Pathology of the Scrotum and Foreskin Flashcards

(69 cards)

1
Q

Where do the testicular veins drain?

A

Left testicular veins drains into renal vein

Right testicular veins drains into IVC

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2
Q

What is the lymphatic drainage of the testes?

A

Para-aortic nodes

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3
Q

Hydrocele

A

A hydrocele is a type of swelling in the scrotum that occurs when fluid collects in the tunica intima. Hydrocele is common in newborns and usually disappears without treatment by age 1 caused by a patent processus vaginalis.

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4
Q

What can cause hydroceles in boys and older men?

A

Older boys and adult men can develop a hydrocele due to inflammation or injury within the scrotum.

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5
Q

How are hydroceles diagnosed?

A

History
Examination - cystic, able to get above swelling.
Ultrasound
Transilluminable

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6
Q

Epididymal cyst / Spermatocele

A

An epididymal cyst is a fluid-filled sac which grows at the top end of the testicle - arising from the epididymal ducts.

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7
Q

What are the symptoms of an epididymal cyst?

A

Painless
Cystic and transilluminant
Usually separate from the testes.

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8
Q

How are epididymal cysts diagnosed?

A

Ultrasound scan

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9
Q

Varicocele?

A

Varicocele is an enlargement of the veins within the scrotum. A varicocele is similar to a varicose vein you might see in your leg.

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10
Q

Where do the varicoceles form?

A

Pampiniform plexus

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11
Q

Pampiniform plexus

A

The pampiniform plexus is a loose network of small veins found within the male spermatic cord.

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12
Q

What are the symptoms of varicocele?

A

Feels like a bag of worms (disappears when lying down).

Varicoceles are a common cause of low sperm production and decreased sperm quality, which can cause infertility.

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13
Q

What are the three main causes of testicular swelling?

A

Torsion
Acute Epididymo-orchitis/epididymitis
Torsion of testicular appendix

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14
Q

How is hydrocele treated?

A

Aspirated if unfit for surgery

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15
Q

Why are varicoceles most commonly found in the left testes?

A

Found most commonly in the left testes due to increased pressure in the left testicular vein as it drains into the left renal vein.

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16
Q

Indirect inguinal hernias

A

Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring due to failure to close the embryonic processus vaginalis.

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17
Q

What is the difference between a direct and indirect inguinal hernia?

A

Symptoms of both include groin pain, which can be severe.

Direct inguinal hernias are often caused by age-related stress and weakened muscles in the inguinal canal.

Indirect inguinal hernias are caused by a persistent opening that does not close during fetal development.

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18
Q

How do tumours of the testes present?

A

Often in 20-40yr old men
Painless lump
Not separate from the testes

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19
Q

Describe testicular torsion.

A

Most common in 20-40yr old men

Testes rotates around it’s vascular base leading to acute pain.

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20
Q

What are the clinical symptoms of testicular torsion?

A

Sudden onset of severe testicular pain
Abdominal pain and vomiting
Retraction of testes into bell clapper position
Swollen, tender erythematous scrotum.

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21
Q

What is the surgical management of testicular torsion?

A

Testes are sutured to tunica vaginalis to prevent further torsion - known as orchiopexy.

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22
Q

Epididymitis

A

Infection of the epididymis

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23
Q

What is the cause of epididymitis?

A

Due to chlamydia - 2 week course of doxycycline may be given.

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24
Q

What are the symptoms of epididymitis?

A

Scrotal discomfort
Scrotal swelling
Pain during micturition

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25
Orchitis and it's cause
Infection of the testes | - commonly has a viral cause such as MUMPS.
26
Epididymo-orchitis
When epididymitis spreads to the testes. | > has a gradual onset causing a dull ache/pain.
27
Lymphocele
Collection of lymphatic fluid
28
Describe how a lymphocele may form.
Following femoral artery surgery in groin. | Disruption of local lymphatics causing a collection of lymphatic fluid forming a lump.
29
Ectopic testes
Testes not present in scrotum
30
Saphena varix
A saphena varix is a dilatation at the top of the long saphenous vein due to valvular incompetence. It may reach the size of a golf ball or larger. The varix is: soft and compressible. disappears immediately on lying down.
31
How is testicular torsion diagnosed?
A Doppler ultrasound
32
Doppler ultrasound
A Doppler ultrasound is a test that uses high-frequency sound waves to measure the amount of blood flow through your arteries and veins.
33
What are the two ways testicular tumours are classified?
Germ cell tumours (90%) | Non-germ cell tumours (10%)
34
Priaprism
Involuntary persistent erection unrelated to sexual stimulation.
35
What are the complications of priaprism?
Hypoxic damage Erectile dysfunction Corporeal fibrosis - loss of penile length
36
Prostatitis
Prostate gland inflammation usually caused by gram negative bacterial infection.
37
Rotation of the testes around the spermatic cord may cause what?
Testicular torsion
38
Erythematous
Redness of the skin due to increased bloodflow - occurs in infections and inflammation.
39
Cryptorchidism
The absence of one or both testes in the scrotum - missing testes are located in the inguinal canal.
40
What are hypospadias and epispadias?
Abnormal urethral openings on the penis: Hypospadias - ventrally Epispadias - dorsally
41
What are the different types of germ cell tumours?
``` Seminomas Non-seminomas GCT Embryonal carcinoma Choriocarcinoma Teratoma ```
42
What are the different types of sex cord / gonadal stromal tumours?
Sertoli cells tumour Leydig cells tumour Granulosa cell tumour
43
Which testicular tumour produces beta-hCG?
Non-seminomas GCT
44
Outline the histology of teratomas.
Contains many tissue types e.g hair, teeth, neurons etc
45
Outline the histology of leydig cells tumour
Reinke crystals
46
What are the signs and symptoms of testicular tumours?
``` Painless mass on testes Lower abdominal pain / heaviness Previously atrophied testis increases in size Gynecomastia Metastasis ```
47
Gynecomastia
Enlarged / swelling of breast tissue in men - commonly caused by raised oestrogen levels.
48
How are testicular tumours diagnosed?
``` Biopsy Chest x-ray - for pulmonary metastasis CT scan MRI Ultrasound ```
49
How do seminoma and NSGCT present on ultrasounds?
Seminoma: Smooth echogenic mass NSGCT: No defined borders appears as calcified cystic masses.
50
What are risk factors of testicular tumours?
``` Cryptorchidism Previous testicular tumour Family history White individuals Congenital abnormalities - hypospadias/inguinal hernias Infection - mumps causing orchitis ```
51
What are the main serum tumour makers in testicular cancer?
Alpha fetoprotein Normal AFP Beta-hCG Lactate dehydrogenase
52
Alphafetoprotein is commonly associated with what testicular tumour?
Yolk sac tumours
53
What is the general treatment for testicular tumours?
Counselling - discussing sperm retrieval and storage as well as prosthesis for cosmetic reasons. Orchidectomy Subsequent treatment depends on histology and staging.
54
Orchidectomy
Removal of one or both testicles
55
What does the prepuce (foreskin) do?
Covers and protects the glans penis and urethral | meatus.
56
Balanoposthitis
Balanoposthitis is inflammation of the head of | the penis and the foreskin”
57
What are the symptoms of balanoposthitis?
``` Redness, swelling and soreness around the head of the penis or foreskin A thick discharge under the foreskin A rash on the penis Itchiness An unpleasant odour Pain when urinating ```
58
What are some of the causes of balanoposthitis?
``` Irritation caused by smegma Thrush Bacterial infection (streptococcal) STI's Playing with foreskin Skin conditions e.g eczema ```
59
When is thrush a more common cause of balanoposthitis?
More common in people with diabetes or people who have recently taken antibiotics.
60
What STI's can cause balanoposthitis?
Gonorrhoea Herpes Syphilis
61
Phimosis
Is a condition where the foreskin is too tight to be pulled | back over the head of the penis.
62
What can cause phimosis?
Common causes are : chronic and recurrent posthitis, | eczema, psoriasis, lichen planus and lichen sclerosis.
63
What is the presentation of phimosis?
Can present with pain due to recurrent tearing and scarring, pin hole meatus and difficulty urinating, sexual problem.
64
Paraphimosis
When the foreskin cannot be returned to its original | position after being retracted.
65
What are the complications of paraphimosis?
Consequence – pain, swelling and restricted blood flow to the glans. A tight constriction ring is formed. In extreme cases the penile head may become gangrenous.
66
Testicular cancer most commonly metastasises where?
Lungs
67
Physiological phimosis
Where the foreskin does not retract - completely normal in boys under 7 years old.
68
A 60 year old man presents with a right sided scrotal swelling. On examination there is a soft swelling in the right hemi-scrotum, you can get above it, the testis is not palpable separate from it. It trans illuminates. The most likely pathology is:
Hydrocele
69
At a well baby check you examine a 3 week old baby boy. You notice that the foreskin appears hooded and the urethral meatus is eccentrically placed on the ventral aspect of the glans. The most likely developmental abnormality is:
Hypospadias