Scrotal mass differential diagnosis: Difference between revisions

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|'''[[Seminoma]]'''
|'''[[Seminoma]]'''
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*Most common
*Most common
*30-50 year-old with painless unilateral testicular mass or mild discomfort
*30-50 year-old with painless unilateral testicular mass or mild discomfort
|
|valign=top|
*Palpable, nontender unilateral testicular mass
*Palpable, nontender unilateral testicular mass
*Usually homogeneous enlargement
*Usually homogeneous enlargement
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*Elevated serum placental ALP (PALP)
*Elevated serum placental ALP (PALP)
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*Hypoechogenic intratesticular well-defined mass on ultrasound with internal blood flow on Doppler ultrasound
*Hypoechogenic intratesticular well-defined mass on ultrasound with internal blood flow on Doppler ultrasound
*Cysts and calcificications are uncommon
*Cysts and calcificications are uncommon
*Hypointense lesion with inhomogeneous enhancement on MRI
*Hypointense lesion with inhomogeneous enhancement on MRI
*Homogeneous when small and heterogeneous when large
*Homogeneous when small and heterogeneous when large
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*Grey-white homogeneous mass with a lobular appearance
*Grey-white homogeneous mass with a lobular appearance
*Fried egg appearance on histopathology (large cells and clear cytoplasm)
*Fried egg appearance on histopathology (large cells and clear cytoplasm)
*Prominent lymphocytic infiltration and less commonly, granulomatous  formation
*Prominent lymphocytic infiltration and less commonly, granulomatous  formation
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*Stains positively for ALP, c-KIT, CD30, EMA, and glycogen
*Stains positively for ALP, c-KIT, CD30, EMA, and glycogen
|-
|-
|'''Embryonal cell carcinoma'''
|'''Embryonal cell carcinoma'''
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*Young adults
*Young adults
*Painful testicular mass
*Painful testicular mass
*Manifests with early mestastasis (bone, lung, CNS)
*Manifests with early mestastasis (bone, lung, CNS)
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* Often unremarkable (small primary tumor)
* Often unremarkable (small primary tumor)
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*Elevated serum hCG
*Elevated serum hCG
*Elevated serum AFP, when mixed
*Elevated serum AFP, when mixed
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*Variable echogenicity (usually hypoechoic on ultrasound)
*Variable echogenicity (usually hypoechoic on ultrasound)
*No differentiating features on imaging
*No differentiating features on imaging
*Commonly invade the surrounding structures (tunica albuginea)
*Commonly invade the surrounding structures (tunica albuginea)
*Irregular calcifications
*Irregular calcifications
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*Pale-grey mass with areas of hemorrhagic and necrosis
*Pale-grey mass with areas of hemorrhagic and necrosis
*Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
*Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
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*Stains positively for CD30 and hCG stain
*Stains positively for CD30 and hCG stain
*May stain positively for AFP, when mixed
*May stain positively for AFP, when mixed
|-
|-
|'''[[Yolk sac tumor]]'''
|'''[[Yolk sac tumor]]'''
|  
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* Most common testicular cancer in children less than 3 years of age
* Most common testicular cancer in children less than 3 years of age
*Rapidly growing unilateral mass in an infant or a young child
*Rapidly growing unilateral mass in an infant or a young child
|  
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*Palpable, nontender unilateral testicular mass
*Palpable, nontender unilateral testicular mass
*Usually heterogeneous enlargement
*Usually heterogeneous enlargement
|  
|valign=top|  
*Elevated serum AFP
*Elevated serum AFP
|
|valign=top|
*Diffuse enlargement of the testis with a heterogeneous appearance on ultrasound
*Diffuse enlargement of the testis with a heterogeneous appearance on ultrasound
*Areas of hemorrhage and necrosis on MRI
*Areas of hemorrhage and necrosis on MRI
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*Yellow, mucinous, non-encapsulated, heterogeneous mass with areas of necrosis and hemorrhage
*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
*Patterns that resemble embryonal structures (yolk sac, allantois) with reticular, papillary, or elongated forms
*Schiller-Duval bodies (perivascular structures)
*Schiller-Duval bodies (perivascular structures)
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*Stains positively for AFP, alpha-1-antitrypsin, PAS diastase
*Stains positively for AFP, alpha-1-antitrypsin, PAS diastase
|-
|-
|'''[[Teratoma]]'''
|'''[[Teratoma]]'''
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*Bimodal distribution of age (infants and middle aged adults)
*Bimodal distribution of age (infants and middle aged adults)
*Painless tumor
*Painless tumor
*History of congenital disease (Down syndrome, klinefelter, spina bifida)
*History of congenital disease (Down syndrome, klinefelter, spina bifida)
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|valign=top|  
*Palpable, nontender unilateral testicular mass
*Palpable, nontender unilateral testicular mass
*Usually heterogeneous enlargement
*Usually heterogeneous enlargement
|
|valign=top|
*Elevated serum hCG
*Elevated serum hCG
*Elevated serum AFP
*Elevated serum AFP
|  
|valign=top|  
*Heterogeneous, cystic appearance with mucinous or sebaceous depositions
*Heterogeneous, cystic appearance with mucinous or sebaceous depositions
*Variable echogenicity on ultrasound
*Variable echogenicity on ultrasound
*Calcifications usually irregular  
*Calcifications usually irregular  
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*Large, heterogeneous appearance with solid, cystic, mucoid, and/or cartilageanous components
*Large, heterogeneous appearance with solid, cystic, mucoid, and/or cartilageanous components
*Presence of at least 2 germ layers
*Presence of at least 2 germ layers
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*Chromosome 12p mutations
*Chromosome 12p mutations
*Stains positively for cytokeratin. hCG, and AFP
*Stains positively for cytokeratin. hCG, and AFP

Revision as of 15:55, 16 March 2016

Scrotal Mass Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

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.

Disease Name History and Symptoms Physical Examination Lab Findings Imaging Findings Gross and Histologic Findings Genetic Studies / Immunohistochemistry
Germ Cell Tumors
Seminoma
  • Most common
  • 30-50 year-old with painless unilateral testicular mass or mild discomfort
  • Palpable, nontender unilateral testicular mass
  • Usually homogeneous enlargement
  • Elevated serum placental ALP (PALP)
  • 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
  • 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
  • Stains positively for ALP, c-KIT, CD30, EMA, and glycogen
Embryonal cell carcinoma
  • Young adults
  • Painful testicular mass
  • Manifests with early mestastasis (bone, lung, CNS)
  • Often unremarkable (small primary tumor)
  • Elevated serum hCG
  • Elevated serum AFP, when mixed
  • Variable echogenicity (usually hypoechoic on ultrasound)
  • No differentiating features on imaging
  • Commonly invade the surrounding structures (tunica albuginea)
  • Irregular calcifications
  • Pale-grey mass with areas of hemorrhagic and necrosis
  • Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
  • Stains positively for CD30 and hCG stain
  • May stain positively for AFP, when mixed
Yolk sac tumor
  • Most common testicular cancer in children less than 3 years of age
  • Rapidly growing unilateral mass in an infant or a young child
  • Palpable, nontender unilateral testicular mass
  • Usually heterogeneous enlargement
  • Elevated serum AFP
  • Diffuse enlargement of the testis with a heterogeneous appearance on ultrasound
  • Areas of hemorrhage and necrosis on MRI
  • 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)
  • Stains positively for AFP, alpha-1-antitrypsin, PAS diastase
Teratoma
  • Bimodal distribution of age (infants and middle aged adults)
  • Painless tumor
  • History of congenital disease (Down syndrome, klinefelter, spina bifida)
  • Palpable, nontender unilateral testicular mass
  • Usually heterogeneous enlargement
  • Elevated serum hCG
  • Elevated serum AFP
  • Heterogeneous, cystic appearance with mucinous or sebaceous depositions
  • Variable echogenicity on ultrasound
  • Calcifications usually irregular
  • Large, heterogeneous appearance with solid, cystic, mucoid, and/or cartilageanous components
  • Presence of at least 2 germ layers
  • Chromosome 12p mutations
  • Stains positively for cytokeratin. hCG, and AFP
B
C
D

References

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