Scrotum URR

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What is the Prehn sign used for?

used to differentiate epididymo-orchitis from torsion

Scrotal wall 1. outermost layer 2. inner layer

1. skin 2. tunica vaginalis

Secretes mucous for lubrication

Cowper's gland

A condition in which one or both testes failed to descend from the abdomen to the scrotum

Cryptorchidism

An infection causing acute necrotizing fasciitis of the perineum, scrotum, and anterior abdominal wall

Fournier Gangrene

Another name for the head of the epididymis

Globus Major

Gonadal stromal tumor cells combined with germ cell tumor cells; majority occurs with cryptorchidism an d hypospadias

Gonadoblastoma

Accumulation of serous fluid between the two layers of the tunica vaginalis

Hydrocele

Right testicular vein drains into the _______

IVC

In pediatric patients, testicular volumes can be calculated using what two formulas?

Lambert and Ellipsoid formulas

What is the second most common primary malignancy of the testicles?

Mixed germ cell tumor

What is the most common non-seminomatous germ cell tumor?

Mixed germ cell tumors

Lines the walls of the scrotal pouch

Parietal layer

Three or more testicles present

Polyorchidism

A series of channels within the mediastinum

Rete testis

What is the nutcracker syndrome?

SMA compresses the left renal vein causing increased pressure and stasis in the venous systems of the left kidney and left testicle

Thin layer of tissue that is in direct contact with the testicular tissue.

Tunica albuginea

Extension of the peritoneum into the scrotal sac

Tunica vaginalis

Inner layer covering the testes, epididymis, and lower part of the spermatic cord.

Visceral Layer

Most common testicular tumor in patients < 2 yrs of age

Yolk sac tumor

What is the most common cause of acute scrotal pain in postpubertal men?

acute epididymitis

sudden onset of inflammation of one or both testicles

acute orchitis

Most common benign extratesticular tumor

adenomatoid

The prostate secretes an _________ fluid into semen

alkaline

The seminal vesicle secretes an __________ component of semen and ________ for sperm

alkaline; nutrients

Doppler waveforms demonstrate high levels of _______, _______ flow

antegrade, monophasic

Right and left gonadal arteries originate from the _______ to supply the testicles; they have a ______ resistance flow with a RI of ____-____

aorta; low; 0.5-0.75

Adrenal rests are associated with ______________ and _____________

cushing syndrome and adrenal hyperplasia

Cystic dysplasia is a rare congenital malformation that consists of multiple _______ of different sizes with _______ that begins at the ___________ area and extends into parenchyma nearby.

cysts; septations; mediastinum testis

With acute orchitis there will be _____________ (_____________) vascular resistance compared to the unaffected side

decreased; hypervascularity

What are 4 postvasectomy changes?

epididymal enlargement, tubular ectasia of the epididymis, spermatoceles and cysts, dilated vas deferens

Where does sperm maturation occur?

epididymis

What is common with lymphoma?

extension into epididymis and cord

Multiple tortuous anechoic structures proximal to the upper pole of the testis

extratesticular

sex cord cells

germ cell stromal

Testicular metastasis is more common than what?

germ cell tumors in patients > 50 years old

Microlithiasis seen with (4)?

germ cell tumors, cryptorchidism, trisomy 21 (down syndrome) and klinefelter syndrome, and a previous radiotherapy

choriocarcinoma can cause _____________ due to _________________

gynecomastia; high levels of beta hCG

Spermatoceles usually are only found where?

head of epididymis

With a ruptured testicle, _________ can form

hematocele

With leukemia ___________ and ____________ tissue replaces the testes tissue

homogeneous and hypoechoic

Most common cause of painless swelling

hydrocele

Another name for extrascrotal calcifications

scrotal pearls

The dartos is the muscle layer (middle) that forms the _____________ and separates the _______________

scrotal raphe; two testicles

Most common "pure" germ cell tumor of testes

seminoma

Most common testicular malignancy?

seminoma (40-50%)

Germ cell tumors are divided into what?

seminomatous (pure seminoma) and non-seminomatous (seminoma and non-seminoma portions) groups

____________ arise from the tunica albuginea to form the mediastinum testis

septula

An epididymal cyst contains what type of fluid?

serous

Coarse calcifications are seen with (2)?

sertoli cell tumors and burned out germ cell tumors

Acute epididymitis usually results from ____________________ in men under 35 yrs and ____________________ in men over 35 yrs.

sexually transmitted disease; lower UTI

What 3 layers make up the scrotal wall?

skin; dartos; tunica vaginalis

The ejaculatory duct has _______ and ______

sperm and seminal vesicle fluid

Extravasation of the spermatozoa into tissues around the epididymis

sperm granulomas

Exocrine function

sperm production

Extratesticular tumors mostly involve ______

the epididymis

Scrotal pearls arise between what?

the two layers of tunica vaginalis

Embryonal cell carcinoma labs

AFP and beta hCG elevated in most cases

Seminoma labs:

AFP levels normal, elevated bhCG

What should be scanned when a varicocele is found on the left side?

left kidney

Left testicular vein drains into the ________

left renal vein

2nd most common metastatic neoplasm

leukemia

Sertoli cell tumors are similar to what?

leydig cell tumors

Stromal cell tumors (non-germ cell tumors) (4)

leydig cell, sertoli cell, granulosa cell, mixed

Mediastinum testis is seen as a ______________ band within the testicle

linear echogenic

Testicles offer _______ vascular resistance

low

acute orchitis can result from __________________

lower UTI

Most common bilateral testicular tumor

lymphoma

most common secondary malignancy of the testes

lymphoma

If a teratoma is found in adults, its usually benign or malignant?

malignant

Most intratesticular masses are ___________ Most extratesticular masses are ___________

malignant benign

Air in the scrotum caused by a bacterial infection

pneumoscrotom

Spermatoceles are commonly seen in what type of patients?

postvasectomy patients

Testicular metastasis most commonly comes from ________ or _________ primary

prostate or lung

Which type of germ cell tumor is very responsive to radiation and chemotherapy?

pure seminomas

sarcoidosis presents as what?

recurrent epididymitis

Cystic dysplasia is frequently seen with ________ or _________

renal agenesis or dysplasia

The efferent ducts form channels called the ________ that carry the seminal fluid from the testicle to the epididymis.

rete testes

Intratesticular cysts are thought to originate from where?

rete testis

The head of the epididymis is formed by the tubules from the __________

rete testis

A pyocele is caused by what?

rupture of an abscess

Most common malignancy in men 15-35 yrs of age

scrotal neoplasms

Cremasteric artery -Originates from the _________ -Feeds the __________ tissues -__________ resistance, RI > ______

-external iliac artery -peritesticular high; 0.75

Tuberculosis -_____________ epididymis -___________ formation within the epididymis -very little _________ in or around the nodules

-heterogenous -nodule -vascularity

Infarction sonographic appearance: -acute -chronic

-hypoechoic -hyperechoic

Deferential Artery -Originates from the _________ -Feeds the _________ and ________ -________ resistance, RI > ______

-internal iliac artery -epididymis and vas deferens -high; 0.75

Centripetal arteries: -Course through the parenchyma to deliver ________ blood to the tissues -these arteries are sampled with Doppler to assess testicular ________ -normally demonstrate ______ resistance, ______ flow volume

-oxygenated blood -perfusion -low; high

The testes normally descends into scrotal sac at ___ weeks gestational age

36

Seminomas occurs at what age?

40-50 yrs

With a ruptured testicle, 90% can be saved if treated within ___ hours

72

Each testicle contains approximately ______ seminiferous tubules that converge to form ___-___ larger efferent ducts.

840; 20-30

Curved structure lying posterior lateral to the testicle

Epididymis

T or F. Lymphoma has hemorrhage and necrosis always.

False; rare

T or F. Normally there is a small amount of fluid between the layers of the tunica vaginalis.

True

T or F. Seminomas have no calcifications

True

T or F: Seminomas are among the most frequent morphologic patterns of testicular cancers AND they have a very good prognosis at all stages

True

Numerous small cystic structures within the rete testes

Tubular ectasia of the rete testis

Leydig cell tumors are mostly malignant or benign?

benign

Most extratesticular tumors are benign or malignant?

benign

Teratomas are usually benign or malignant

benign

With a leydig cell tumor, increased peripheral vascularity is usually __________

benign

Another name for an epidermoid cyst

benign teratoma

Inflammatory scrotal wall thickening can cause ________ and ________

cellulitis and fournier gangrene

Rarest type of germ cell tumor

choriocarcinoma

What is the worst prognosis of all germ cell tumors

choriocarcinoma

The ___________ muscle manipulates the position of the testicles in the scrotum.

cremasteric

Increased risk of seminoma formation in patients with _____________

cryptorchidism

Fournier gangrene is usually seen in ___________ patients

diabetic

What causes a simple epididymal cyst?

dilatation of the epididymal tubules

What causes a spermatocele?

dilatation of the epididymal tubules

The tubules converge into the __________, which forms the body and tail (____________)

ductus epididymis; globus minor

Teratomas labs

elevated AFP and beta hCG levels with malignancy

Yolk sac tumor labs

elevated AFP levels, beta hCG usually normal

What is the most aggressive testicular malignancy?

embryonal cell carcinoma

Leydig cell tumors can cause ___________, ___________, ____________, and ___________

endocrine imbalance, precocious puberty, impotence, gynecomastia

A cyst that contains thick keratin

epidermoid cysts

Mediastinum testis creates an _______________ and provides support for ____________.

incomplete septum; testicular vessels

Choriocarcinoma labs

increased levels of beta hCG, AFP levels usually normal

varicocele is associated with what?

infertility

Most undescended testes are palpable at the ________ area

inguinal canal

multiple cystic structures within the rete testes that fill with color on doppler evaluation

intratesticular

Where do the blood vessels and ductules enter/exit the testicle?

mediastinum

Folds of the tunica albuginea form sections within the testicles called the ____________ (similar to a _______)

mediastinum testis; hilum

5 types of non-seminoma germ cell tumors

mixed malignant germ cell, embryonal cell carcinoma, yolk sac tumor, teratoma, choriocarcinoma

The appendix testis is a remnant of the ____________

mullerian duct

sarcoidosis can form _________ in the epoididymis

nodules

Which is more aggressive a non-seminoma or a seminomatous?

non-seminoma

Epidermoid cysts are described as having an ________ or _______ appearance due to alternating rings of _______ and ________ tissues

onion; target; hyperechoic; hypoechoic

What is the surgical procedure performed to correct cryptorchidism?

orchiopexy

An abscess is usually a complication of what?

orchitis/epididymitis

Capsular artery courses along the testicle __________ and produces branches called _________

periphery; centripetal

What is the most common cause of a hydrocele in pediatric patients?

persistent communication between the scrotal sac and peritoneum

____________ are a common residual effect of a vasectomy

spermatic granulomas

What is the most common scrotal mass?

spermatocele

Tubular ectasia of the rete testis is usually bilateral and seen with a ___________.

spermatocle

Spermatocele contains _______ and _______

spermatozoa and sediment

The appendix testis is a small ovoid structure that is usually located between the ___________ and the __________

superior pole; epididymal head

In acute epididymitis what thickens first?

tail

What is the most common combination of a mixed germ cell tumor?

teratoma and embryonal cell carcinoma

2nd most common testicular tumor in infants and young children

teratomas

Endocrine function

testosterone secretion

Leydig cell tumors produce __________ and sometimes _________

testosterone; estrogen

T or F. A non-seminoma requires orchiectomy

true

T or F. The tunica albuginea is not normally visualized

true

Scattered calcifications are seen with (3)?

tuberculosis, filariasis, previous trauma

Embryonal cell carcinoma is most aggressive with invasion of what?

tunica albuginea

Collection of abnormal dilated veins posterior to testes that extend to the spermatic cord (pampiniform plexus)

varicocele

The spermatic cord holds what 6 things?

vas deferens, cremasteric, deferential and testicular arteries, pampiniform plexus of veins, lymph vessels, and nerves

Diastolic flow reversal in cases of epididymo-orchitis can indicate what?

venous infarction

The _____________ layer of the tunica vaginalis covers the tunica albuginea

visceral layer

Non-seminomatous germ cell tumors cause what?

visceral metastasis

What is the Prehn sign?

when you lift up the painful scrotum above the level of the symphysis pubis, pain will be relieved when infection is the cause for the symptoms, but no pain reduction if the pain is due to torsion


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