Scrotum URR
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