological examination showed a very well-differentiated squamous cell carcinoma. PCR (polymerase chain reaction) did not detect any type of human papillomavirus (HPV) in the tumor. CONCLUSIONS: Verrucous carcinoma is a strictly-defined lesion with a different biological behaviour from that of squamous carcinoma. Preoperative deep biopsy may miss the squamous cell carcinoma. Definitive diagnosis can only be achieved by histological examination of the surgical specimen. In future, DNA studies could possibly support preoperative diagnosis of this lesion.     

Laparoscopically assisted colpopoesis using sigmoid colon]

Presentation of one case of scrotal vesical hernia in a 66-year old patient who presented with scrotal mass, micturition difficulty and two-phase micturition that improved when pressure was exerted on the scrotum. Diagnosis was established by physical examination and CUMS. The patient underwent surgery during which a direct inguinal hernia due to paraperitoneal vesical sliding was found. Right herniorrhaphy was performed with Shouldice's technique. Postoperative radiological monitoring showed normal vesical morphology. The pathogeny, classification and treatment, as well as the differential diagnosis uncommonly reported by the authors consulted, are commented.     

Carcinoma of scrotum

Twelve patients with carcinoma of the scrotum were evaluated: 9 with squamous carcinoma and 3 with basal cell carcinoma. The presenting complaint was a visible skin lesion; the interval between awareness of this lesion and diagnosis averaged 3.3 years. Three of the 12 patients were black, although this disease previously has been considered rare in blacks. No occupation predominated among the patients in this series, and scrotal carcinoma today may occur as a result of nonspecific factors such as poor hygiene and chronic irritation, rather than industrial exposure. Only 5 of 12 patients were disease-free after treatment; 5 of the others died of squamous carcinoma, 1 died of a postoperative complication, and 1 was lost to follow-up. The most significant correlative with survival was stage at initial diagnosis, indicating the need for a high index of suspicion regarding lesions of the scrotum.     

Chondroid syringoma of the scrotum

A 65-year-old man presented with a 3.5 cm scrotal mass. Ultrasound showed a solid mass of indeterminate aetiology within the skin. Excisional biopsy revealed a benign chondroid syringoma. This is the first report of chondroid syringoma involving the scrotum.     

Scrotoschisis associated with contralateral meconium periorchitis

Scrotoschisis, a congenital defect of the scrotal wall associated with extracorporeal testicular ectopy, has been previously reported only twice. Meconium periorchitis is another rare scrotal anomaly indicative of an antenatally healed gastrointestinal perforation. The authors present a third case of scrotoschisis and the first associated with meconium periorchitis. Several hours after birth of an otherwise-normal term baby boy, a scrotal exploration was performed with orchidopexy and primary closure of the scrotal wall defect. At 4 months of age the baby underwent a contralateral inguino-scrotal exploration with excision of a paratesticular mass of calcified meconium. The role of a normally developed scrotum in testicular descent and causes of calcified scrotal masses in infants are discussed.     

Apolipoprotein E and A-IV polymorphisms in the Estonian population

A 41-year-old man was admitted to our hospital with chief complaints of painless tumor in the left scrotal contents and loss of body weight. As the tumor was suspected of being a neoplastic lesion, left radical inguinal orchiectomy was carried out. Histopathological examination showed metastatic adenocarcinoma of the bile duct. Metastatic carcinoma to the testicle, epididymis, and their tunics is unusual and testicular metastases from adenocarcinoma of the bile duct is extremely rare. A case of testicular metastases from carcinoma of the bile duct is reported and the literature reviewed.     

Risks of transplanting kidneys from hepatitis B surface antigen-negative, hepatitis B core antibody-positive donors

OBJECTIVES: An indirect inguinal hernia is a common cause of inguinoscrotal swelling in young boys. We describe 3 cases of an extremely unusual entity that has a similar clinical presentation to more commonly diagnosed intrascrotal processes. METHODS: Two patients presented with acute hemiscrotal enlargement and pain, and a third patient presented with scrotal enlargement only. All patients underwent a scrotal ultrasound evaluation and subsequent inguinoscrotal exploration. RESULTS: All patients had a multiseptated peritesticular fluid-filled mass on ultrasound evaluation. Subsequent inguinoscrotal exploration revealed a torsion of the indirect hernia sac in each case. A high ligation and excision of the sac was curative. CONCLUSIONS: Torsion of a hernia sac is an extremely rare entity, and current sonographic imaging fails to clearly diagnose this unusual phenomenon. Because pediatric urologists are commonly called to evaluate a child with an acutely swollen scrotum, awareness of this diagnosis is important.     

Focal myoclonus associated with posterior thalamic hematoma

PURPOSE: We report a new incision for repair of penile fracture. MATERIALS AND METHODS: We describe 2 cases in which the inguinal scrotal incision was used for repair of penile fracture. The preoperative evaluation as well as the technical case and rationale for use of this incision are discussed. RESULTS: Preoperative cavernosogram delineated the site of the fracture. Immediate repair of the fracture using the inguinal scrotal incision was successful. CONCLUSIONS: The inguinal scrotal incision should be entertained for cases of penile fracture. It avoids incision into markedly edematous penile skin and allows for excellent visualization of the fracture site.     

Modern treatments of menorrhagia attributable to dysfunctional uterine bleeding

The adaptive significance of the scrotum and the evolution of the descent of the testicles and epididymis have been a focus of interest among biologists for a long time. In this paper we use three anatomical character states of the scrotum and descensus: (1) testicles descended and scrotal; (2) testicles descended but ascrotal; (3) testicles not descended (testicondy). These states are then mapped on an up to date phylogeny of the Mammalia. Three main points arise out of this mapping procedure: (1) the presence of a scrotum is either primitive in extant Mammalia or primitive within eutherian mammals except Insectivora; (2) evolution has generally proceeded from a scrotal condition to progressively more ascrotal; (3) loss of testicular descensus is less common in mammalian evolution than is loss of the scrotum. In the light of these findings we discuss some current hypotheses regarding the origin and evolution of the scrotum. We find that these are all incomplete in so far as it is not the presence of the scrotum in various mammal groups that requires explaining. Instead, it is the reverse process, why the scrotum has been lost in so many groups, that should be explained. We suggest that the scrotum may have evolved before the origin of mammals, in concert with the evolution of endothermy in the mammalian lineage, and that the scrotum has been lost in many groups because descensus in many respects is a costly process that will be lost in mammal lineages as soon as an alternative solution to the problem of the temperature sensitivity of spermatogenesis is available.     

A case of testicular tumor associated with the contralateral undescended testis

A 36-year-old man visited the hospital complaining of painless swelling of the right scrotal contents. His left scrotal contents were absent in the scrotum. Right inguinal orchiectomy was performed on May 17, 1993 under the diagnosis of testicular tumor. The pathological diagnosis of the tumor was pure seminoma. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) revealed the enlargement of para-aortic lymph nodes and there was a soft tissue signal in the left inguinal region which seemed to be the left testis in MRI. His serum testosterone level was low and gonadotropin level was high. The left orchiopexy was performed on June 24, 1993, but the left testis was finally removed because of methicillin-resistant Staphylococcus aureus (MRSA) infections. Radiation therapy was done against the metastatic lesion in the retroperitoneal lymph nodes and complete remission was obtained. The left undescended testis pathologically showed atrophy of germ cells but there was no appearance of atypia of Leydig cells or germ cells.     

Use of Doppler ultrasonography and positive-contrast corpus cavernosography to evaluate a persistent penile hematoma in a bull

A 32-month-old Angus bull was evaluated because of a 2-month history of a slowly progressive swelling located cranial to the base of the scrotum. The mass was 8 x 8 x 6 cm, and was causing phimosis. The mass was determined to be a penile hematoma on the basis of results of ultrasonography and exploratory surgery. Surgical evacuation was not performed initially because the deep fascia of the penis was intact and the hematoma was small; however, the hematoma enlarged slowly during the ensuring 2 months, despite sexual rest and isolation from other livestock. Doppler ultrasonography and positive-contrast corpus cavernosography were performed, and the hematoma was seen as a space-occupying mass within the corpus cavernosum penis; vascular anomalies were not found. The penile hematoma was surgically excised, and the bull was isolated for 60 days. At follow-up, the owner indicated that the bull had returned to pasture-breeding soundness and was still being used 2 years after surgery. The small penile hematoma in this bull was unusual in that it did not respond to medical treatment. Surgical treatment was apparently curative, even though surgery was not performed until 4 months after the hematoma was first detected.     

Scrotal perforation by a ventriculoperitoneal shunt

A case is reported of an adult male in whom the distal ventriculoperitoneal shunt tip migrated through the right inguinal canal into the scrotum. It perforated the scrotal skin, leading to an infection of the still draining shunt. Migration of ventriculoperitoneal shunts into the scrotum occurs occasionally in children but until now has not been reported in an adult with perforation of the scrotum.     

Squamous cell carcinoma of the scrotum

A patient complained of scrotal mass which was found to be a squamous cell carcinoma. There was no occupational exposure and nodal spread was not obtained. We present this rare case.     

High scrotal orchidopexy for palpable maldescended testes

OBJECTIVE: To confirm that most spermatic cords of palpable maldescended testes are long enough to place the testes in the scrotum and therefore that a satisfactory scrotal testicular position can be achieved by a single high scrotal incision with less dissection of the inguinal region. PATIENTS AND METHOD: Between January 1991 and June 1995, 106 high scrotal orchidopexies (HSOs) for clinically palpable maldescended testes were carried out in 96 patients (mean age 41 months, range 14 months to 11 years). Ten patients had bilateral undescended testes. Regardless of the initial testicular position or the age of the patients, all orchidopexies were commenced with a high scrotal incision. Ninety-two testes (87%) were placed satisfactorily in the scrotum and the remaining 14 testes (13%) required a second inguinal incision. RESULTS: During the follow-up (mean 16 months, range 8 months to 3 years), 85 testes (80%) showed good anatomical and cosmetic results. Five testes required a repeat conventional orchidopexy 6 months after the HSO. Three testes were excised because they showed atrophic changes; 11 of the 14 testes which required two incisions initially have shown good results. CONCLUSION: High scrotal orchidopexy is a satisfactory approach to any palpable maldescended testis, having the advantage of using a single incision and requiring less dissection and anatomical disruption of the inguinal region, with excellent cosmesis.     

Epididymal sarcoidosis: a case report]

A rare case of epididymal sarcoidosis is reported. A 52-year-old man was admitted with a painless mass in the left scrotum. An operation revealed that a 1-cm mass was located at the epididymal head and well demarcated from the testis and the surrounding tissue. Epididymectomy was performed. Histopathological diagnosis was noncaseating granulomas consistent with sarcoidosis. Systemic examination showed bilateral hilar lymphadenopathy and bilateral peripheral anterior synechiae, but these lesions were diagnosed as inactive. Serum level of angiotensin-converting enzyme was normal.     

Posttraumatic syringomyelia. A report of an atypical case

Isolated congenital lymphoedema of the external genitalia in boys is extremely rare. It can have major physical and emotional consequences for the children. Three male patients with primary lymphoedema of the penis and scrotum are described. The first case presented with lymphoedema of the prepuce and the phallic skin that persisted after the age of 1 year. Circumcision and excision of the subcutaneous tissues of the phallic skin were successful in producing the appearance of a normal circumcised penis. The second case presented with oedema of both phallic and scrotal skin. At age 1 year only a pastous thickening of the prepuce remained, scrotal and phallic skin normalised spontaneously. Routine circumcision was successful with a 5-year follow up. The third case presented with persistent oedema of both the scrotum and the phallus. He suffered leakage of lymph requiring incontinence pads, with complicating skin infections recurring every 4-6 weeks at age 8 years. After complete peeling of the scrotal and phallic skin from subcutaneous tissue some leakage persisted, infections subsided. The cause of this disorder remains unknown, although hypoplasia of the lymphatic vessels is reported in most cases. In the literature, several congenital malformations have been associated with primary lymphoedema. These were not noted in our patients. Rarely, the lymphoedema regresses spontaneously. The treatment of persistent lymphoedema is surgical and consists of meticulous excision of all subcutaneous layers of the affected skin, combined with reconstruction of the penis and/or scrotum. CONCLUSION: Primary lymphoedema of the male external genitalia is an extremely rare malformation of the lymphatic vessels of unknown origin. If persistent, surgical treatment is necessary.     

Urethral duplication in children: surgical treatment and results

PURPOSE: Urethral duplication is a rare congenital anomaly. We report the clinical presentation, imaging findings and surgical treatment in 7 boys with incomplete sagittal duplication of the urethra. MATERIALS AND METHODS: Duplication involved hypospadias in 5 cases (group 1) and a bifid urethra with an accessory preanal tract (Y duplication) in 2 (group 2). Group 1 was treated with 1-stage urethroplasty, including marsupialization of the dorsal orthotopic urethra, ventral-to-dorsal urethrourethrostomy and penile island flap onlay repair to cover the open dorsal urethra. In contrast, group 2 was treated with 2-stage urethral reconstruction with detachment and mobilization of the accessory preanal branch in association with a scrotal tubed neourethra followed by urethroplasty, as in group 1. In all cases the dorsal penile urethra was located between the corpora cavernosa and surrounded by the tunica albuginea. RESULTS: A urethrocutaneous fistula developed in 1 of the 5 group 1 patients. In group 2, 1 patient had recurrent penoscrotal meatal stenosis after the 1-stage procedure and 1 had a urethral diverticulum with calculi at the scrotal tubed neourethra 7 years after urethral reconstruction. Six of the 7 patients now void spontaneously through a meatus located normally at the tip of the glans. The remaining patient with a neurogenic bladder is on intermittent catheterization via appendicovesicostomy due to difficult catheterization of the irregular and sensitive neourethra. CONCLUSIONS: While the ideal surgical management of urethral duplication anomalies remains uncertain, we used a combination of surgical techniques to correct this severe malformation.