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Unusual scrotal pathology: an overview

Nature Reviews Urology volume 6, pages 491–500 (2009)Cite this article

Abstract

The diverse embryological origins of the contents of the scrotum create an environment that fosters a wide variety of unusual pathologies. Most scrotal pathologies are discovered by the patient and are initially evaluated by a thorough physical examination and scrotal ultrasonography. Scrotal lesions can be broadly grouped by the anatomical location in which they develop; the clinician must consider a wide differential diagnosis based on this location. Solid testicular masses are considered germ cell tumors until proven otherwise, but numerous other possible pathologies exist, including ectopic tissue, metastasis, and other neoplastic growths. Rete testis lesions are classified as developmental, benign or malignant. Cystic lesions of the epididymis are most commonly benign, but malignant neoplasms can also be present. The paratesticular region has the broadest differential diagnosis, as it contains numerous distinct structures and is a common location for ectopic tissue and metastatic disease; a narrower range of lesions develop in the scrotal wall because of its simpler anatomy. Treatment options range from conservative observation to wide surgical excision and should be considered carefully; the aim of therapy is to remove malignant or potentially malignant tissue while minimizing effects on fertility and function.

Key Points

  • Differential diagnosis of a scrotal mass is complicated by the numerous distinct structures found in the scrotum

  • The diversity of pathologies found in the scrotum can be partially explained by the numerous embryological origins of its structures

  • Final diagnosis might not be achieved until removal and examination of the specimen, which requires intimate anatomical knowledge

  • Urologists should be aware of the myriad of pathologies that can present in the scrotum

  • Knowledge of rare scrotal pathologies can prevent excessive treatment while maximizing the patient's safety

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Acknowledgements

We thank Kristina Greiner for critical reading of the manuscript.

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Authors and Affiliations

  1. Department of Urology, University of Iowa, Iowa City, IA, USA

    Henry M. Rosevear & Moshe Wald

  2. Department of Urology, State University of New York at Stony Brook, NY, USA,

    Alek Mishail & Yefim Sheynkin

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Rosevear, H., Mishail, A., Sheynkin, Y. et al. Unusual scrotal pathology: an overview. Nat Rev Urol 6, 491–500 (2009). https://doi.org/10.1038/nrurol.2009.149

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