Since the scrotum is rarely exposed to sunlight, basal cell carcinoma (BCC) development in this area is an uncommon occurrence. As result, there is a scarcity of research covering this particular presentation, which poses a diagnostic and therapeutic challenge for clinicians. The objective of this systematic review is to provide a thorough overview of scrotal BCC, including a summary of its clinical characteristics, and microscopic subtypes. It also seeks to discuss the many techniques used in the management of this uncommon clinical presentation. Utilizing data from 1957 to October 2023, a systematic review of PubMed and Wiley Online Library was conducted to identify all cases of scrotal BCC with various presentations and managements. A total of 73 patients were included. The median patient age was 65.9 years (range 42 to 87). All studies were either case reports or case series. Our review shows that treatment with Mohs micrographic surgery (MMS), leads to a superior patient outcome based on anecdotal evidence in select cases. To deepen our understanding of Mohs surgery\'s efficacy in treating scrotal BCC, it is imperative to conduct more robust research in the form of randomized clinical trials.

Acute idiopathic scrotal edema is a clinical entity predominant in children under 10 years whose true incidence is unknown in our setting. Diagnosis is challenging and avoids unnecessary surgeries. We present the case of an idiopathic acute scrotal edema with ultrasound findings highly suggestive of the diagnosis, which was managed conservatively with complete signs and symptoms resolution after discharge. We aim to review the ultrasound characteristics and differential diagnosis of this disorder.

BACKGROUND: Extramammary Paget\'s disease of the scrotum and penis is a relatively rare cutaneous malignant tumor. At present, its pathogenesis, and clinical and pathological characteristics are not very clear. This is controversial regarding surgical margin width to decrease the high recurrence rate. This paper aimed to report the case and review the literature of extramammary Paget\'s disease of scrotum and penis.
METHODS: We presented the case of a 74-year-old male patient with the patchy erythema and pruritus in the perineum who was admitted to our department. Biopsy of the large plaque revealed Paget disease. Under the condition of ensuring negative surgical margins by rapid frozen pathology, a wide local excision of the lesion, bilateral orchiectomy, and adnexectomy were performed on the patient. Pathology revealed that many scattered vacuolated Paget cells were observed in the epidermal layer, and the diagnosis was Paget\'s disease of the scrotum and penis. The 2 cm outside the skin lesion was used as the initial surgical margin, and free skin flap transplantation was used to repair the surgical wound. The patient recovered well and was discharged 1 week after surgery.
CONCLUSIONS: Currently, histopathologic biopsy is the most important diagnostic method for EMPD. Once confirmed, for patients eligible for surgical intervention, wide local excision of the lesion and rapid intraoperative frozen pathological examination should be performed as soon as possible. The skin flap transplantation is the first choice for the repair of large-scale wound after surgery.

Computed tomography (CT) may show a variety of scrotal and penile pathologic finding, but is usually not used as a first-line imaging due to its limited soft tissue contrast. Nonetheless, there are three main scenarios for imaging of the scrotum and penis with CT. Pathologies may be found incidentally in patients undergoing abdominal and pelvic CT scanning for different reasons. In emergency settings, CT is frequently performed, and the recognition of scrotal and penile pathologies by the reporting radiologist is crucial to ensure optimal patient treatment and outcome. If MRI scanning cannot be performed due to contraindications or is unavailable in resource, limited CT may be used for the further characterization of scrotal and penile pathology found on ultrasound. This pictorial review wants to familiarize general and emergency radiologists with the anatomy and possible pathological findings of the scrotum and penis on CT.

暂无摘要。

Polyorchidism, the presence of more than two testes, usually presents as a painless scrotal mass or is diagnosed incidentally during the management of another condition.1 It is a rare congenital abnormality with approximately 200 reported cases in the literature. Most cases are found on the left side within the scrotum. We report a case of right-sided polyorchidism in a 9-year-old patient found incidentally during inguinal orchiopexy. As there is debate on the management of polyorchidism, a careful approach is required as the surgeon must decide between either scrotal fixation or the removal of the supernumerary testis. This case report will discuss the anatomical and clinical considerations when making this decision.

OBJECTIVE: The incidence of scrotal migration of a ventriculoperitoneal shunt (VPS) catheter is rare and may lead to life-threatening visceral complications. Management requires prompt removal of the migrated portion of the shunt and closure of the scrotal sac. We report an interesting case of a young child who presented with asymptomatic unilateral swelling of his scrotum secondary to a migrated VPS catheter. A repeat X-ray prior to his surgery to remove the migrated catheter showed that the entire length of the distal VPS catheter was back in the peritoneal cavity. In view of this unusual phenomenon, the case is discussed in corroboration with published literature.
RESULTS: A systematic search of publications in the English language is performed in PubMed and Google Scholar. Our findings show that there are 49 reported cases (including our patient) of scrotal migration of shunt catheters in patients less than 18 years old. There is only 1 other case of spontaneous resolution of shunt catheter from the scrotum. Favoured management of choice is repositioning the distal shunt catheter back into the peritoneal cavity and herniotomy in the same setting, if possible. Overall, the literature suggests this is a shunt-related complication that has a good prognosis if intervention is timely.
CONCLUSIONS: Scrotal migration of a VPS catheter is a rare but potentially life-threatening complication in children. Our case report highlights the role of updated preoperative imaging and the need for consistent long-term shunt surveillance in children.

OBJECTIVE: This case experience aims to question the current know-how when a masked testicle malignancy occurs, in order to achieve the correct clinical framework and avoid mistakes during surgical procedures. in the evaluation MATERIALS AND METHODS: A 36-year-old male patient was admitted with an incorrect diagnosis of left-sided incarcerated inguinoscrotal hernia, and then discovered a seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge.
RESULTS: The surgery was perceived by the patient as the best possible treatment because the symptoms were relieved.
CONCLUSIONS: A 36-year-old male patient was admitted to our surgical department due to an incorrect diagnosis of leftsided incarcerated inguinoscrotal hernia, consequently to a misguided scrotal ultrasound-doppler exam. During the urgent surgical operation, we realized that we were dealing with an enormous 17x10x9 cm seminomatous testicular neoplasm matched with a hypertensive ipsilateral hydrocele. Therefore, we performed a radical epididymo-orchiectomy and referred the patient to the oncologist for adjuvant chemotherapy after discharge.
CONCLUSIONS: This case report points out that there may be a poor correlation between clinical findings and pathophysiologic processes affecting scrotal structures. Additional radiological investigations, such as CT scan, could clarify and confirm the clinical scenario, improving the preoperative planning and surgical outcomes.
BACKGROUND: Inguinal Hernia, Seminoma, Testicular Neoplasm.
Le neoplasie testicolari, comuni tra gli uomini adulti, rappresentano circa l’1% dei tumori maligni, specialmente nella giovinezza e nella prima età adulta. Le valutazioni cliniche ed ecografiche non sono sempre in grado di identificare il gonfiore scrotale subacuto. Questo manoscritto, basato su revisione della letteratura e case experience, ha come obiettivo migliorare le attuali conoscenze e pratiche per la diagnosi del cancro ai testicoli, clinicamente mascherato da ernia o idrocele, al fine di differenziare i pazienti e prevenire errori chirurgici. Nella fattispecie il caso tratta di un paziente, m, 36 anni lamentava di un vago dolore allo scroto omolaterale nelle ultime 72 ore, è stato ricoverato presso il reparto di Chirurgia Generale dell’ospedale San Pio di Castellaneta (TA), con una diagnosi di ernia inguino-scrotale sinistra. Durante la valutazione clinica, ha presentato uno scroto rigonfiato, dolorante e allungato, con scarsa dolorabilità addominale inferiore, addome trattabile con movimenti peristaltici udibili e segno di Blumberg negativo. Nessuna ostruzione intestinale, contrazione della diuresi o segni di shock sono stati registrati al momento del ricovero. Il radiologo ha eseguito un’ecografia focalizzata riportando una iperdistensione del sacco scrotale con abbondante liquido transonico libero e un’alterazione morfologica del testicolo omolaterale, iperecogeno, ben vascolarizzato allo spettro doppler, testicolo controlaterale non visibile. Alla luce della presunta diagnosi di idrocele ipertensivo, è stata eseguita un’esplorazione chirurgica con un approccio trans-scrotale iniziale, durante la quale si è scoperta invece una massa testicolare solida irregolare ostruiva il canale di Nuck a causa delle sue dimensioni e forma ostacolava il riassorbimento del liquido sieroso. È stata quindi eseguita un’orchifunicolectomia radicale sinistra tramite inguinotomia, è stata rimossa una pastiglia tout-court comprendente l’incisione precedente e anche l’intera superficie scrotale interna della tunica vaginale (Fig. 1). Un sistema di drenaggio di aspirazione per la cavità vuota scrotale è stato fornito per 48 ore dopo l’intervento. Con terapia antibiotica cefazolina 2 gr/die per un totale di 72 ore dopo l’intervento. Dopo il secondo giorno postoperatorio, il dosaggio di beta-HCG è stato di 0,1 mU/ml. Una TAC postoperatoria IV con mezzo di contrasto del torace, dell’addome e della pelvi non ha rivelato alcun pattern patologico retroperitoneale o lesioni target significative. Il paziente è stato dimesso senza incidenti il quarto giorno postoperatorio e alla fine è stato indirizzato al team oncologico per la somministrazione della terapia adiuvante di carboplatino, 6 cicli. L’esame istopatologico del campione ha rivelato un pattern immuno-fenotipico di neoplasia seminomatosa a cellule germinali di 10x9x17 cm con bande necro-emorragiche e fibro-sclerotiche interne con invasione endovasale e albuginea, stadio di pT2 - Nx - Mx, fosfatasi alcalina placentare/CD117 positiva e alfa- FP/CKAE1/AE3 negativa. Nella pratica medica corrente, un paziente che presenta in urgenza un gonfiore scrotale subacuto doloroso viene sottoposto a esame clinico e valutazione ecografica, al fine di scegliere il trattamento più adeguato. In questo particolare caso clinico, tenendo conto che non sono stati registrati segni di ostruzione intestinale, il processo decisionale è stato erroneamente influenzato da una scarsa interazione del paziente a causa delle comorbidità psichiatriche esistenti e da una valutazione ecografica errata. A nostra conoscenza, non sono stati riportati casi clinici simili in letteratura, probabilmente dovuti ad una così rara condizione di coesistenza di idrocele ipertensivo sostenuta da una neoplasia testicolare gigante. Riteniamo che il trattamento chirurgico sia stato adeguato in uno scenario urgente così peculiare, dovuto alla completa asportazione della massa primaria tramite inguinotomia. L’intervento chirurgico è stato percepito dal paziente come il miglior trattamento possibile perché i sintomi sono stati alleviati. In conclusione, la diagnosi di tali malattie scrotali croniche, acute, benigne e maligne è di solito ottenuta in quasi tutti i casi attraverso un esame clinico e risultati ecografici. Tuttavia, nei casi dubbi di gonfiore scrotale subacuto o eccessivamente grande prima dell’intervento chirurgico, i medici dovrebbero approfondire le indagini strumentali eseguendo una TAC con contrasto IV al fine di evitare diagnosi errate e trattamenti di down. Questo caso clinico dimostra la natura peculiare di una neoplasia seminomatosa all’esordio e per quanto riguarda la sopravvivenza globale, il fatto che quasi tutte le neoplasie sono diagnosticate precocemente, e che il tumore più grande dovrebbe essere il più maligno, secondo la letteratura. Ulteriori indagini e casi dovrebbero essere segnalati per fornire dati statisticamente rilevanti in futuro.

The objective of this review was to summarize the applications of sonoelastography in testicular tumor identification and inquire about their test performances. Two authors independently searched English journal articles and full conference papers from CINAHL, Embase, IEEE Xplore®, PubMed, Scopus, and Web of Science from inception and organized them into a PIRO (patient, index test, reference test, outcome) framework. Eleven studies (n = 11) were eligible for data synthesis, nine of which (n = 9) utilized strain elastography and two (n = 2) employed shear-wave elastography. Meta-analyses were performed on the distinction between neoplasm (tumor) and non-neoplasm (non-tumor) from four study arms and between malignancy and benignity from seven study arms. The pooled sensitivity of classifying malignancy and benignity was 86.0% (95%CI, 79.7% to 90.6%). There was substantial heterogeneity in the classification of neoplasm and non-neoplasm and in the specificity of classifying malignancy and benignity, which could not be addressed by the subgroup analysis of sonoelastography techniques. Heterogeneity might be associated with the high risk of bias and applicability concern, including a wide spectrum of testicular pathologies and verification bias in the reference tests. Key technical obstacles in the index test were manual compression in strain elastography, qualitative observation of non-standardized color codes, and locating the Regions of Interest (ROI), in addition to decisions in feature extractions. Future research may focus on multiparametric sonoelastography using deep learning models and ensemble learning. A decision model on the benefits-risks of surgical exploration (reference test) could also be developed to direct the test-and-treat strategy for testicular tumors.

Polyorchidism, a congenital malformation characterized by supernumerary testes (SNTs), is usually revealed incidentally during ultrasound or open scrotal surgery. In the approximately 200 cases so far published in the literature, the left side is affected more often than the right. Despite the rarity of this anomaly, a surgeon must have basic knowledge of its embryological basis and classifications to implement proper treatment and avoid overlooking it, since the consequences could harm the patient. This review summarizes previous classifications. It can be assumed that determining the risk of malignancy, and the level of reproductive potential based on location, vascularization, ductus deferens drainage, and environmental factors (e.g., temperature) affecting the SNTs, indicates the best approach to management. Therefore, we have created a new classification based on previous ones, addressing the aforementioned issues, which will guide the clinician to select the most appropriate treatment.