Scrotal mass differential diagnosis: Difference between revisions

Latest revision as of 15:16, 23 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD [2] Preeti Singh, M.B.B.S.[3]

Overview

Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.

Differentiating Scrotal masses from the other Diseases

Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.

The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.

	Symptoms				Physical examination					Lab Findings		Past Medical History	Histopathology
Diseases	Clinical manifestations									Para-clinical findings				Gold standard	Associated
	Symptoms				Physical examination					Para-clinical findings
	Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tender -ness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Blood/Urine Analysis	Doppler U/S	Past Medical History	Histopathology
Painful
Epididymitis^[1]^[2] ^[3]^[4]^[5]^[6]^[7]^[8]	Unilateral	Gradual	±	Dysuria, frequency, and/or urgency	+	-	+ (Pyuria Bacteriuria)	Painful local lymphadenopathy	+	CBC-Leukocytosis Urine culture (pre-pubertal and elderly) NAAT Immunofluorescent antibody testing	Decreased epididymal blood flow	Enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow	Acute infection is characterized by infiltration of neutrophils. Chronic cases are characterized by granulomatous inflammation.	Ultrasound for diagnosis (Testicular massesor swollen testicles with hypoechoic and hypervascular areas)	Hydrocele Urinary tract infection Gonococcal infection chlamydia infection Phen sign +ve
Orchitis (Mumps)^[9]^[10]^[11]^[12] ^[13]^[8]^[7]^[14]	Bilateral	Abrupt	±	Dysuria	+	-	±	Painful local lymphadenopathy	+	CBC-Leukocytosis raised CRP Immunofluorescent antibody testing Urine analysis and culture - normal	Increased blood flow in affected side.	Mumps, coxsackievirus infection Concurrent epididymitis Congenital abnornmalities	Tubules are infiltration with neutrophiles, lymphocytes and cells resembling histiocytes Microscopic destruction of spermatogenic cells	RT‐PCR Serum immunofluorescence antibody testing.	Phen sign +ve Testicular atrophy Infertility
Testicular Torsion^[15]^[16]^[17]^[18]^[19]^[7]	Unilateral	Sudden	-	Absent	+	+	+ Blood in semen may be present	Absent	-	Normal	Absent or decreased arterial perfusion of the testis	Previous history of testicular torsion Family history of testicular torsion Prematurity Undescended testes Low birth weight	In the first 4 hours: testicular parenchyma shows edema and and desquamation of the germ cells 4-8 hours partial necrosis of germ cells. >24 hrs: necrosis	Doppler ultrasound> CT scan	Phen sign +ve
Hematocele^[20]^[21] ^[22]^[23]^[24]	Unilateral or bilateral	Sudden	-	Absent	+	+	+ Blood in semen	Absent	-	Urinalysis may be the only indication of injury to urinary tract Hematuria.	Scrotal wall thickening and testicular hematoma	Testicular trauma related to: Sports injuries. Direct trauma Motor vehicle accidents Straddle injuries	Increased destruction and fibrosis of the dartos fascia,. Dense inflammatory cells, necrotic areas and destruction of the muscular layer.	Ultrasonography: to check for testicular rupture.	_
Incarcerated Hernia^[25]^[26]	Unilateral	Sudden	+	Absent	+	+	-	Absent	+	Normal	Normal	-	-	Groin ultrasound or CT scan show presence of bowel and omentum.	Valsalva maneuvers performed while palpating the inguinal canal will push a hernia against the examiner's finger.
Brucellosis^[27]^[28]^[29]^[30]	Unilateral or Bilateral	Sudden	±	Dysuria	-	-	±	Painful local lymphadenopathy	+	CBC-Leukocytosis raised CRP Immunofluorescent antibody testing Urine analysis and culture - normal	Increased blood flow in affected side	-	Acute infection is characterized by infiltration of neutrophils. Chronic cases are characterized by granulomatous inflammation.	Culture of the organism from blood.	Antibodies are detected using: Serum agglutination (standard tube agglutination) Enzyme-linked immunosorbent assay Rose Bengal agglutination Coombs test Immunocapture agglutination (Brucellacapt) 2-mercaptoethanol agglutination
Torsion of the appendix testis^[31]^[32]^[33]^[34]	Unilateral or Bilateral	Sudden	-	Absent	+	-	-	Absent	+	Normal	Normal blood flow to the testis with an occasional increase on the affected side	-	In the first 4 hours: testicular appendages shows edema and and desquamation. 4-8 hours partial necrosis of appendix cells. >24 hrs: necrosis	scrotal ultrasound shows the torsed appendage as a lesion of low echogenicity with a central hypoechogenic area.	Scrotal wall mayshow the classical "blue dot" sign, which is due to infarction and necrosis of the appendix testis
Henoch-Schonlein purpura^[35]^[36]^[37]^[38]	Unilateral	Sudden	-	Absent	+	+	-	-	-	Serum IgA levels are elevated Elevated ESR	-	Sore throat 2-3 weeks back	Light microscopy shows leukocytoclastic vasculitis in postcapillary venules with IgA deposition	Biopsy	Palpable purpura Age at onset is less than 20 years Acute abdominal pain
Fournier's gangrene^[39]^[40]^[41]^[42]	Bilateral	Sudden	+	Absent	+	+	-	-	+	Leukocytosis Acidosis Elevated ESR and CRP Blood cultures are positive in majority of patient for streptococcus.	-	-	-	Computed tomography (CT) scan shows most useful finding is presence of gas in soft tissues.	Patient show signs of tense edema outside the involved skin, blisters, bullae, crepitus, and subcutaneous gas.
Diseases	Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tender<be>-ness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Blood/Urine Analysis	Doppler U/S	Past Medical History	Histopathology	Gold standard	Additional findings
Painless
Fragile X Macroorchidism^[43]^[44]^[45]^[46]	Bilateral	Gradual	-	Absent	-	-	+	Absent	+	Normal	-	-	Increased volume of testis	FMR1 DNA analysis	Long and narrow face with prominent forehead and chin (prognathism) Large ears Intellectual Disability
Testicular Tumors^[47]^[48]^[49]^[50]	Unilateral or bilateral	Gradual	±	Absent	±		+	Present	+	Increased serum beta-hCG or alpha fetoprotien (AFP)	-	-	Seminoma shows findings such as: Large cells with watery cytoplasm Fried egg appearance	Biopsy	Pain in the back or abdomen Ascites Weight loss Gynecomastia Precocious Puberty Infertility
Hydrocele^[51]^[52]^[53]^[54]^[55]	Bilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	-	-	Ultrasound: simple fluid collection	Transillumination test is positive
Varicocele^[56]^[57]^[58]^[59]	Unilateral (Mainly left)	Gradual	Local warmth	Absent	-	±	-	Absent	+	Elevations in unstimulated luteinizing hormone and follicle stimulating hormone levels may be seen in when associated with infertility in adults	Thrombosis of Inferiror vena cava Thrombosis of Right renal vein Abdominal mass	Renal cancer Nephrectomy Nut-cracker syndrome	-	Ultrasonography: tortuous, tubular, anechoic structures adjacent to the testis corresponding to dilated veins of the pampiniform plexus with calibers of 2–3 mm during the Valsalva maneuver	Infertility
Spermatocele^[60]^[55]^[61]	Unilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Falling snow, resulting from internal echoes moving away from the transducer	Epididymitis Trauma	Epididymal scarring is seen	Ultrasonography: hypoechoic with posterior acoustic enhancement	Transillumination test is positive
Scrotal edema^[62]^[63]	Bilateral and can extend to perineum	Gradual	-	Absent	-	-	-	Absent	+	Eosinophilia Hypoalbuminemia Hyperlipidemia. Proteinurea	Deep Vein Thrombosis	Nephrotic Syndrome Hepatic Cirrhosis Insect Bite	-	Kidney or Liver biopsy	Occurs between 4-12 years of age.
Sebaceous cyst^[64]^[65]^[66]	Unilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	-	Fibrous tissues and fluids A fatty,(keratinous), substance that resembles cottage cheese,. A viscous, serosanguinous fluid (containing purulent and bloody material).	Histological examination	Freely movable on palpation.
Carcinoma of the scrotum^[67]^[68]^[69]	-	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	-	keratinocytic dysplasia involving the full thickness of the epidermis without infiltration of atypical cells into the dermis. The keratinocytes are pleomorphic with hyperchromatic nuclei Numerous mitoses are present.	Biopsy	Scaly patch or plaque is seen over the testis.
Chylocele (Filariasis)^[70]^[71]^[72]	Unilateral or Bilateral	Gradually Rapidly	+	Absent	-	-	-	Absent	+	Circulating filarial antigen (CFA) assays are positve	Lymphatics containing worms can be differentiated from the blood vessels by irregular movement	-	-	CFA assay	Ultrasound demonstrates living worms which has been described as "filarial dance" sign.
Scrotoliths^[73]^[74]^[75]	Unilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	Trauma Torsion of appendix	-	Ultrasound	Ultrasound shows mobile hyperechoic extratesticular focus in the potential tunica space.

References

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↑ Polk P, McCutchen WT, Phillips JG, Biggs PJ (September 1996). "Polypoid scrotal calcinosis: an uncommon variant of scrotal calcinosis". South. Med. J. 89 (9): 896–7. PMID 8790314.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Scrotal mass}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Scrotal_mass]]
-{{CMG}}{{AE}}{{SR}}
+{{CMG}};{{AE}}{{NE}}{{Preeti}}
 ==Overview==
-Scrotal masses may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies from other diseases that cause testicular mass with discomfort, [[back pain]], [[abdominal discomfort]], or [[abdominal mass]]. Common differential diagnoses include [[yolk sac tumor]], [[teratoma]], [[choriocarcinoma]], [[embryonal cell carcinoma]], [[seminoma]], and [[lymphoma|testicular lymphoma]] (usually [[non-Hodgkin lymphoma]]).
+Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.
+==Differentiating Scrotal masses from the other Diseases==
+[[Scrotal mass|Scrotal masses]] must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as [[Testicular cancer|testicular tortion]] ,[[Epidemic abscess|epididimitis,]]<nowiki/>testicular tumors,[[Inguinal canal|inguinal herniation]] and many other diseases.
+*The table below summarizes the findings that differentiates [[Scrotal mass (patient information)|scrotal mass]] according to the clinical features, laboratory findings, imaging features, [[Histological section|histological features]], and [[genetic]] studies.
-==Differential Diagnosis==
-The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.<ref name="Unilateraltesticularlesions1">Unilateral testicular lesions. Dr Yuranga Weerakkody and Dr Vinod G Maller et al. Radiopaedia 2016. http://radiopaedia.org/articles/unilateral-testicular-lesions. Accessed on March 15, 2016</ref><ref name="Bilateraltesticularlesions1">Bilateral testicular lesions. Radiopaedia 2016. Dr Matt A. Morgan and Dr Vinod G Maller et al. Radiopaedia 2016. http://radiopaedia.org/articles/bilateral-testicular-lesions. Accessed on March 15, 2016</ref>
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Scrotal Swelling
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
-| rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
+| colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
-|
+! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
-|
-|
-|
-|
-|
-|
-! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
 | colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
-! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
+! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated
 |-
-| rowspan="11" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Painful
 | colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
-! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
+! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
 |-
-! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
+! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Past Medical History
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
 |-
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Unilateral /Bilateral swelling
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Onset
 ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary symptoms
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tender<br>-ness
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Erythema
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
 ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Discharge
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inguinal Lymphadenopathy
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cremasteric Reflex
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urine Analysis
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood/Urine Analysis
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymoorchitis]]
+! colspan="16" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Painful
-| style="background: #F5F5F5; padding: 5px;" |
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymoorchitis|Epididymitis]]<ref name="pmid22483426">{{cite journal |vauthors=Yu KJ, Wang TM, Chen HW, Wang HH |title=The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis |journal=Chang Gung Med J |volume=35 |issue=1 |pages=38–45 |date=2012 |pmid=22483426 |doi= |url=}}</ref><ref name="pmid15949072">{{cite journal |vauthors=Manavi K, Turner K, Scott GR, Stewart LH |title=Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh |journal=Int J STD AIDS |volume=16 |issue=5 |pages=386–7 |date=May 2005 |pmid=15949072 |doi=10.1258/0956462053888853 |url=}}</ref><br><ref name="pmid29668706">{{cite journal |vauthors=Lee YS, Kim SW, Han SW |title=Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis |journal=PLoS ONE |volume=13 |issue=4 |pages=e0194761 |date=2018 |pmid=29668706 |pmc=5905873 |doi=10.1371/journal.pone.0194761 |url=}}</ref><ref name="pmid2161009">{{cite journal |vauthors=Ralls PW, Jensen MC, Lee KP, Mayekawa DS, Johnson MB, Halls JM |title=Color Doppler sonography in acute epididymitis and orchitis |journal=J Clin Ultrasound |volume=18 |issue=5 |pages=383–6 |date=June 1990 |pmid=2161009 |doi= |url=}}</ref><ref name="pmid26112484">{{cite journal |vauthors=Michel V, Pilatz A, Hedger MP, Meinhardt A |title=Epididymitis: revelations at the convergence of clinical and basic sciences |journal=Asian J. Androl. |volume=17 |issue=5 |pages=756–63 |date=2015 |pmid=26112484 |pmc=4577585 |doi=10.4103/1008-682X.155770 |url=}}</ref><ref name="pmid19002691">{{cite journal |vauthors=Tracy CR, Costabile RA |title=The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed? |journal=World J Urol |volume=27 |issue=2 |pages=259–63 |date=April 2009 |pmid=19002691 |doi=10.1007/s00345-008-0338-0 |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref><ref name="pmid18336454">{{cite journal |vauthors=Ludwig M |title=Diagnosis and therapy of acute prostatitis, epididymitis and orchitis |journal=Andrologia |volume=40 |issue=2 |pages=76–80 |date=April 2008 |pmid=18336454 |doi=10.1111/j.1439-0272.2007.00823.x |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Unilateral
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Gradual
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
+| style="background: #F5F5F5; padding: 5px;" |Dysuria, frequency, and/or urgency
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
 | style="background: #F5F5F5; padding: 5px;" | +
+(Pyuria
+Bacteriuria)
+| style="background: #F5F5F5; padding: 5px;" |Painful local lymphadenopathy
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
 | style="background: #F5F5F5; padding: 5px;" |
+* CBC-[[Leukocytosis]]
+* Urine culture (pre-pubertal and elderly)
+* NAAT
+* Immunofluorescent antibody testing
 | style="background: #F5F5F5; padding: 5px;" |
+* Decreased epididymal blood flow
 | style="background: #F5F5F5; padding: 5px;" |
+* Enlarged (>17 mm) [[epididymis]] with a hypoechoic, hyperechoic, or [[heterogeneous]] echotexture, increased blood flow
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
+* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]].
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Hydrocele]]
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Urinary tract infection]]
-| style="background: #F5F5F5; padding: 5px;" |
+* Gonococcal infection
-| style="background: #F5F5F5; padding: 5px;" |
+* chlamydia infection
+* Phen sign +ve
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion|Testicular Torsion]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Orchitis]]
-| style="background: #F5F5F5; padding: 5px;" |
+[[Orchitis|(]][[Mumps]])<ref name="pmid20070300">{{cite journal |vauthors=Davis NF, McGuire BB, Mahon JA, Smyth AE, O'Malley KJ, Fitzpatrick JM |title=The increasing incidence of mumps orchitis: a comprehensive review |journal=BJU Int. |volume=105 |issue=8 |pages=1060–5 |date=April 2010 |pmid=20070300 |doi=10.1111/j.1464-410X.2009.09148.x |url=}}</ref><ref name="pmid18873054">{{cite journal |vauthors=CHARNY CW, MERANZE DR |title=Pathology of mumps orchitis |journal=J. Urol. |volume=60 |issue=1 |pages=140–6 |date=July 1948 |pmid=18873054 |doi= |url=}}</ref><ref name="pmid4580293">{{cite journal |vauthors=Bjorvatn B |title=Mumps virus recovered from testicles by fine-needle aspiration biopsy in cases of mumps orchitis |journal=Scand. J. Infect. Dis. |volume=5 |issue=1 |pages=3–5 |date=1973 |pmid=4580293 |doi= |url=}}</ref><ref name="pmid609284">{{cite journal |vauthors=Beard CM, Benson RC, Kelalis PP, Elveback LR, Kurland LT |title=The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974 |journal=Mayo Clin. Proc. |volume=52 |issue=1 |pages=3–7 |date=January 1977 |pmid=609284 |doi= |url=}}</ref><br><ref name="pmid19970951">{{cite journal |vauthors=Gall EA |title=The Histopathology of Acute Mumps Orchitis |journal=Am. J. Pathol. |volume=23 |issue=4 |pages=637–51 |date=July 1947 |pmid=19970951 |pmc=1934294 |doi= |url=}}</ref><ref name="pmid18336454">{{cite journal |vauthors=Ludwig M |title=Diagnosis and therapy of acute prostatitis, epididymitis and orchitis |journal=Andrologia |volume=40 |issue=2 |pages=76–80 |date=April 2008 |pmid=18336454 |doi=10.1111/j.1439-0272.2007.00823.x |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref><ref name="pmid10823460">{{cite journal |vauthors=Başekim CC, Kizilkaya E, Pekkafali Z, Baykal KV, Karsli AF |title=Mumps epididymo-orchitis: sonography and color Doppler sonographic findings |journal=Abdom Imaging |volume=25 |issue=3 |pages=322–5 |date=2000 |pmid=10823460 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Bilateral
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Abrupt
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
-| style="background: #F5F5F5; padding: 5px;" | +
+| style="background: #F5F5F5; padding: 5px;" |Dysuria
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | ±
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Painful local lymphadenopathy
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* CBC-[[Leukocytosis]]
+* raised CRP
+* Immunofluorescent antibody testing
+* Urine analysis and culture - normal
 | style="background: #F5F5F5; padding: 5px;" |
+* Increased blood flow in affected side.
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Mumps]], [[Coxsackie virus|coxsackie]]<nowiki/>virus infection
+* Concurrent [[epididymitis]]
+* [[Congenital disorder|Congenital abnornmalities]]
 | style="background: #F5F5F5; padding: 5px;" |
+* Tubules are infiltration with neutrophiles, lymphocytes and cells resembling histiocytes
+* Microscopic destruction of  spermatogenic cells
 | style="background: #F5F5F5; padding: 5px;" |
+* RT‐PCR
+* Serum immunofluorescence antibody<nowiki/> testing.
 | style="background: #F5F5F5; padding: 5px;" |
+* Phen sign +ve
+* Testicular atrophy
+* Infertility
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Torsion of testicular appendix
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion|Testicular Torsion]]<ref name="pmid29240370">{{cite journal |vauthors=Hazeltine M, Panza A, Ellsworth P |title=Testicular Torsion: Current Evaluation and Management |journal=Urol Nurs |volume=37 |issue=2 |pages=61–71, 93 |date=2017 |pmid=29240370 |doi= |url=}}</ref><ref name="pmid28714632">{{cite journal |vauthors=Estremadoyro V, Meyrat BJ, Birraux J, Vidal I, Sanchez O |title=[Diagnosis and management of testicular torsion in children] |language=French |journal=Rev Med Suisse |volume=13 |issue=550 |pages=406–410 |date=February 2017 |pmid=28714632 |doi= |url=}}</ref><ref name="pmid24364548">{{cite journal |vauthors=Sharp VJ, Kieran K, Arlen AM |title=Testicular torsion: diagnosis, evaluation, and management |journal=Am Fam Physician |volume=88 |issue=12 |pages=835–40 |date=December 2013 |pmid=24364548 |doi= |url=}}</ref><ref name="pmid3842075">{{cite journal |vauthors=Mikuz G |title=Testicular torsion: simple grading for histological evaluation of tissue damage |journal=Appl Pathol |volume=3 |issue=3 |pages=134–9 |date=1985 |pmid=3842075 |doi= |url=}}</ref><ref name="pmid16724203">{{cite journal |vauthors=Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL |title=Acute testicular torsion in children: the role of sonography in the diagnostic workup |journal=Eur Radiol |volume=16 |issue=11 |pages=2527–32 |date=November 2006 |pmid=16724203 |doi=10.1007/s00330-006-0287-1 |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Unilateral
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Sudden
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Absent
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
 | style="background: #F5F5F5; padding: 5px;" | +
+Blood in semen may be present
+| style="background: #F5F5F5; padding: 5px;" |Absent
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
 | style="background: #F5F5F5; padding: 5px;" |
+* Normal
 | style="background: #F5F5F5; padding: 5px;" |
+* Absent or decreased arterial perfusion of the testis
 | style="background: #F5F5F5; padding: 5px;" |
+* Previous history of [[testicular torsion]]
+*<nowiki/>[[Family history]]<nowiki/> of [[testicular torsion]]
+* [[Prematurity]]
+*<nowiki/>[[Undescended testes]]
+* [[Low birth weight]]
 | style="background: #F5F5F5; padding: 5px;" |
+* In the first 4 hours: testicular parenchyma shows edema and and desquamation of the germ cells
+* 4-8 hours partial necrosis of germ cells.
+* >24 hrs: necrosis
 | style="background: #F5F5F5; padding: 5px;" |
+* [[Doppler ultrasound]]> [[Computed tomography|CT scan]]
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* Phen sign +ve
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-|-
-|[[Hematocele]]
-|
-|
-|
-|
-|<nowiki>+</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|[[Inguinal hernia|Incarcerated Hernia]]
-|
-|
-|
-|
-|<nowiki>-</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|Testicular Abcess
-|
-|
-|
-|
-|<nowiki>-</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |-
-|[[Brucellosis]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematocele]]<ref name="pmid25667770">{{cite journal |vauthors=Bowen DK, Gonzalez CM |title=Intratesticular hematoma after blunt scrotal trauma: a case series and algorithm-based approach to management |journal=Cent European J Urol |volume=67 |issue=4 |pages=427–9 |date=2014 |pmid=25667770 |pmc=4310892 |doi=10.5173/ceju.2014.04.art24 |url=}}</ref><ref name="pmid28609265">{{cite journal |vauthors=Askari R, Khouzam RN, Dishmon DA |title=Image Diagnosis: Rapidly Enlarging Scrotal Hematoma: A Complication of Femoral Access? |journal=Perm J |volume=21 |issue= |pages= |date=2017 |pmid=28609265 |pmc=5469436 |doi=10.7812/TPP/16-111 |url=}}</ref><br><ref name="pmid2048502">{{cite journal |vauthors=Mizutani Y, Miyakawa M |title=[A case of idiopathic chronic scrotal hematocele] |language=Japanese |journal=Hinyokika Kiyo |volume=37 |issue=2 |pages=199–201 |date=February 1991 |pmid=2048502 |doi= |url=}}</ref><ref name="pmid2681835">{{cite journal |vauthors=Kratzik C, Hainz A, Kuber W, Donner G, Lunglmayr G, Frick J, Schmoller HJ |title=Has ultrasound influenced the therapy concept of blunt scrotal trauma? |journal=J. Urol. |volume=142 |issue=5 |pages=1243–6 |date=November 1989 |pmid=2681835 |doi= |url=}}</ref><ref name="pmid23833421">{{cite journal |vauthors=Rao MS, Arjun K |title=Sonography of scrotal trauma |journal=Indian J Radiol Imaging |volume=22 |issue=4 |pages=293–7 |date=October 2012 |pmid=23833421 |pmc=3698892 |doi=10.4103/0971-3026.111482 |url=}}</ref>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral or bilateral
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; " | +
-|
+Blood in semen
-|
+| style="background: #F5F5F5; padding: 5px; " |Absent
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |-
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-|
+* Urinalysis  may be the only indication of injury to urinary tract
-|
+* [[Hematuria]].
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Scrotal wall thickening and testicular hematoma
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Testicular trauma related to:
+* Sports injuries.
+* Direct [[trauma]]
+* Motor vehicle accidents
+* [[Straddle injury|Straddle injuries]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Increased destruction and fibrosis of the dartos fascia,.
+* Dense inflammatory cells, necrotic areas and destruction of the muscular layer.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Ultrasonography: to check for testicular rupture.
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
 |-
-|[[Mumps]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Incarcerated Hernia]]<ref name="pmid18244999">{{cite journal |vauthors=Jenkins JT, O'Dwyer PJ |title=Inguinal hernias |journal=BMJ |volume=336 |issue=7638 |pages=269–72 |year=2008 |pmid=18244999 |pmc=2223000 |doi=10.1136/bmj.39450.428275.AD |url=}}</ref><ref name="pmid26987468">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Sudden
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | Absent
-|<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | +
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* Normal
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* Normal
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Groin ultrasound or CT scan show presence of bowel and omentum.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Valsalva maneuvers performed while palpating the inguinal canal will push a hernia against the examiner's finger.
 |-
-|
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brucellosis]]<ref name="pmid27331193">{{cite journal |vauthors=Kaya F, Kocyigit A, Kaya C, Turkcuer I, Serinken M, Karabulut N |title=Brucellar Testicular Abscess Presenting as a Testicular Mass: Can Color Doppler Sonography be used in Differentiation? |journal=Turk J Emerg Med |volume=15 |issue=1 |pages=43–6 |date=March 2015 |pmid=27331193 |pmc=4909939 |doi=10.5505/1304.7361.2014.82698 |url=}}</ref><ref name="pmid11698991">{{cite journal |vauthors=Navarro-Martínez A, Solera J, Corredoira J, Beato JL, Martínez-Alfaro E, Atiénzar M, Ariza J |title=Epididymoorchitis due to Brucella mellitensis: a retrospective study of 59 patients |journal=Clin. Infect. Dis. |volume=33 |issue=12 |pages=2017–22 |date=December 2001 |pmid=11698991 |doi=10.1086/324489 |url=}}</ref><ref name="pmid17141451">{{cite journal |vauthors=Colmenero JD, Muñoz-Roca NL, Bermudez P, Plata A, Villalobos A, Reguera JM |title=Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis |journal=Diagn. Microbiol. Infect. Dis. |volume=57 |issue=4 |pages=367–72 |date=April 2007 |pmid=17141451 |doi=10.1016/j.diagmicrobio.2006.09.008 |url=}}</ref><ref name="pmid2313817">{{cite journal |vauthors=Reisman EM, Colquitt LA, Childers J, Preminger GM |title=Brucella orchitis: a rare cause of testicular enlargement |journal=J. Urol. |volume=143 |issue=4 |pages=821–2 |date=April 1990 |pmid=2313817 |doi= |url=}}</ref>
-|'''[[Histoplasmosis|Histoplasma]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Dysuria
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Painful local lymphadenopathy
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* CBC-[[Leukocytosis]]
-|
+* raised CRP
-|
+* Immunofluorescent antibody testing
-|
+* Urine analysis and culture - normal
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* Increased blood flow in affected side
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
+* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]].
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Culture of the organism from blood.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Antibodies are detected using:
+* Serum agglutination (standard tube agglutination)
+* Enzyme-linked immunosorbent assay
+* Rose Bengal agglutination
+* Coombs test
+* Immunocapture agglutination (Brucellacapt)
+* 2-mercaptoethanol agglutination
 |-
-|
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Torsion of the appendix testis<ref name="pmid16569689">{{cite journal |vauthors=Rakha E, Puls F, Saidul I, Furness P |title=Torsion of the testicular appendix: importance of associated acute inflammation |journal=J. Clin. Pathol. |volume=59 |issue=8 |pages=831–4 |date=August 2006 |pmid=16569689 |pmc=1860437 |doi=10.1136/jcp.2005.034603 |url=}}</ref><ref name="pmid9651416">{{cite journal |vauthors=Kadish HA, Bolte RG |title=A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages |journal=Pediatrics |volume=102 |issue=1 Pt 1 |pages=73–6 |date=July 1998 |pmid=9651416 |doi= |url=}}</ref><ref name="pmid7967303">{{cite journal |vauthors=Okui N, Tomita K, Kimura A, Uekane K, Kawamura T, Teshima S |title=[Heterochronic occurrence of bilateral torsion of appendix testis a case report] |language=Japanese |journal=Nippon Hinyokika Gakkai Zasshi |volume=85 |issue=9 |pages=1395–8 |date=September 1994 |pmid=7967303 |doi= |url=}}</ref><ref name="pmid25704247">{{cite journal |vauthors=Lev M, Ramon J, Mor Y, Jacobson JM, Soudack M |title=Sonographic appearances of torsion of the appendix testis and appendix epididymis in children |journal=J Clin Ultrasound |volume=43 |issue=8 |pages=485–9 |date=October 2015 |pmid=25704247 |doi=10.1002/jcu.22265 |url=}}</ref>
-|'''[[Gonorrhea]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-|
+* Normal
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* Normal blood flow to the testis with an occasional increase on the affected side
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* In the first 4 hours: testicular appendages shows edema and and desquamation.
+* 4-8 hours partial necrosis of appendix cells.
+* >24 hrs: necrosis
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* scrotal ultrasound shows the torsed appendage as a lesion of low echogenicity with a central hypoechogenic area.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Scrotal wall mayshow the classical "blue dot" sign, which is due to infarction and necrosis of the appendix testis
 |-
-|
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Henoch-Schönlein purpura|Henoch-Schonlein purpura]]<ref name="pmid10934812">{{cite journal |vauthors=Choong CS, Liew KL, Liu PN, Kuo TU, Su CM |title=Acute scrotum in Henoch-Schönlein purpura |journal=Zhonghua Yi Xue Za Zhi (Taipei) |volume=63 |issue=7 |pages=577–80 |date=July 2000 |pmid=10934812 |doi= |url=}}</ref><ref name="pmid27169017">{{cite journal |vauthors=Modi S, Mohan M, Jennings A |title=Acute Scrotal Swelling in Henoch-Schonlein Purpura: Case Report and Review of the Literature |journal=Urol Case Rep |volume=6 |issue= |pages=9–11 |date=May 2016 |pmid=27169017 |pmc=4855902 |doi=10.1016/j.eucr.2016.01.004 |url=}}</ref><ref name="pmid11702171">{{cite journal |vauthors=Dayanir YO, Akdilli A, Karaman CZ, Sönmez F, Karaman G |title=Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura |journal=Eur Radiol |volume=11 |issue=11 |pages=2267–9 |date=2001 |pmid=11702171 |doi=10.1007/s003300100843 |url=}}</ref><ref name="pmid22693978">{{cite journal |vauthors=Akgun C |title=A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schönlein vasculitis |journal=Bratisl Lek Listy |volume=113 |issue=6 |pages=382–3 |date=2012 |pmid=22693978 |doi= |url=}}</ref>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* Serum IgA levels are elevated
-|
+* Elevated ESR
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* Sore throat 2-3 weeks back
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Light microscopy shows  leukocytoclastic vasculitis in postcapillary venules with IgA deposition
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Biopsy
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Palpable purpura
+* Age at onset is less than 20 years
+* Acute abdominal pain
 |-
-|
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fourniers gangrene|Fournier's gangrene]]<ref name="pmid29146218">{{cite journal |vauthors=Voelzke BB, Hagedorn JC |title=Presentation and Diagnosis of Fournier Gangrene |journal=Urology |volume=114 |issue= |pages=8–13 |date=April 2018 |pmid=29146218 |doi=10.1016/j.urology.2017.10.031 |url=}}</ref><ref name="pmid28328332">{{cite journal |vauthors=Huang CS |title=Fournier's Gangrene |journal=N. Engl. J. Med. |volume=376 |issue=12 |pages=1158 |date=March 2017 |pmid=28328332 |doi=10.1056/NEJMicm1609306 |url=}}</ref><ref name="pmid29052826">{{cite journal |vauthors=Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S, Acar A, Baş G |title=Fournier's gangrene: A retrospective analysis of 25 patients |journal=Ulus Travma Acil Cerrahi Derg |volume=23 |issue=5 |pages=400–404 |date=September 2017 |pmid=29052826 |doi=10.5505/tjtes.2017.01678 |url=}}</ref><ref name="pmid26138056">{{cite journal |vauthors=Namkoong H, Ishii M, Koizumi M, Betsuyaku T |title=Fournier's gangrene: a surgical emergency |journal=Infection |volume=44 |issue=1 |pages=143–4 |date=February 2016 |pmid=26138056 |doi=10.1007/s15010-015-0816-4 |url=}}</ref>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
+* Leukocytosis
-|
+* Acidosis
-|
+* Elevated ESR and CRP
-|
+* Blood cultures are positive in majority of patient for streptococcus.
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Computed tomography (CT) scan shows most useful finding is presence of gas in soft tissues.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Patient show signs of  tense edema outside the involved skin, blisters, bullae, crepitus, and subcutaneous gas.
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Scrotal Swelling
 !Diseases
 !Unilateral /Bilateral swelling
+!Onset
 ! colspan="1" rowspan="1" |Fever
 !Urinary symptoms
+!Tender<be>-ness
 !Erythema
-!Tenderness
 ! colspan="1" rowspan="1" |Discharge
 !Inguinal Lymphadenopathy
 !Cremasteric Reflex
-!Urine Analysis
+!Blood/Urine Analysis
 !Doppler U/S
-!Lab 3
 !Past Medical History
 !Histopathology
@@ Line 270: / Line 303: @@
 !Additional findings
 |-
-| rowspan="8" |Painless
+! colspan="16" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Painless
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fragile X syndrome|Fragile X]]'''[[Macroorchidism]]'''
+|-
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fragile X syndrome|Fragile X]]   [[Macroorchidism]]<ref name="pmid6348096">{{cite journal |vauthors=Hagerman RJ, McBogg P, Hagerman PJ |title=The fragile X syndrome: history, diagnosis, and treatment |journal=J Dev Behav Pediatr |volume=4 |issue=2 |pages=122–30 |date=June 1983 |pmid=6348096 |doi= |url=}}</ref><ref name="pmid9678703">{{cite journal |vauthors=de Vries BB, Halley DJ, Oostra BA, Niermeijer MF |title=The fragile X syndrome |journal=J. Med. Genet. |volume=35 |issue=7 |pages=579–89 |date=July 1998 |pmid=9678703 |pmc=1051369 |doi= |url=}}</ref><ref name="pmid8190590">{{cite journal |vauthors=Lachiewicz AM, Dawson DV |title=Do young boys with fragile X syndrome have macroorchidism? |journal=Pediatrics |volume=93 |issue=6 Pt 1 |pages=992–5 |date=June 1994 |pmid=8190590 |doi= |url=}}</ref><ref name="pmid25767309">{{cite journal |vauthors=Saldarriaga W, Tassone F, González-Teshima LY, Forero-Forero JV, Ayala-Zapata S, Hagerman R |title=Fragile X syndrome |journal=Colomb. Med. |volume=45 |issue=4 |pages=190–8 |date=2014 |pmid=25767309 |pmc=4350386 |doi= |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Bilateral
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Gradual
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Absent
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | +
+| style="background: #F5F5F5; padding: 5px;" |Absent
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
+* Normal
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Increased volume of testis
 | style="background: #F5F5F5; padding: 5px;" |
+* FMR1 DNA analysis
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* Long and narrow face with prominent forehead and chin (prognathism)
-| style="background: #F5F5F5; padding: 5px;" |
+* Large ears
-| style="background: #F5F5F5; padding: 5px;" |
+* Intellectual Disability
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Tumors
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Tumors<ref name="pmid28967388">{{cite journal |vauthors=Shen J, Bi Y, Wang X, Lu L, Tang L, Liu Y, Chen H, Zhang B |title=Epidemiologic study of 230 cases of testicular/paratesticular tumors or masses: 15-year experience of a single center |journal=J. Pediatr. Surg. |volume=52 |issue=12 |pages=2056–2060 |date=December 2017 |pmid=28967388 |doi=10.1016/j.jpedsurg.2017.08.027 |url=}}</ref><ref name="pmid25096628">{{cite journal |vauthors=Hohšteter M, Artuković B, Severin K, Kurilj AG, Beck A, Šoštarić-Zuckermann IC, Grabarević Ž |title=Canine testicular tumors: two types of seminomas can be differentiated by immunohistochemistry |journal=BMC Vet. Res. |volume=10 |issue= |pages=169 |date=August 2014 |pmid=25096628 |pmc=4129470 |doi=10.1186/s12917-014-0169-8 |url=}}</ref><ref name="pmid22677786">{{cite journal |vauthors=McDonald MW, Reed AB, Tran PT, Evans LA |title=Testicular tumor ultrasound characteristics and association with histopathology |journal=Urol. Int. |volume=89 |issue=2 |pages=196–202 |date=2012 |pmid=22677786 |doi=10.1159/000338771 |url=}}</ref><ref name="pmid28549629">{{cite journal |vauthors=Naouar S, Braiek S, El Kamel R |title=Testicular tumors of adrenogenital syndrome: From physiopathology to therapy |journal=Presse Med |volume=46 |issue=6 Pt 1 |pages=572–578 |date=June 2017 |pmid=28549629 |doi=10.1016/j.lpm.2017.05.006 |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Unilateral or bilateral
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Gradual
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |±
+| style="background: #F5F5F5; padding: 5px;" |Absent
+| style="background: #F5F5F5; padding: 5px;  text-align: center;" | ±
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
+| style="background: #F5F5F5; padding: 5px;" |Present
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* Increased serum beta-hCG or alpha fetoprotien (AFP)
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-|-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Henoch-Schönlein purpura|Henoch-Schonlein purpura]]
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Seminoma  shows findings such as:
+* Large [[cells]] with watery [[cytoplasm]]
+* Fried egg [[appearance]]
 | style="background: #F5F5F5; padding: 5px;" |
+* Biopsy
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* Pain in the back or abdomen
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Ascites]]
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Weight loss]]
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Gynecomastia]]
-| style="background: #F5F5F5; padding: 5px;" |
+* Precocious Puberty
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Infertility]]
-| style="background: #F5F5F5; padding: 5px;" |
-|-
-|[[Hydrocele]]
-|
-|
-|
-|
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|[[Varicocele]]
-|
-|
-|
-|
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|[[Spermatocele]]
-|
-|
-|
-|
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|[[Inguinal hernia|Inguino-scrotal hernia]]
-|
-|
-|
-|
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|Scrotal edema
-|
-|
-|
-|
-|<nowiki>-</nowiki>
-|<nowiki>-</nowiki>
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|[[Epididymal cyst]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|Scrotal oedema
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|[[Sebaceous cyst]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|[[Scrotum Carcinoma|Carcinoma of the scrotum]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|'''[[filariasis|Chylocele]] ([[Filariasis]])'''
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|'''[[Congenital cystic dysplasia|Cystic dysplasia]]'''
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|[[Srotoliths]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|}
-{| class="wikitable"
-! Disease Name
-! History and Symptoms
-! Physical Examination
-! Lab Findings
-! Imaging Findings
-! Gross and Histologic Findings
-! Genetic Studies / Immunohistochemistry
-|-
-| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Germ Cell Tumors'''}}
-|-
-| align="center" |
-'''[[Seminoma]]'''
-| valign="top" |
-*Most common
-*30-50 year-old with painless unilateral testicular mass or mild discomfort
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Usually homogeneous enlargement
-| valign="top" |
-*Elevated serum placental ALP (PALP)
-| valign="top" |
-*Hypoechogenic intratesticular well-defined mass on ultrasound with internal blood flow on Doppler ultrasound
-*Cysts and calcificications are uncommon
-*Hypointense lesion with inhomogeneous enhancement on MRI
-*Homogeneous when small and heterogeneous when large
-| valign="top" |
-*Grey-white homogeneous mass with a lobular appearance
-*Fried egg appearance on histopathology (large cells and clear cytoplasm)
-*Prominent lymphocytic infiltration and less commonly, granulomatous  formation
-| valign="top" |
-*Stains positively for ALP, c-KIT, CD30, EMA, and glycogen
-|-
-| align="center" |
-'''[[germ cell tumor|Embryonal cell carcinoma]]'''
-| valign="top" |
-*Young adults
-*Painful testicular mass
-*Manifests with early mestastasis (bone, lung, CNS)
-| valign="top" |
-* Often unremarkable (small primary tumor)
-| valign="top" |
-*Elevated serum hCG
-*Elevated serum AFP, when mixed
-| valign="top" |
-*Variable echogenicity (usually hypoechoic on ultrasound)
-*No differentiating features on imaging
-*Commonly invade the surrounding structures (tunica albuginea)
-*Irregular calcifications
-| valign="top" |
-*Pale-grey mass with areas of hemorrhagic and necrosis
-*Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
-| valign="top" |
-*Stains positively for CD30 and hCG stain
-*May stain positively for AFP, when mixed
-|-
-| align="center" |
-'''[[Yolk sac tumor]]'''
-| valign="top" |
-* Most common testicular cancer in children less than 3 years of age
-*Rapidly growing unilateral mass in an infant or a young child
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Usually heterogeneous enlargement
-| valign="top" |
-*Elevated serum AFP
-| valign="top" |
-*Diffuse enlargement of the testis with a heterogeneous appearance on ultrasound
-*Areas of hemorrhage and necrosis on MRI
-| valign="top" |
-*Yellow, mucinous, non-encapsulated, heterogeneous mass with areas of necrosis and hemorrhage
-*Patterns that resemble embryonal structures (yolk sac, allantois) with reticular, papillary, or elongated forms
-*Schiller-Duval bodies (perivascular structures)
-| valign="top" |
-*Stains positively for AFP, alpha-1-antitrypsin, PAS diastase
-|-
-| align="center" |
-'''[[Teratoma]]'''
-| valign="top" |
-*Bimodal distribution of age (infants and middle aged adults)
-*Painless tumor
-*History of congenital disease (Down syndrome, klinefelter, spina bifida)
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Usually heterogeneous enlargement
-| valign="top" |
-*Elevated serum hCG
-*Elevated serum AFP
-| valign="top" |
-*Heterogeneous, cystic appearance with mucinous or sebaceous depositions
-*Variable echogenicity on ultrasound
-*Calcifications usually irregular
-| valign="top" |
-*Large, heterogeneous appearance with solid, cystic, mucoid, and/or cartilageanous components
-*Presence of at least 2 germ layers
-| valign="top" |
-*Chromosome 12p mutations
-*Stains positively for cytokeratin. hCG, and AFP
-|-
-| align="center" |
-'''[[teratoma|Teratocarcinoma]] '''
-| valign="top" |
-*Middle aged adult with painless testicular mass of mild discomfort
-*May manifest with features of metastasis
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Usually heterogeneous enlargement
-| valign="top" |
-*Elevated serum hCG
-*Elevated serum AFP
-| valign="top" |
-*Variable echogenicity on ultrasound
-| valign="top" |
-*Features of both teratoma and embryonal carcinoma (more common) or both teratoma and choriocarcinoma (less common)
-*Solid and cystic components with mucoid, cartilagenous, sebaceous gland, myxoid stroma components
-*Additional features of underlying embryonal carcinoma or choriocarcinoma
-| valign="top" |
-*Stains positively for cytokeratin. hCG, AFP, and CD30
-|-
-| align="center" |
-'''[[Choriocarcinoma]]'''
-| valign="top" |
-*Adolescent or young adult with extratesticular symptoms
-*Mass is small and locally asymptomatic
-*Manifests with early metastasis and signs of hemorrhage  (hemorrhagic stroke, hyperthyroidism, cannon-ball metastasis in lung, liver involvement, neurological deficits)
-| valign="top" |
-*Often unremarkable (small primary tumor)
-| valign="top" |
-*Elevated serum hCG
-| valign="top" |
-*Variable echogenicity
-*No differentiating features on imaging
-*Commonly invade the surrounding structures (tunica albuginea)
-| valign="top" |
-*Prominent areas of hemorrhage and necrosis
-*Nest and sheet pattern that simultaneously includes both cytotrophoblast and syncytiotrophoblast (rarely pure)
-*Paucity of intermediate trophoblasts (unlike placental site trophoblastic tumor)
-| valign="top" |
-*Stains positively for hCG
-|-
-| align="center" |
-'''[[Germ cell tumor|Diffuse embryoma]]'''
-| valign="top" |
-*20-25 yo man with painful testicular mass
-| valign="top" |
-*Tender testicular mass
-| valign="top" |
-*Elevated serum hCG
-*Elevated serum AFP
-| valign="top" |
-*Poorly-defined, heterogeneous hyperechoic mass on ultrasound
-| valign="top" |
-*Non-encapsulated mass
-*Intermingled (lace-like) embryonal carcinoma and yolk sac components in equal proportions, but no discrete embyoid bodies
-*Scattered trophoblastic components
-*Necklace-like arrangement of cells
-| valign="top" |
-*Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
-|-
-| align="center" |
-'''[[Polyembryoma]]'''
-| valign="top" |
-*20-25 yo man with painful testicular mass
-| valign="top" |
-*Tender testicular mass
-| valign="top" |
-*Elevated serum AFP
-*Elevated serum hCG
-| valign="top" |
-*Poorly-defined, heterogeneous hyperechoic mass on ultrasound
-| valign="top" |
-*Multiple discrete embyoid bodies (combination of both embryonal carcinoma and yolk sac components)
-| valign="top" |
-*Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
-|-
-| align="center" |
-'''[[Placental site trophoblastic tumor]]'''
-| valign="top" |
-*Infant or young adult
-*Painful small testicular mass
-| valign="top" |
-*Small nontender or minimally painful testicular mass
-| valign="top" |
-*Elevated serum hCG
-| valign="top" |
-*Variable echogenicity
-*No differentiating features on imaging
-*May have vascular flow
-| valign="top" |
-*Solid yellowish mass that resembles uterine tissue
-*Less prominent foci of hemorrhage and ncerosis
-*Predominance of intermediate trophoblast cells (implantation-site type) that invade surrounding blood vessels
-*Paucity of cytotrophoblast and syncytiotrophoblast cells (unlike choriocarcinoma)
-| valign="top" |
-*Stains positively for hPL (diffuse), cytokeratin, AFP, and hCG (patchy)
-*Negative p63 staining
-|-
-| align="center" |
-'''[[Epithelioid trophoblastic tumor]]'''
-| valign="top" |
-*Infant or young adult
-*Painful small testicular mass
-| valign="top" |
-*Small nontender or minimally painful testicular mass
-| valign="top" |
-*Elevated serum hCG
-| valign="top" |
-*Variable echogenicity
-*No differentiating features on imaging
-*May have vascular flow
-| valign="top" |
-*Solid yellowish mass that resembles uterine tissue
-*Less prominent foci of hemorrhage and ncerosis
-*Predominance of intermediate trophoblast cells (implantation-site type) that invade surrounding blood vessels
-*Paucity of cytotrophoblast and syncytiotrophoblast cells (unlike choriocarcinoma)
-| valign="top" |
-*Stains positively for p63 (diffuse), p63, cytokeratin, AFP, and hCG (patchy)
-*Negative hPL staining
-|-
-| align="center" |
-'''[[germ cell tumor|Mixed germ cell tumor]]'''
-| valign="top" |
-*Typical age at diagnosis and other clinical features based on underlying components
-| valign="top" |
-*Physical exam findings based on underlying components
-| valign="top" |
-*Elevated serum hCG, AFP, and/or PALP dependeing on the underlying compoenents
-| valign="top" |
-*Imaging findings based on underlying components
-| valign="top" |
-*Histopathological findings based on underlying components
-*Variable proportion of choriocarcinoma, embryonal cell carcinoma, yolk sac tumor, seminoma, and/or teratoma tissue
-| valign="top" |
-*May stain positively for any of CD30, hCG, AFP, ALP, c-KIT, CD30, EMA,  alpha-1-antitrypsin, PAS diastase, and glycogen depending on underlying compoenents
-|-
-| align="center" |
-'''[[Carcinoid|Carcinoid<br>(pure neuroendocrine neoplasm)]]'''
-| valign="top" |
-*Middle-aged and elderly adult
-*Manifests as a minimally painful, rapidly growing mass
-*May manifest as carcinoid syndrome
-| valign="top" |
-*Tender testicular mass
-*Hydrocele or cryptorchidism
-| valign="top" |
-*Elevated serum and urine 5-HIAA if carcinoid syndrome present
-| valign="top" |
-*Unilateral, well-circumscribed mass without vascular invasion
-*Solid and cystic appearance
-*Mixed echogenicity on ultrasound
-*Irregular calcifications
-| valign="top" |
-*Well-circumscribed, yellowish solid mass
-*Occasional cystic masses
-*Small acini, cord-forming rosettes, prominent cytoplasmic granularity
-*Salt and pepper chromatic pattern
-*Absent features of atypia
-*Neurosecretory granules on electron microscopy
-| valign="top" |
-*Stains positively for cytokeratin, serotonin, chromogranin, synaptophysin, and CD56
-|-
-| align="center" |
-'''[[PNET|PNET<br>(Ewing's tumor of the testes)]]'''
-| valign="top" |
-*30-50 yo man with rapidly enlarging mass
-*Often metastatic at presentation
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*No differentiating features on imaging
-*Vascular flow on Doppler
-| valign="top" |
-*Greyish necrotic mass of immature neural tissue
-*Sheet-like / rosette distribution of small round blue tumor cells
-*Neurosecretory granules on electron microscopy
-| valign="top" |
-*Stains positively for synaptophysin, NSE, chromogranin, CD99, GFAP, FLI1
-*Split of EWS gene on chromosome 22
-|-
-| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Sex-cord stromal tumors'''}}
-|-
-| align="center" |
-'''[[Fibroma]]'''
-| valign="top" |
-*Middle-aged adult (range 20-70 years) with slowly-growing, painless testicular mass
-*History of nevoid basal cell carcinoma (Gorlin syndrome)
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Isoechoic mass on ultrasound with prominent acoustic shadowing (fibrous component)
-*May be homogeneous or heterogeneous
-*Margins often blended with the tunica albuginea
-*No vascular flow on Dopper
-| valign="top" |
-*Well-circumscribed, often non-encapsulated solid pale yellow mass
-*No hemorrhage, no necrosis
-*Pure fibromatous features of collagenized plaques and spindle cells that synthesize collagen.
-*Low cellularity
-| valign="top" |
-*Mutation in ''PTCH'' gene
-*Positive staining for calretinin, inhibin, CD56, CD34, actin, vimectin
-*Usually (but not always) negative staining for S-100, keratin, CD99/MIC-2, and desmin
-|-
-| align="center" |
-'''[[Granulosa cell tumor]]'''
-| valign="top" |
-*Young or middle-aged adult (adult-type) or infant/child (juvenile-type) patient with slowly-enlarging painless testicular mass
-*May manifest with symptoms of metastasis or hormonal secretion (e.g. gynecomastia in estrogen-secreting tumors)
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Hypoechoic mass with solid and cystic appearance on ultrasound (swiss-cheese appearance)
-| valign="top" |
-*Well-circumscribed tumor between the seminiferous tubules
-*May be solid, cystic, of lobular
-*Pseudo-capsule
-*No hemorrhage, no necrosis
-*Elongated grooved nuclei (coffee-bean appearance)
-*Call-Exner bodies
-*Variable atypia
-| valign="top" |
-*Stains positively for calretinin, inhibin, vimentin, actin, and MIC2
-|-
-| align="center" |
-'''[[leydig cell tumor|Leydig (interstitial) cell tumor]]'''
-| valign="top" |
-*Bimodal age distribution
-*Slowly enlarging painless unilateral mass
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Signs of excess estradiol (e.g. gynecomastia)
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Well-defined, hypoechoic solid mass on ultrasound
-*May have cystic component
-*Irregular calcifications
-| valign="top" |
-*Well-circumscribed, unencapsulated solid mass
-*Yellowish-brown tumor
-*May have cystic, hemorrhagic, or necrotic areas
-*Often dffuse growth of large polygonal Leydig cells, but may have unique patterns of growth
-*Vacuolated cells with marked atypia
-*Reinke crystals
-*Psammoma bodies
-| valign="top" |
-*Mutation in fumarate hydratase
-*Stains positively for inhibin, cytokeratin, calretinin, synaptophysin, vimentin, Melan-A
-|-
-| align="center" |
-'''[[sertoli cell|Sertoli hyperplasia<br>(Sertoli adenoma, Pick's adenoma)]]'''
-| valign="top" |
-*Child or young adult with history of Peutz-Jegher syndrome, androgen insensitivity syndrome, or McCune Albright syndrome
-*Slowly enlarging painless bilateral masses
-| valign="top" |
-*Palpable, nontender bilateral testicular masses
-*Signs of excess estradiol (e.g. gynecomastia)
-| valign="top" |
-*Elevated serum estradiol
-*Elevated anti-Mullerian hormone and inhibin B
-*Reduced androgen concentration
-| valign="top" |
-*Hyperechogenic nodules on ultrasound
-| valign="top" |
-*Well-demarcated yellowish nodules in the testis
-*Unencapsulated nodules composed of Sertoli cells
-| valign="top" |
-*Stains positively for anti-Mullerian hormone, inhibin A, CK8, and CK18
-*Negative staining for AFP, hCG, and p53
-|-
-| align="center" |
-'''[[sertoli cell|Large cell calcifying Sertoli cell tumor]]'''
-| valign="top" |
-*Young patient with history of Carney syndrome, Peutz-Jeghers syndrome, or tuberous sclerosis
-*Slowly enlarging painless unilateral/bilateral mass(es)
-| valign="top" |
-*Palpable, nontender unilateral or bilateral testicular mass
-*Signs of excess estradiol (e.g. gynecomastia)
-| valign="top" |
-*Elevated serum estradiol
-| valign="top" |
-*Diffuse and regular (smooth, rounded, large) calcifications
-*Variable appearance on ultrasound
-*Often multiple hyperechogenic regions with strong shadowing
-*Possible increased blood flow
-| valign="top" |
-*Multifocal, well-circumscribed yellowish-grey nodules
-*Absent hemorrhage or necrosis
-*Patterrns (sheet or trabeculae) of large cells and formation of solid tubules
-*Psammoma bodies
-*Charcot Bottcher crystals on electron microscopy
-| valign="top" |
-*Stains positively for inhibin, vimentin, calretinin, S100, and cytokeratin
-*Negative staining for laminin, PALP, AFP, and hCG
-|-
-| align="center" |
-'''[[Sertoli-Leydig cell tumor|Sclerosing Sertoli cell tumor]]'''
-| valign="top" |
-*Variable age at presentation (adolescence to elderly)
-*Slowly enlarging painless unilateral mass
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Well-circumscribed hypoechogenic lesion on ultrasound
-| valign="top" |
-*Well-circumscribed, yellowish-grey nodule
-*Absent hemorrhage or necrosis
-*Tubuules and cords of Sertoli cells surrounded by hypocellular collagenous strome (sclerosis)
-| valign="top" |
-*Stains positively for calretinin, inhibin, and vimentin
-*Negative staining for cytokeratin, AFP, and hCG
-|-
-| align="center" |
-'''[[Sertoli-Leydig cell tumor|Sertoli tumor, non-specific]]'''
-| valign="top" |
-*Bimodal age districution: either 40-50 year old man or infants with history of Carney syndrome or Peutz-Jegher syndrome
-*Slowly enlarging testicular mass
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Signs of excess estradiol (e.g. gynecomastia)
-| valign="top" |
-*Often unremarkable
-*Elevated serum estradiol may be present, less common
-| valign="top" |
-*Well-circumscribed mass with variable echogenicity
-| valign="top" |
-*Well-circumscribed, yellowish-grey nodule
-*Hemorrhage and necrosis may be present, but uncommon
-*Features of fetal, prepubertal, and adult Sertoli cells present simultaneously
-*Charcot Bottcher crystals on electron microscopy
-| valign="top" |
-*Stains positively for vimentin, cytokeratin, inhibin, S100, chromogranin, synaptophysin, and CD99
-*Negative staining for hCG, AFP, and PLAP
-|-
-| align="center" |
-'''[[Sertoli-Leydig cell tumor|Sertoli-Leylig cell tumor (SLCT)]]'''
-| valign="top" |
-*Young adult or phenotypic female with history of androgen insensitivity
-*Slowly enlarging painless unilateral mass
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Signs of excess estradiol (e.g. gynecomastia)
-| valign="top" |
-*Often unremarkable
-*Elevated serum estradiol may be present, less common
-*Abrnomally elevated testosterone among pts with androgen insensitivity
-| valign="top" |
-*Well-circumscribed mass with variable echogenicity
-*Solid mass with intratumoral cysts may be present
-| valign="top" |
-*Heterogeneous, lobulated, encapsulated yellowish solid mass
-*Mass contains combination of Sertoli cells and Leydig cells
-*Poorly differentiated cells (immature tubules of Sertoli cells, large Leydig cells)
-| valign="top" |
-*Stains positively for inhibin, melanA, and CD99
-*Negative staining for EMA, PLAP, and S100
-|-
-| align="center" |
-'''[[CAH|Testicular tumor of andrenogenital syndrome<br>(testicular adrenal rest tumor)]]'''
-| valign="top" |
-*Post-pubertal patient with history of congenital adrenal hyperplasia (CAH)
-*Often asymptomatic, detected during screening in patients with CAH
-| valign="top" |
-*Unremarkable testicular exam
-*Other signs of congenital adrenal hyperplasia
-| valign="top" |
-*Elevated 11-beta-hydroxylase activity
-*Reduced concentrations of AFP, LDH, and hCG
-| valign="top" |
-*Uniform hypoechogenicity on ultrasound
-*Usually multifocal and bilateral lesions
-| valign="top" |
-*Hyperplasia, bilateral lesions in testicular hilum
-*Yellowish nodules
-*Cells resemble adrenocortical cells, no mitoses
-*Normal surrounding tissue
-*Absent Reinke crystals
-| valign="top" |
-*Stains positively for CD56, synaptophysin, and inhibin
-*Negative staining for androgen receptor protein
-|-
-| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Other tumors'''}}
-|-
-| align="center" |
-'''[[Lymphoma]]'''
-| valign="top" |
-*Elderly patient (>60 years) with history of lymphoma (commonly diffuse large B cell lymphoma)
-*Unilateral or bilateral painless testicular mass
-| valign="top" |
-*Palpable, nontender unilateral or bilateral testicular mass
-| valign="top" |
-*Depends on lymphoma subtype
-| valign="top" |
-*Diffuse infiltration
-*Hypoechoic solid masses on ultrasound
-*Hypervascularity on Doppler ultrasound
-| valign="top" |
-*Whitish-tan colored mass
-*Large, pleomorphic malignant cells
-*Seminiferous tubules may be spared or undergo sclerosis
-*Vascular invasion
-| valign="top" |
-*Stains positively for CD45
-*Depends mainly on lymphoma subtype
-*Usually negative staining for PLAP and SALL4
-|-
-| align="center" |
-'''[[Angiosarcoma]]'''
-| valign="top" |
-*Bimodal age distribution
-*Young man with history of teratoma or elderly man with history of radiation or chronic hydrocele
-*Painless/painful testicular mass
-| valign="top" |
-*Tender or non-tender testicular mass
-*Low-grade fever
-*Scrotal swelling
-*Flank pain
-*Hydrocele
-| valign="top" |
-*Often unremarkable
-| valign="top" |
-*Hypervascularity on Doppler ultrasound
-| valign="top" |
-*Solid vascular lesion
-*Classical pattern of proliferating anastomosing blood-filled channels
-*2 patterns: solid (sheet proliferation without lumen) and primitive (small lumina filled withblood)
-| valign="top" |
-*Stains positively for CD31, CD34, lectin, and factor VIII-related antigen
-*Negative staining for pancytokeratin, PLAP, CD45, CD68, CAM5.2, and AE1/AE3
-|-
-| align="center" |
-'''[[Chondrosarcoma]]'''
-| valign="top" |
-*Young or middle-aged adult with history of teratoma
-*Painless testicular mass
-| valign="top" |
-*Palpable, non-tender, heterogeneous mass
-| valign="top" |
-*Often unremarkable
-| valign="top" |
-*Lobulated mass
-| valign="top" |
-*Firm, grey mass with irregular lobulations
-*Cartilaginous (chondroid) matrix surrounded by fibrovascular bands
-*Most have non-cartilagenous components (rarely pure)
-| valign="top" |
-*Stains positively for S100
-|-
-| align="center" |
-'''[[Hemangioma]]'''
-| valign="top" |
-*Painless testicular mass among pts of any age
-| valign="top" |
-*Palpable, non-tender, homogeneous mass
-| valign="top" |
-*Often unremarkable
-| valign="top" |
-*Homogeneous hypoechoic mass
-*Hypervascularity on Doppler ultrasound
-| valign="top" |
-*Well-defined hemorrhagic mass
-*Red blood cells in tubules
-| valign="top" |
-*Stains positively for CD31, CD34, FLI1, and factor VIII-related antigen
-*Negative staining for pancytokeratin, AE, keratin, PLAP, and EMA
-|-
-| align="center" |
-'''[[Mesothelioma]]'''
-| valign="top" |
-*Middle aged man with painless testicular mass and history of hydrocele or exposure to asbestos
-| valign="top" |
-*Palpable, non-tender testicular mass
-*Scrotal swelling
-| valign="top" |
-*Often unremarkable
-| valign="top" |
-*Thickening of tunica vaginais
-*Solid paratesticular mass
-*Hydrocele
-| valign="top" |
-*May be benign or malignant
-*Papillary patterns of uniform epithelioid cells with fibrovacular core
-*Polygonal cells with microvilli on electron microscopy
-*Psammoma bodies
-| valign="top" |
-*Benign: stains positively for p53 (focal) and CEA
-*Malignant: Stains positively for calretinin, WT1, EMA, thrombomodulin, CK5, CK6, CK7 and negative staining for CEA and CK20
-|-
-| align="center" |
-'''[[Plasmacytoma]]'''
-| valign="top" |
-*Adult (of any age) with concurrent or history of plasma cell neoplasia (commonly multiple myeloma)
-*Symptoms of multiple myeloma (e.g. fatigue, back pain)
-| valign="top" |
-*Testicular exam unremarkable
-| valign="top" |
-*Lab findings of plasmacytosis (e.g. anemia, elevated creatinine, hypercalcemia)
-*No specific lab finding for testicular involvement
-| valign="top" |
-*Poorly circumscribed hypoechoic lesions on ultrasound
-*Hypervascularity on Doppler ultrasound
-| valign="top" |
-*Large, tan-yellow mass
-*Areas of hemorrahge
-*Atypical plasma cells
-*Tubule effacement in the center and tubule sparing in the periphery
-| valign="top" |
-*Positive staining for EMA, CD45, CD79am CD138, kappa or lambda light chains, and other plasma cell markers
-|-
-| align="center" |
-'''[[AIDS|AIDS-related testicular cancer]]'''
-| valign="top" |
-*Commonly testicular lymphoma or germ cell tumor
-*Patient with history of AIDS presents with testicular swelling or pain
-*Systemic manifestations of underlying malignancy
-| valign="top" |
-*Palpable testicular mass that may be tender or non-tender
-| valign="top" |
-*Depends on underlying malignancy
-| valign="top" |
-*Depends on underlying malignancy
-| valign="top" |
-*Depends on underlying malignancy
-| valign="top" |
-*Depends on underlying malignancy
-|-
-| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Non-neoplastic mass'''}}
-|-
-| align="center" |
-'''[[adrenal cortex|Adrenal cortical rest]]'''
-| valign="top" |
-*Usually asymptomatic (incidental finding)
-*Young man with scrotal swelling and dull pain
-*History of congenital adrenal hyperplasia (hydroxylase deficiency)
-| valign="top" |
-*Scrotal swelling
-| valign="top" |
-*May be unremarkable
-*If secretory, elevated concentration of adrenal hormone
-| valign="top" |
-*Heterogeneous, well-circumscribed hypoechoic mass on ultrasound
-*No or minimal vascularity on Doppler
-*No distinguishing features
-| valign="top" |
-*Well-circumscribed, small, round, orange-yellow nodule
-*Adrenal cortical tissue with absence of adrenal medullary tissue
-| valign="top" |
-*Positive staining for  markers of cortical adrenal tissue
-|-
-| align="center" |
-'''[[filariasis|Chylocele]]'''
-| valign="top" |
-*Scrotal swelling in a man with history of filariasis / elephantiasis
-| valign="top" |
-*Scrotal swelling
-*Negative trans-illumination test
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Fluid collection surrounding the testes
-| valign="top" |
-*Milky chylous fluid (not waterry) on aspiration
-*Usually no evidence of microfliariae in chylous fluid
-*Abundant leukocytes
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Congenital cystic dysplasia|Cystic dysplasia]]'''
-| valign="top" |
-*Young child with history of renal agenesis / dysplasia
-*May be unilateral or bilateral, painless testicular mass
-| valign="top" |
-*Palpable, non-tender testicular mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Irregular cystic spaces witht varying sizes
-*Absence of solid or vascular components
-| valign="top" |
-*Varying cystic spaces
-*Formation of incomplete connective tissue septa
-*Cells resembling the normal adult rete testes
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Dermoid cyst]]'''
-| valign="top" |
-*Young or middle aged adult with slowly growing painless mass
-*Ruptured cyst may manifest with scrotal swelling, erythema, and pain
-| valign="top" |
-*Palpable, nontender unilateral testicular mass
-*Usually heterogeneous enlargement
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Onioin-skin appearance on ultrasound
-*Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound
-*No vacular flow on Doppler
-| valign="top" |
-*Mature epithelial tissue
-*May have hair (similar to teratoma)
-*Keratin filled cyst
-*Epidermal epithelium surrounded by pilosebaceious units
-*Formation of lipogranulomas and microcalcifications
-*Absence of atypia
-| valign="top" |
-*Absence of any mutation (normal 12p)
-*Stains positively for cytokeratin
-|-
-| align="center" |
-'''[[Epidermoid cyst|Epidermoid cyst<br>(keratocyst)]]'''
-| valign="top" |
-*10-40 yo
-*Painless slowly growing testicular mass
-*Ruptured cyst may manifest with scrotal swelling, erythema, and pain
-| valign="top" |
-*Palpable, non-tender testicular mass
-*Usually heterogeneous enlargement
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Onioin-skin appearance on ultrasound
-*Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound
-*No vacular flow on Doppler
-| valign="top" |
-*Absence of dermal structures, such as hair, sebaceous glands etc. (found in dermoid cyst)
-*Cyst with white keratin debris
-*Lined by squamous epithelium
-*Laminated keratin
-*Granuloma when cyst ruptures
-| valign="top" |
-*Absence of any mutation (normal 12p)
-|-
-| align="center" |
-'''[[orchitis|Granulomatous orchitis]]'''
-| valign="top" |
-*40-60 yo man with sudden-onset testicular tenderness and mass formation
-*History of infection, sarcoidosis, or testicular trauma
-| valign="top" |
-*Tender testicular mass
-*Fever
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Solid hypoechoic mass
-| valign="top" |
-*Solid nodule
-*Lymphocytic infiltration and formation of giant cells and macrophages
-*Not true granuloma
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Hematocele]]'''
-| valign="top" |
-*Scrotal mass in patients with history of testicular trauma, torsion, or increased bleeding tendency
-| valign="top" |
-*Scrotal swelling
-*Negative trans-illumination test
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Fluid collection surrounding the testes
-| valign="top" |
-*Bloody fluid on aspiration
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Hydrocele]]'''
-| valign="top" |
-*Scrotal mass in patients with history of testicular trauma or epidymitis
-| valign="top" |
-*Scrotal swelling
-*'''Positive''' trans-illumination test
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Fluid collection surrounding the testes
-| valign="top" |
-*Clear fluid on aspiration
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Macroorchidism]]'''
-| valign="top" |
-*History of fragile X syndrome, FSH secreting adenoma
-| valign="top" |
-*Large testicle (the testicle itself is large)
-*Signs of underlying disease
-| valign="top" |
-*May have elevated hormone concentration (e.g. FSH) if secretory adenoma
-| valign="top" |
-*Large testicle, but normal architecture
-| valign="top" |
-*Normal testicular findings
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Malakoplakia]]'''
-| valign="top" |
-*Young man with long-standing symptoms of orchi-epididymitis (pain, scrotal swelling)
-*History of immunosuppression
-| valign="top" |
-*Palpable, tender testicular mass
-*Scrotal swelling
-*Erythema
-| valign="top" |
-*Positive culture results for bacterial infection (chronic inflammation)
-| valign="top" |
-*Hypoechogenic mass on ultrasound
-*Increased vascularity on Doppler
-| valign="top" |
-*Soft yellow friable plaques (malakos=soft | plakos=plaques)
-*Von Hansemann cells (large cells with abundant eosinophilic cytoplasm) and Michaelis-Gutmann bodies (intracytoplasmic inclusion bodies with owl eyes appearance)
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[vasculitis|Testicular vasculitits]]'''
-| valign="top" |
-*Middle aged man with history of polyarteritis nodosa (less commonly granulomatosis with polyangiomatosis, Henoch-Schonlein purpura, or giant cell arteritis)
-*History of HBV or HIV
-Painful testicular mass with intra-testicular hemorrhage
-*Symptoms of underlying vasculitis
-| valign="top" |
-*Signs of underlying vasculitis
-*Palpable, tender testicular mass
-*Scrotal swelling if vasculitis includes extratesticular structures
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Heterogeneous, hypoechogenic lesion on ultrasound
-*Inreased intralesional vascularity on Doppler
-| valign="top" |
-*Soft, dark red lesion with areas of hemorrhage
-*Fibrinoid necrosis
-*Vascular wall fibrosis
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Fibrous connective tissue|Fibrous proliferation<br>(paratesticular fibrous pseudotumor)]]'''
-| valign="top" |
-*Patients of all ages (peak during young adulthood)
-*Slowly growing painless unilateral scrotal masss
-*History of genitourinary infection or trauma
-| valign="top" |
-*Palpable, non-tender scrotal mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Paratesticular mass between tunica layers
-*Hypoechogenic solid mass on ultrasound
-*No vascularity on Doppler
-| valign="top" |
-*Whitish mass with multinoduular thickening
-*Collagen-rich fibrous tissue with increased fibroblasts
-*Dystrophic calcifications
-*No hemorrhage or necrosis
-| valign="top" |
-*Stains positiively for actin and keratin
-*Negative staining for ALK-1, beta-catenin
-|-
-| align="center" |
-'''[[testis|Polyorchism<br>(supranumerary testes)]]'''
-| valign="top" |
-*Often asymptomatic (incidental finding)
-*Young patient with scrotal pain, swelling, hydrocele, varicocele
-*Patients may present with testicular torsion
-| valign="top" |
-*Palpable, non-tender scrotal mass
-*Scrotal swelling
-*Testicular torsion manifests with excruciating testicular or pelvic pain, erythema, and swelling
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Isoechogenic scrotal mass
-| valign="top" |
-*Normal testicular tissue
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Spermatocele]]'''
-| valign="top" |
-*Young or middle aged adult with painless testicular or scrotal mass
-| valign="top" |
-*Homogeneous palpable non-tender testicular or scrotal mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Well-defined, homogeneous,, hypoechoic mass on ultrasound
-*Increased vascular flow on Doppler
-| valign="top" |
-*Splenic tissue (red with clear boundaries)
-*Occasional calcification, thrombi, or fibrosis
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[spleen|Splenogodal fusion syndrome<br>(ectopic scrotal spleen)]]'''
-| valign="top" |
-*Child or adolescent with painless, left scrotal mass (not right) and history of perimelia (continuous subtype) or cardiac defect (discontinuous subtype)
-| valign="top" |
-*Homogeneous palpable non-tender scrotal mass
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Well-defined, homogeneous,, hypoechoic mass on ultrasound
-*Increased vascular flow on Doppler
-| valign="top" |
-*Splenic tissue (red with clear boundaries)
-*Occasional calcification, thrombi, or fibrosis
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Varicocele]]'''
-| valign="top" |
-*Often asymptomatic
-*Dull or sharp testicular pain that increases with standing or physical activity and improves when lying down
-*History of infertility
-| valign="top" |
-*Scrotal mass and swelling
-*Often left-sided
-*Dilated, tortuous veins
-*"Bag of worms" sensation upon palpation
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*On ultrasound, CT/MRI, and venography, apperance of dilated pampiniform plexus veins with serpentine appearance is diagnostic
-*Flow reversal (reflux) with Valsalva maneuver on Doppler
-*Enhancement following administration of gadolinium on MRI
-| valign="top" |
-*Testicular atrophy in advanced cases
-| valign="top" |
-*N/A
-|-
-| align="center" |
-'''[[Testicular torsion]]'''
-| valign="top" |
-*Excruciating, acute, sharp testicular pain that radiates to the pelvis and abdomen
-*Testicular swelling and pain
-| valign="top" |
-*Scrotal swelling and tenderness
-| valign="top" |
-*Unremarkable
-| valign="top" |
-*Focal/diffuse hypoechogenicity on ultrasound
-*No blood flow on Doppler (vs. increased flow in infections)
-*Scrotal wall thickening
-| align="center" | ---
-| valign="top" |
-*N/A
-|-
-| colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Scrotal'''}}
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid28551604">{{cite journal |vauthors=Costantino E, Ganesan GS, Plaire JC |title=Abdominoscrotal hydrocele in an infant boy |journal=BMJ Case Rep |volume=2017 |issue= |pages= |date=May 2017 |pmid=28551604 |doi=10.1136/bcr-2017-220370 |url=}}</ref><ref name="pmid26708803">{{cite journal |vauthors=Kaefer M, Agarwal D, Misseri R, Whittam B, Hubert K, Szymanski K, Rink R, Cain MP |title=Treatment of contralateral hydrocele in neonatal testicular torsion: Is less more? |journal=J Pediatr Urol |volume=12 |issue=5 |pages=306.e1–306.e4 |date=October 2016 |pmid=26708803 |doi=10.1016/j.jpurol.2015.07.009 |url=}}</ref><ref name="pmid174600034">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref><ref name="pmid28389795">{{cite journal |vauthors=Chen Y, Wang F, Zhong H, Zhao J, Li Y, Shi Z |title=A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele |journal=Surg Endosc |volume=31 |issue=12 |pages=4888–4901 |date=December 2017 |pmid=28389795 |doi=10.1007/s00464-017-5491-3 |url=}}</ref><ref name="pmid21592287">{{cite journal |vauthors=Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA |title=Adult hydrocele and spermatocele |journal=BJU Int. |volume=107 |issue=11 |pages=1852–64 |date=June 2011 |pmid=21592287 |doi=10.1111/j.1464-410X.2011.10353.x |url=}}</ref>
-'''[[Brucellosis]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
-*Patient with history of exposure to cattle/sheep/goat/swine or animal products (milk, meat, cheese) presents with acute scrotal pain and swelling
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Undulant fever and night sweats (characteristic wet hay odor)
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-*Relapses common with similar symptoms
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-*Tender testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-*Fever
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-*Hydrocele
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Elevated WBC count
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-*Positive serum STA test for brucellosis
+* Normal
-*Elevated Brucella IgM and IgG antibodies
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Urine PCR positive for Brucella
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Focal/diffuse hypoechogenicity on ultrasound
+* [[Ultrasound|Ultrasound:]] simple fluid collection
-*Focal/diffusre increased blood flow on Doppler
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Scrotal wall thickening
+* Transillumination test is positive
-| valign="top" |
-*Granulomatous inflammation with lymphocytic infiltration
-| valign="top" |
-*Urethral Gram stain demonstrates Gram-negative diplococci
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Varicocele]]<ref name="pmid28865534">{{cite journal |vauthors=Clavijo RI, Carrasquillo R, Ramasamy R |title=Varicoceles: prevalence and pathogenesis in adult men |journal=Fertil. Steril. |volume=108 |issue=3 |pages=364–369 |date=September 2017 |pmid=28865534 |doi=10.1016/j.fertnstert.2017.06.036 |url=}}</ref><ref name="pmid174600033">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref><ref name="pmid28851509">{{cite journal |vauthors=Locke JA, Noparast M, Afshar K |title=Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials |journal=J Pediatr Urol |volume=13 |issue=5 |pages=437–445 |date=October 2017 |pmid=28851509 |doi=10.1016/j.jpurol.2017.07.008 |url=}}</ref><ref name="pmid26806081">{{cite journal |vauthors=Shridharani A, Owen RC, Elkelany OO, Kim ED |title=The significance of clinical practice guidelines on adult varicocele detection and management |journal=Asian J. Androl. |volume=18 |issue=2 |pages=269–75 |date=2016 |pmid=26806081 |doi=10.4103/1008-682X.172641 |url=}}</ref>
-'''[[Brucellosis]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
-| valign="top" |
+(Mainly left)
-*Patient with history of exposure to cattle/sheep/goat/swine or animal products (milk, meat, cheese) presents with acute scrotal pain and swelling
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
-Undulant fever and night sweats (characteristic wet hay odor)
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Local warmth
-*Relapses common with similar symptoms
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-*Tender testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
-*Fever
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-*Hydrocele
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-*Elevated WBC count
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Positive serum STA test for brucellosis
+* Elevations in unstimulated luteinizing hormone and follicle stimulating hormone levels  may be seen in when associated with infertility in adults
-*Elevated Brucella IgM and IgG antibodies
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Urine PCR positive for Brucella spp.
+* Thrombosis of Inferiror vena cava
-| valign="top" |
+* Thrombosis of Right renal vein
-*Focal/diffuse heterogeneous, hypoechoic intratesticular mass on ultrasound
+* Abdominal mass
-*Focal/diffuse increased blood flow on Doppler
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Scrotal wall thickening
+* [[Renal cancer]]
-| valign="top" |
+* [[Nephrectomy]]
-*Abscess formation at diagnosis is common
+* Nut-cracker syndrome
-*Grey-white mass suggestive of testicular atrophy
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
-*Granulomatous inflammation with lymphocytic infiltration
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| valign="top" |
+* Ultrasonography: [[tortuous]], [[tubular]], anechoic structures adjacent to the testis corresponding to dilated veins of the [[pampiniform plexus]] with calibers of 2–3 mm during the [[Valsalva maneuver]]
-*N/A
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Infertility
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]<ref name="pmid174600032">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref><ref name="pmid21592287">{{cite journal |vauthors=Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA |title=Adult hydrocele and spermatocele |journal=BJU Int. |volume=107 |issue=11 |pages=1852–64 |date=June 2011 |pmid=21592287 |doi=10.1111/j.1464-410X.2011.10353.x |url=}}</ref><ref name="pmid17606432">{{cite journal |vauthors=Yeh HC, Wang CJ, Liu CC, Wu WJ, Chou YH, Huang CH |title=Giant spermatocele mimicking hydrocele: a case report |journal=Kaohsiung J. Med. Sci. |volume=23 |issue=7 |pages=366–9 |date=July 2007 |pmid=17606432 |doi=10.1016/S1607-551X(09)70423-1 |url=}}</ref>
-'''[[Gonorrhea|Gonorrhea infection]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
-*Patient with history of unprotected sexual intercourse presents with unilaterla testicular pain, swelling, and fever
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
-*May be either acute or chronic
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
-*Tender testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
-*Fever
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
-*Hydrocele
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-*Elevated WBC count
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
-*Gram-negative diplococci on urethral Gram stain
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Urine PCR positive for Gonorrhea
+* Falling snow, resulting from internal echoes moving away from the transducer
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Focal/diffuse hypoechogenicity on ultrasound
+* Epididymitis
-*Focal/diffusre increased blood flow on Doppler
+* Trauma
-*Scrotal wall thickening
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| valign="top" |
+* Epididymal scarring is seen
-*Granulomatous inflammation with lymphocytic infiltration
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| valign="top" |
+* [[Ultrasonography]]: hypoechoic with posterior acoustic enhancement
-*Urethral Gram stain demonstrates Gram-negative diplococci
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Transillumination test is positive
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal edema<ref name="pmid28316300">{{cite journal |vauthors=Geffre M, Maki C, Maier S |title=Acute Scrotal Edema in Cirrhotic after Laparoscopic Cholecystectomy |journal=Am Surg |volume=83 |issue=3 |pages=e93–95 |date=March 2017 |pmid=28316300 |doi= |url=}}</ref><ref name="pmid28625172">{{cite journal |vauthors=Esposito F, Sanchez O, Siebert JN, Manzano S |title=Acute scrotal idiopathic edema: A misleading erythema |journal=CJEM |volume=20 |issue=S2 |pages=S37 |date=October 2018 |pmid=28625172 |doi=10.1017/cem.2017.343 |url=}}</ref>
-'''[[Histoplasmosis|Histoplasma infection]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral and can extend to perineum
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
-*Chronic testicular enlargement
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Patients may have systemic manifestations of histoplasmosis
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-*Tender/non-tender testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
-*Elevated WBC count and eosinophilia may be present (may be normal in chronic cases)
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-*Focal/diffuse hypoechogenicity on ultrasound
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-*Focal/diffusre increased blood flow on Doppler
+* [[Eosinophilia]]
-*Scrotal wall thickening
+* Hypoalbuminemia
-| valign="top" |
+* Hyperlipidemia.
-*Caseating granuloma with giant cells
+* Proteinurea
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-*Yeast observed on silver stain
+* Deep Vein Thrombosis
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Nephrotic Syndrome
+* Hepatic Cirrhosis
+* Insect Bite
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Kidney or Liver biopsy
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Occurs between 4-12 years of age.
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sebaceous cyst]]<ref name="pmid26400592">{{cite journal |vauthors=Solanki A, Narang S, Kathpalia R, Goel A |title=Scrotal calcinosis: pathogenetic link with epidermal cyst |journal=BMJ Case Rep |volume=2015 |issue= |pages= |date=September 2015 |pmid=26400592 |pmc=4593290 |doi=10.1136/bcr-2015-211163 |url=}}</ref><ref name="pmid25297369">{{cite journal |vauthors=Prasad KK, Manjunath RD |title=Multiple epidermal cysts of scrotum |journal=Indian J. Med. Res. |volume=140 |issue=2 |pages=318 |date=August 2014 |pmid=25297369 |pmc=4216510 |doi= |url=}}</ref><ref name="pmid25015622">{{cite journal |vauthors=Ząbkowski T, Wajszczuk M |title=Epidermoid cyst of the scrotum: a clinical case |journal=Urol J |volume=11 |issue=3 |pages=1706–9 |date=July 2014 |pmid=25015622 |doi= |url=}}</ref>
-'''[[Mumps]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
-*Post-pubertal man with recent manifestations of mumps (e.g. parotiditis, pancreatitis, arthritis, myocarditis, meningoencephalitis) presents with acute, unilateral painful testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-*Tender testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Hydrocele
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Fever
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Parotiditis
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-*Rash
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Elevated WBC
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-*Elevated paramyxovirus IgM and IgG
+* Normal
-*Urine PCR positive for paramyxovirus
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Focal/diffuse hypoechogenicity on ultrasound
+* [[Fibrous tissues]] and fluids
-*Focal/diffusre increased blood flow on Doppler
+* A fatty,([[keratinous]]), substance that resembles cottage cheese,.
-*Scrotal wall thickening
+* A viscous, serosanguinous fluid (containing [[purulent]] and bloody material).
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-*Non-specific interstitial edema, degenerative changes, vascular dilation
+* Histological examination
-*Lymphocytic infiltration
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| valign="top" |
+* Freely movable on palpation.
-*N/A
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scrotum Carcinoma|Carcinoma of the scrotum]]<ref name="pmid21791720">{{cite journal |vauthors=Casasola Chamorro J, Gutiérrez García S, de Blas Gómez V |title=Scrotal carcinoma |journal=Arch. Esp. Urol. |volume=64 |issue=6 |pages=541–3 |date=July 2011 |pmid=21791720 |doi= |url=}}</ref><ref name="pmid26113906">{{cite journal |vauthors=Halfya A, Elmortaji K, Redouane R, Fethi M, Rafik A, Mohamed E, Abdessamad C |title=[Squamous cell carcinomas of the scrotum: about 7 cases with review of the literature] |language=French |journal=Pan Afr Med J |volume=20 |issue= |pages=163 |date=2015 |pmid=26113906 |pmc=4469445 |doi=10.11604/pamj.2015.20.163.5991 |url=}}</ref><ref name="pmid26959967">{{cite journal |vauthors=Armas-Alvarez AL, Salinas-Sánchez AS, Atienzar-Tobarra M, Virseda-Rodríguez JA |title=Scrotal tumors |journal=Arch. Esp. Urol. |volume=69 |issue=2 |pages=86–9 |date=March 2016 |pmid=26959967 |doi= |url=}}</ref>
-'''[[epididymo-orchitis|Pyogenic epididymo-orchitis]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
-*Patient with history of unprotected sexual intercourse presents with acute scrotal swelling and pain
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-*Tender testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Fever
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Hydrocele
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-*Elevated WBC
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-*Bacterial growth on urethral swab specimin (usually E. coli)
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Urine PCR positive for offending bacterial agent
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| valign="top" |
+* Normal
-*Focal/diffuse hypoechogenicity on ultrasound
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Focal/diffusre increased blood flow on Doppler
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Scrotal wall thickening
+* keratinocytic dysplasia involving the full thickness of the epidermis without infiltration of atypical cells into the dermis.
-| valign="top" |
+* The keratinocytes are pleomorphic with hyperchromatic nuclei
-*Abscess formation in advanced cases
+* Numerous mitoses are present.
-*Non-specific interstitial edema, degenerative changes, vascular dilation
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-*Lymphocytic infiltration
+* Biopsy
-*Grey-white mass suggestive of testicular atrophy
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| valign="top" |
+* Scaly patch or plaque is seen over the testis.
-*N/A
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[filariasis|Chylocele]] ([[Filariasis]])<ref name="pmid25989164">{{cite journal |vauthors=Otabil KB, Tenkorang SB |title=Filarial hydrocele: a neglected condition of a neglected tropical disease |journal=J Infect Dev Ctries |volume=9 |issue=5 |pages=456–62 |date=March 2015 |pmid=25989164 |doi=10.3855/jidc.5346 |url=}}</ref><ref name="pmid28507911">{{cite journal |vauthors=Janssen KM, Willis CJ, Anderson M, Gelnett MS, Wickersham EL, Brand TC |title=Filariasis Orchitis-Differential for Acute Scrotum Pathology |journal=Urol Case Rep |volume=13 |issue= |pages=117–119 |date=July 2017 |pmid=28507911 |pmc=5426035 |doi=10.1016/j.eucr.2017.04.002 |url=}}</ref><ref name="pmid21771446">{{cite journal |vauthors=Yagain K, Mathew M |title=Filariasis presenting as a scrotal nodule in a 2 year old child: a case report |journal=Asian Pac J Trop Med |volume=4 |issue=2 |pages=167–8 |date=February 2011 |pmid=21771446 |doi=10.1016/S1995-7645(11)60062-X |url=}}</ref>
-'''[[Syphilis]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradually
-*Patient with long history of unprotected sexual intercourse presents with painful testicular swelling (tertiary syphilis)
+Rapidly
-*Often manifests as epidimo-orchitis that is resistant to conventional antibiotic therapy
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-*May have other systemic symptoms of tertiary syphilis
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Irregular tender testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Thickened epididymis
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Hydrocele
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-*Positive syphilis serology (suggest latent syphilis)
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*VDRL may be either positiive or negative
+* Circulating filarial antigen (CFA) assays are positve
-*Positive dark field microscopy from lesion content
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| valign="top" |
+* Lymphatics containing worms can be differentiated from the blood vessels by irregular movement
-*Heterogeneous hypoechogenicity on ultrasound
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Solid and cystic appearance with areas of necrosis
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*May have increased blood flow on Doppler
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| valign="top" |
+* CFA assay
-*Discrete gummas on gross pathology
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Microscopic features of gumma (interstitial inflammation, lymphocytic and plasma cell infiltration, obliterative endorteritis (endoarteritis obliterans), perivascular cuffing)
+* Ultrasound demonstrates living worms which has been described as  "filarial dance" sign.
-*Spirochetes may occasionally be observed
-| valign="top" |
-*May stain positively for silver-based methods (Warthin-Starry stain, Wright stain, Levaditi stain)
 |-
-| align="center" |
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotoliths<ref name="pmid21935341">{{cite journal |vauthors=Khallouk A, Yazami OE, Mellas S, Tazi MF, El Fassi J, Farih MH |title=Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment |journal=Rev Urol |volume=13 |issue=2 |pages=95–7 |date=2011 |pmid=21935341 |pmc=3176555 |doi= |url=}}</ref><ref name="pmid16836500">{{cite journal |vauthors=Noël B, Bron C, Künzle N, De Heller M, Panizzon RG |title=Multiple nodules of the scrotum: histopathological findings and surgical procedure. A study of five cases |journal=J Eur Acad Dermatol Venereol |volume=20 |issue=6 |pages=707–10 |date=July 2006 |pmid=16836500 |doi=10.1111/j.1468-3083.2006.01578.x |url=}}</ref><ref name="pmid8790314">{{cite journal |vauthors=Polk P, McCutchen WT, Phillips JG, Biggs PJ |title=Polypoid scrotal calcinosis: an uncommon variant of scrotal calcinosis |journal=South. Med. J. |volume=89 |issue=9 |pages=896–7 |date=September 1996 |pmid=8790314 |doi= |url=}}</ref>
-'''[[Tuberculosis]]'''
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradual
-*Patient with history of tuberculosis presents with painless mass or chronically dull testicular discomfort
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Positive constitutional symptoms (weight loss, malaise)
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
-*May be isolated or may be associated with other systemic symptoms of tuberculosis (e.g. lymphadenopathy, pulmonary lesions, renal involvement)
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*May have concomitant involvement of other GU organs (e.g. prostate, seminal vesicles)
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| valign="top" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Irregular testicular mass
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
-*May be tender or non-tender
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-*Thickened scrotal skin
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Hydrocele
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| valign="top" |
+* Normal
-*Ejaculum may demonstrate positive acid fast bacilli (AFB) staining
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| valign="top" |
+* Trauma
-*Heterogeneous hypoechogenicity on ultrasound
+* Torsion of appendix
-*No/minimal blood flow on Doppler
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-*Hypointense lesion on T1WI MRI and hyperintense on T2WI MRI
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| valign="top" |
+* Ultrasound
-*Possible abscess formation
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-*Caseating necrosis
+* Ultrasound shows  mobile hyperechoic extratesticular focus in the potential tunica space.
-*Epithelioid cells and lymphocytic infiltration with presence of multinucleated giant cells
-| valign="top" |
 |}

Scrotal mass differential diagnosis: Difference between revisions

Latest revision as of 15:16, 23 October 2019

Overview

Differentiating Scrotal masses from the other Diseases

References

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