Scrotum Pathology ARDMS
The degree of torsion may vary between ___-___ degrees.
180-540
Dilated veins of a varicocele are >___mm.
2
Sonographically, epididymitis is associated with: ________, ______echoic epididymis ______echoic testicle Increased _______ ______ Reactive _______ Scrotal wall ________ _______ resistance waveform
Enlarged Hypo Hypo Blood flow Hydrocele Thickening Low
Mixed germ cell tumors contain different germ cell elements in various combinations. Types include: (4)
Choriocarcinoma Embryonal cell carcinoma Teratoma Yolk sac tumor
Testicular microlithiasis are (common/rare). It is associated with ______, _______, ______ and _______ syndrome
Common Malignancies Infertility Cryptorchidism Klinefter
Bell clapper deformity is (acquired/congenital) and can be found in as many as ___% of males.
Congenital 12
Hydroceles may be _______ or _______. They may be idiopathic or the result of trauma, _______, neoplasms, _______itis or ______itis.
Congenital Acquired Torsion Epididym Orch
Patients with cryptorchidism have an increased risk of developing malignancy in both the undescended testis and the ________ ______.
Contralateral testis
An undescended testicle is called ________.
Cryptochidism
Chronic epididymitis appears as an ________, _______echoic epididymis with _______.
Enlarged Hyper Calcifications
Sonographically, testicular ischemia appears with an (atrophic/enlarged), ________ and _____echoic testicle as compared to the contralateral one.
Enlarged Inhomogenous Hypo
Patients with torsion of the appendix testis will present with ______ rather than _______ pain, usually localized to the ______ pole of the testis.
Focal General Superior
_______ ______ tumors account for 95% of testicular tumors and include (5)
Germ cell Seminomas Teratomas Choriocarcinomas Yolk sac tumors Mixed tumors
A spermatocele is a cyst in the _______ of the epididymis that may contain layering of _______. It may be _______ but it is typically not painful.
Head Debris Palpable
Choriocarcinoma metastasizes by _______ routes, thus patients present with ______ metastases (3)
Hematogenous Distal Lung Liver Brain
Yolk sac tumors appear as ________ mass with areas of _______ and ________.
Heterogenous Hemorrhage Calcifications
Choriocarcinoma appears as a _______ mass with areas of ______, _______ and _______.
Heterogenous Hemorrhage Necrosis Calcifications
Most malignant testicular neoplasms are _____echoic compared to the normal testicular parenchyma.
Hypo
An undescended testis appears _______ compared to normal testis
Hypoechoic
Complications of cryptorchidism include ________ and ________, most commonly ________.
Infertility Cancer Seminoma
The most common location of the cryptorchid testis is in the _______ ______. Less than 10% of undescended are located in the _______.
Inguinal canal Abdomen
The most common form of torsion is (extra/intra)vaginal torsion.
Intra
Seminomas appear as (intra/extra)testicular _______, ______echoic mass.
Intra Solid Hypo
Two types of torsion:
Intravaginal Extravaginal
The left testicular vein drains into to ______, where pressure is higher than it is in the ______. This explains the greater incidence of left varicoceles.
LRV IVC
90% of varicoceles are on the (left/right) side.
Left
Torsion more often involves the (left/right) testicle.
Left
The most common malignancies to metastasize to the testicles are _______ and _______.
Leukemia Lymphoma
The most common gonadal stromal tumor in children and adults is the ______ _____ tumor.
Leydig cell
Seminoma spreads initially to draining ______ _____ in the retroperitoneum.
Lymph nodes
Intratesticular cysts are normally located near the _______ _______ and probably originate from the _____ _____.
Mediastinum testis Rete testis
The second most common testicular malignancy after seminoma is ______ _____ ______ tumors.
Mixed germ cell
Spermatoceles are (less/more) common than epydidymal cysts.
More
Extravaginal torsion occurs during the ______ period is Or in _______ when torsion of the _______ ______ occurs in the ______ _______.
Neonatal Utero Spermatic cord Inguinal canal
A spermatocele is composed of _______ sperm, fat, cellular ______ and _______ where as an epididymal cyst is made of ______ _____.
Nonviable Debris Leukocytes Clear fluid
A predisposing factor for some patients with varicocele is "_______" syndrome, because the entrapment of the _______ between the ______ and ______.
Nutcracker LRV SMA AO
Testicular torsion leads to venous _______ and arterial _______ causing ______ of the testicle.
Occlusion Ischemia Infarction
The treatment for cryptorchidism is ________ which is usually performed on patients aged ___-___ years.
Orchioplexy 2-10
If epididymitis extends into the testicle it causes _______, which appears as an ________ and _______echoic testicle with increased _______ ______.
Orchitis Enlarged Hypo Blood flow
Tunica albuginea cysts are located anywhere on the _______ of the testicle within the tunica albuginea.
Periphery
The presence of _______ within the scrotum confirms hernia diagnosis.
Peristalsis
Acute epididymitis is usually caused by _______ in men under 35 years and ______ in men over 35.
STDs UTIs
Varicoceles should distend when a patient is _______, during _______ or with _______ ______.
Standing Valsalva Abdominal compression
Torsion presents as _______ onset of _______ (bi/uni)lateral scrotal pain. It can be associated with trauma, strenuous _______ and ______.
Sudden Severe Uni Exercise Sex
The most common mixed germ call tumor is a combination of _______ and _______ ______ carcinoma, formerly called ________.
Teratoma Embryonal cell Teratocarcinoma
The second most common testicular tumor in children are ______. They are usually (benign/malignant). However, in adults, they are usually (benign/malignant).
Teratomas Benign Malignant
The most common solid tumor in men 15-35 years of age are _______ neoplasms.
Testicular
The two types of benign testicular cysts are cysts of the _______ _______ and _______ cysts.
Tunica albuginea Intratesticular
Typically the testicle is attached to the _______ _______. If this attachment is absent, the testicle can rotate freely on the ______ ______ and cause _______.
Tunica vaginalis Spermatic cord Torsion
There is an increased risk of developing a seminoma in an _______ testis and in the ________ normally locates testis, even after orchioplexy.
Undescended Contralateral
Small inguinal hernias can be visualized using the _______ _______.
Valsalva maneuver
Incompetent or abnormal venous _______ lead to increased _______ _______ in the venous system which dilates and leads to varicoceles.
Valves Hydrostatic pressure
Intravaginal torsion occurs when the testicle is not attached to the scrotal ______.
Wall
Sonographically, teratomas appear as (poorly/well)defined masses containing ______ and ______ components. Dense, echogenic ______ are common, representing calcifications, immature ______ and fibrosis.
Well Cystic Solid Foci Bones
The most common prepubertal testicular tumor is the ______ ______ tumor. Lab values will show increased levels of ______.
Yolk sac AFP
Increased ______ levels are found in 60% of malignant testicular tumors.
hCG
Choriocarcinoma and embryonal carcinoma are associated with increased levels of (AFP/hCG) while yolk sac tumors are associated with increased (AFP/hCG).
hCG AFP
The dilated veins have increased ______ supply, which in turn increases the _______ of the sperm leading to male _______.
Blood Temperature Infertility
Scrotal hernias result when the ______ or ______ protrudes through the inguinal canal into the _______ _______ of the scrotum.
Bowel Omentum Tunica vaginalis
Testicular torsion is observed in males younger than ___, with most aged ___-___.
30 12-18
Leydig cell tumors occur most frequently in males aged ___-___ years.
4-5
There is an 80-100% salvage rate if torsion is treated within ___ Hours, however it nears 0% by ___ Hours.
6 12
Acute epididymitis presents with _______ scrotal _______ which may be associated with ________ and _______.
Acute Pain Fever Pyuria
The most common extratesticular tumor is the ________ tumor.
Adenomatoid
Adrenal rests are ectopic _______ tissue caused by its migration with _______ tissue during fetal development.
Adrenal Gonadal
Sonographic appearance depends on the ______ of the infarction. Initially, the infarction produces a focal or diffuse ________ testicle. With time, the testicle size (increases/decreases) and develops areas of increased echogenicity representing ________ or _______.
Age Hypoechoic Decreases Fibrosis Calcification
The congenital absence of a testis is called _______. It accounts for only ___% of patients with cryptorchidism.
Anorchia 4
Torsion of the _______ ______ is the most common cause of acute scrotal pain in prepubertal boys.
Appendix testis
Sonographically, a torsed appendage appears as a small, ________, ______echoic mass adjacent to the _______ pole of the testis.
Avascular Hypo Superior
The absence of the testicular attachment to the tunica vaginalis is called _____ ______ deformity.
Bell clapper
The epidermoid cyst is a (benign/malignant) cyst of ______ ______ origin.
Benign Germ cell
Most extratesticular masses are (benign/malignant) but the majority of intratesticular lesions are (benign/malignant).
Benign Malignant
Leydig cell tumors are usually (benign/malignant) and produce _______, which can lead to _______ ______.
Benign Testosterone Precocious puberty
Adrenal rests appear as (bi/uni)lateral, round _____echoic intratesticular masses, most commonly near the ______ ______.
Bi Hypo Mediastinum testis
Scrotal pearls are ________ that may be located within the testicle or between the layers of the tunica _______.
Calcifications Vaginalis
Seminomas are ______- and ______sensitive, resulting in (good/poor) prognosis.
Chemo Radio Good
The most lethal and least common form of germ cell tumor is the _______.
Choriocarcinoma
The amount of ischemic damage to the testicle is directly related to the _______ of _______.
Degree Torsion
A varicocele is a ________ of the venous _______ _______.
Dilatation Pampiniform plexus
Scrotal pearls are _______ and _______, but lack _______ _______.
Echogenic Mobile Posterior shadowing
Teratomas consist of three different germinal layers:
Endoderm Mesoderm Ectoderm
A yolk sac tumor is also known as _______ ______ tumor.
Endodermal sinus
Abscesses present with an _______ testicle containing a predominantly _______-filled mass with ______echoic or _______ echogenic areas. Flow is increased at the ________ and absent _______.
Enlarged Fluid Hypo Mixed Margins Centrally
The "bow tie" central echogenic pattern is a sign of ________ cyst.
Epidermoid
Extratesticular thmor usually involve the _______.
Epididymis
Spermatoceles are cystic masses of the ________ that result from dilatation of the _______ _______.
Epididymis Epididymal tubules
Spermatoceles and epididymal cysts result from prior episodes of _______.
Epididymitis
The most common condition causing acute scrotal pain in adults is ________.
Epididymitis
Testicular abscesses are usually a complication of ______-______.
Epididymo-orchitis
True or false? Blood flow within the testicle definitively rules out torsion.
False
Low level echoes from ______ or _______ crystals may be visualized within the hydrocele. Scrotal wall ______ May also be present.
Fibrin Cholesterol Thickening
Although CT and MRI are typically used to image undescended testis, a _______ _______ can aid in ultrasound evaluation.
Filled bladder
A varicocele on the right side by be considered a "_______" varicocele and could be associated with: ________ mass Marked ________ Hepato________ Retroperitoneal ________
Secondary Hepatic Hydronephrosis Megaly Neoplasm
The most common germ cell tumor in adult males is the ______.
Seminoma
The most common malignant neoplasm in males aged 30-50 is the ______.
Seminoma
A hydrocele is ______ fluid that accumulates within or between the ______ and ______ layers of the ______ ______.
Serous Visceral Parietal Tunica vaginalis
Even when presenting with distal metastases, the primary testicular choriocarcinoma May be ______ or nonpalpable (_______ ______).
Small Burned out
Epidermoid cysts appear as well-defined, _______, _______echoic masses with an _______ capsule or "______ _____" pattern formed by multiple layers of ________.
Solid Hypo Echogenic Onion ring Keratin
Testicular torsion is also referred to as _______ _______ torsion.
Spermatic cord
The most common scrotal mass is the _________.
Spermatocele
Due to the slow blood flow, varicoceles may become _______.
Thrombosed
Scrotal pearls are thought to be remnants of a formerly ________ and displace testicular ________.
Torsed Appendage
The blue dot sign refers to the appearance of a _______ _______ under the surface of the skin.
Torsed appendage
Testicular infarction commonly results from ______ or _____.
Torsion Trauma
A hematocele is associated with _______.
Trauma
True of false? An epididymal cyst can occur anywhere along the length of the epididymis.
True
True or false? Epididymitis can be focal or diffuse.
True
Intratesticular cysts May also be referred to ______ ______.
Tubular ectasia
Epidermoid cysts are solid tumors lying beneath the ______ ______.
Tunica albuginea