Unusual Scrotal Pathology: An Overview

Main Category: Urology / Nephrology
Article Date: 30 Nov 2009 - 9:00 PST

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UroToday.com - The diverse embryological origins of the scrotal contents, including the genital swelling, the retroperitoneum, and the abdominal wall, create an environment where unusual pathologies can and do appear. Our review of less commonly clinically encountered scrotal pathologies is intended to broaden the differential diagnosis the practicing urologist considers when presented with a scrotal mass.

This review includes both benign and malignant pathologies, some representing possible systemic diseases. The benign lesions include examples of both developmental abnormalities such as adenomatous rete hyperplasia and cystic dysplasia of the rete testes and acquired pathologies such as adenomatoid tumors or papillary cystadenomas both of which are found in the epididymis. The malignant lesions include various primary carcinomas including carcinomas of the rete testes and epididymis and sarcomas including rhabdomyosarcoma, liposarcoma and leiomyosarcoma each of which have presented in the paratesticular region. Metastatic lesions of a wide variety have also been found in the scrotum and should be considered when presented a scrotal mass. The majority of these diseases are only known via case reports or small case series. This paper is an exhaustive, though certainly not complete, list of these rare pathologies.

We organized this review anatomically (testicle, rete testis, epididymis, paratesticular region, and scrotal wall), both as a memory aid and because the anatomical location of a scrotal lesion can often be determined through a combination of physical exam and ultrasound examination prior to surgical intervention. When presented with a scrotal mass, the initial goal of the physician should be to identify which of the broad anatomical regions of the scrotum is involved. Once the approximate location of the lesion is identified, the data given in our review can be used in treatment planning. Because of the potential negative effects on fertility of surgical intervention in this location, we attempted to highlight anatomical locations where rare benign lesions present in an effort to guide operative resection. While intraoperative frozen section analysis is an imperfect tool for diagnosis, we describe cases where this technique may be used to allow optimal, though minimal, surgical resection.

While we have not included radiographical or histological examples of the various disease processes, we have cited examples from the literature which include these details to allow interested readers to further investigate these topics. We encourage clinicians to have a broad differential diagnosis when they encounter a scrotal lesion and present this review as an aid for what can be a daunting diagnostic experience, especially when more common scrotal pathologies are ruled out.

Written by Henry M. Rosevear MD, Alek Mishail MD, Yefim Sheynkin MD, and Moshe Wald. MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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