Testicular and scrotal conditions: Pathology review
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Testicular and scrotal conditions: Pathology review
Pathology
Male and female reproductive system disorders
Precocious puberty
Delayed puberty
Klinefelter syndrome
Turner syndrome
Androgen insensitivity syndrome
5-alpha-reductase deficiency
Kallmann syndrome
Male reproductive system disorders
Hypospadias and epispadias
Bladder exstrophy
Priapism
Penile cancer
Prostatitis
Benign prostatic hyperplasia
Prostate cancer
Cryptorchidism
Inguinal hernia
Varicocele
Epididymitis
Orchitis
Testicular torsion
Testicular cancer
Erectile dysfunction
Male hypoactive sexual desire disorder
Female reproductive system disorders
Amenorrhea
Ovarian cyst
Premature ovarian failure
Polycystic ovary syndrome
Ovarian torsion
Krukenberg tumor
Sex cord-gonadal stromal tumor
Surface epithelial-stromal tumor
Germ cell ovarian tumor
Uterine fibroid
Endometriosis
Endometritis
Endometrial hyperplasia
Endometrial cancer
Choriocarcinoma
Cervical cancer
Pelvic inflammatory disease
Urethritis
Female sexual interest and arousal disorder
Orgasmic dysfunction
Genito-pelvic pain and penetration disorder
Mastitis
Fibrocystic breast changes
Intraductal papilloma
Phyllodes tumor
Paget disease of the breast
Breast cancer
Hyperemesis gravidarum
Gestational hypertension
Preeclampsia & eclampsia
Gestational diabetes
Cervical incompetence
Placenta previa
Placenta accreta
Placental abruption
Oligohydramnios
Polyhydramnios
Potter sequence
Intrauterine growth restriction
Preterm labor
Postpartum hemorrhage
Chorioamnionitis
Congenital toxoplasmosis
Congenital cytomegalovirus (NORD)
Congenital syphilis
Neonatal conjunctivitis
Neonatal herpes simplex
Congenital rubella syndrome
Neonatal sepsis
Neonatal meningitis
Miscarriage
Gestational trophoblastic disease
Ectopic pregnancy
Fetal hydantoin syndrome
Fetal alcohol syndrome
Reproductive system pathology review
Disorders of sex chromosomes: Pathology review
Prostate disorders and cancer: Pathology review
Testicular tumors: Pathology review
Uterine disorders: Pathology review
Ovarian cysts and tumors: Pathology review
Cervical cancer: Pathology review
Vaginal and vulvar disorders: Pathology review
Benign breast conditions: Pathology review
Breast cancer: Pathology review
Complications during pregnancy: Pathology review
Congenital TORCH infections: Pathology review
Disorders of sexual development and sex hormones: Pathology review
Amenorrhea: Pathology Review
Testicular and scrotal conditions: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
HIV and AIDS: Pathology review
Penile conditions: Pathology review
Assessments
Testicular and scrotal conditions: Pathology review
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Content Reviewers
Antonella Melani, MDContributors
Antonia Syrnioti, MD
Evan Debevec-McKenney
Cassidy Dermott
Talia Ingram, MSMI, CMI
In the middle of the night, a 16 year old male named Shane is brought to the emergency department by his parents after waking up with severe pain in his right scrotum. Shane does not recall any traumatic events prior to the onset of his symptoms. On physical examination, the scrotum appears swollen; in addition, you notice that the pain is worsened with elevation of the scrotum, and stroking of the right inner thigh does not result in elevation of the right testis.
Later that day, you meet a 28 year old male called Elias, who comes in for a fertility evaluation. Elias and his wife have been trying to conceive for two years without success. Recently, Elias has also noticed an enlargement and a feeling of pressure in his left scrotum. On physical examination, you palpate a mass along the spermatic cord that feels like a “bag of worms”.
Based on the initial presentation, both Shane and Elias seem to have some form of testicular and scrotal condition. Now, for your exams, remember that the testes begin their development in the abdominal cavity, within the peritoneum. During the third trimester of pregnancy, the testes usually begin to descend into the pelvis via the inguinal canal, and ultimately settle in the scrotum. This needs to occur because sperm can't survive at body temperature, and that’s a high yield fact!
Now, as the testes gradually migrate, a peritoneal outpouching called the processus vaginalis forms, and pulls the layers of the anterolateral abdominal wall with it into the developing scrotum. The testes then follow the processus vaginalis into the scrotum. After the testes have descended to the scrotum, the processus vaginalis closes up. Within the scrotum, each testis remains partially covered by an extension of the peritoneum, which forms a serous layer called the tunica vaginalis. The only part that’s not covered by the tunica vaginalis is where the testes are attached to the epididymis and spermatic cord.
Summary
The testicles and scrotum are part of the male reproductive system and can be affected by a variety of conditions. Common testicular and scrotal conditions include epididymitis, orchitis, testicular torsion, cryptorchidism, testicular tumor, varicocele, hydrocele, and spermatocele. Epididymitis refers to an inflammation of the epididymis usually caused by a bacterial infection. Orchitis occurs when there is an inflammation of one or both testicles. It is usually caused by mumps infection, but it can also be caused by bacterial infections, such as sexually transmitted infections. Next, there is testicular torsion, which occurs when the spermatic cord that provides blood to the testicle twists, cutting off the blood supply. There is also cryptorchidism, a common male birth defect that occurs when testicles fail to descend from the abdominal cavity into the scrotum, and often get stuck in the inguinal canal. Next come testicular tumors, which include tumors like germ cell type, such as seminoma. There is also varicocele, which is an enlargement of the veins in the scrotum, similar to varicose veins in the legs. Finally, we have hydrocele, which is a fluid-filled sac that develops in the scrotum, and spermatocele, which is a cyst that develops in the epididymis, usually containing dead sperm cells.
Sources
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Robbins Basic Pathology" Elsevier (2017)
- "Diagnostic Immunohistochemistry" Elsevier (2021)
- "Bates' Guide to Physical Examination and History Taking" LWW (2017)
- "Atlas of Emergency Medicine" NA (2015)
- "Aetiology of testicular cancer: association with congenital abnormalities, age at puberty, infertility, and exercise" BMJ (1994)
- "Testicular cancer and antecedent diseases" British Journal of Cancer (1987)
- "Urologic Emergencies" Surgical Clinics of North America (2016)
- "Age at Surgery for Undescended Testis and Risk of Testicular Cancer" New England Journal of Medicine (2007)
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