Clinico-radiological and pathological evaluation of extra testicular scrotal lesions

Abstract

Background: Scrotal ultrasound, though reliable in distinguishing between intratesticular and extratesticular lesions and characterizing them as cystic and solid, cannot distinguish benign from malignant pathology. Although fine needle aspiration cytology (FNAC) has proved to be of great diagnostic importance in testicular lesions, its scope in extratesticular lesions is largely unexplored.

Aim: To evaluate extratesticular scrotal lesions cytologically and compare it with their clinical, radiological, and histological findings.

Materials and methods: Sixty five patients with extratesticular scrotal lesions were assessed clinically, radiologically, and cytologically. Histopathology was done in 45 cases where surgical exploration was undertaken. All the data were then analyzed and correlated.

Results: Extratesticular lesions accounted for 72.2% of the scrotal swellings. Of these, the epididymis is most commonly involved (61.5% cases) with the commonest type of lesion being cystic (49.3% cases). Ultrasonography preferably with color doppler is highly useful for the evaluation of the scrotum. Apart from distinguishing extratesticular from testicular and cystic from solid lesions, it has an important role in identifying individual lesions, thus reducing the list of differential diagnosis. Fine needle aspiration cytology contributed to a definitive diagnosis in 47.7% cases. It helps classify cystic masses on the basis of their contents and defines the etiology of chronic inflammatory lesions, apart from corroborating with the clinico-radiological diagnosis. Histological evaluation was possible only in cases where surgery was performed and helps further define the diagnosis.

Conclusion: Fine needle aspiration cytology is essentially non-traumatic and easy to carry out and should be a technique of choice for the study of scrotal pathology, main advantage being avoidance of delays in diagnosis.

Keywords: Cytology; epididymis; extratesticular; scrotum; ultrasound.

Figure 1

(a) Epididymal cyst/spermatocele. Anechoic cyst in the head of epididymis; (b) Spermatocele. Smear shows dense population of dispersed sperm, other spermatogenic cells and histiocytes (H and E, ×500); (c) Tuberculous epididymo-orchitis. Smear shows clusters of epithelioid cells and lymphocytes in a background of neutrophils (H and E, ×500); (d) Elephantiasis. Smear shows single intact microfilaria against a background of inflammatory cells and cellular debris (Pap, ×500)

Figure 2

Late post-vasectomy syndrome. Smear shows sperm granuloma around a tubule showing two multinucleated giant cells, epithelioid cells, inflammatory cells and histiocytes (H and E, ×250)

Figure 3

(a) Fibrous pseudotumor (gross). Cut section of tumor is pale homogenous and attached to capsule of testis; (b) Fibrous pseudotumor – Section shows fascicles of spindle-shaped cells with few inflammatory cells (H and E, ×250)

Figure 4

(a) Scrotal calcinosis – Multinodular, large, yellowish swellings on scrotum; (b) Scrotal calcinosis – Smear shows calcium deposits and few degenerating cells (H and E, ×500); (c) Scrotal calcinosis – Section shows intradermal basophilic calcific masses, with overlying epidermis (H and E, ×50)