The Histopathological Spectrum of Scrotal Lesions in a Tertiary Care Hospital: A Cross-Sectional Study

Abstract

Background: The incidence and clinical presentation of testicular and paratesticular lesions are variable. A preoperative diagnosis is often difficult with only a clinical examination. The diagnosis of testicular lesions is mainly based on histological investigation, despite advances in imaging and tumor marker testing. This study aimed to document the histopathological spectrum of scrotal lesions, including testicular and paratesticular lesions.

Aim: The study aimed to research the histopathological spectrum of scrotal lesions.

Settings and design: This was a cross-sectional study conducted at NKP Salve Institute of Medical Sciences & Research Centre and Lata Mangeshkar Hospital, a tertiary care hospital in Nagpur, India.

Materials and methods: Following the institutional ethics committee's approval, a two-year cross-sectional study was carried out in the tertiary care hospital. Seventy operated scrotal specimens sent for histopathological examination were included in the study. The clinical details and investigations of the patients, as well as the gross and histopathological findings of all the specimens, were studied carefully.

Statistical analysis: The clinical details and gross and histopathological findings were noted in a proforma, entered in a Microsoft Excel sheet (Microsoft Corp., Redmond, WA), and verified. The data were presented in a tabular form using tablets, pie charts, and bar diagrams. The collected data were analyzed and presented in percentages and frequencies.

Results: The present study evaluated the histopathological spectrum of scrotal lesions in 70 operated scrotal masses. The mean age of the participants in the study was 46.55 ± 18.69 years, with the youngest patient at four years and the oldest being 88 years of age. Sixty-six (80%) of the 70 cases were of non-neoplastic lesions, while 14 (20%) were of neoplastic lesions. Testicular atrophy (16 cases) was the most common non-neoplastic lesion. The most frequent neoplastic lesion in the present study was a seminoma (seven cases).

Conclusion: This study strongly recommends routine histopathological examination of all scrotal specimens for the detection of various testicular and paratesticular lesions, as well as neoplasms. Histopathology not only provides a tissue diagnosis in scrotal disorders, but it also adds to understanding etiopathogenesis and can aid in the development of future treatment options.

Keywords: histopathological spectrum; para-testicular lesions; scrotal lesions; seminoma; testicular tumours.

Figure 1. Atrophic testis

Specimen of an atrophic testis with an attached cord. The testis measures 2.6 x 1.2 x 0.8cm. The patient presented with an inguinoscrotal swelling, clinically diagnosed to be undescended testis.

Figure 2. Histopathology of atrophic testis

Photomicrographs of atrophic testis show seminiferous tubules lined by one to two layers of germinal cells with stromal fibrosis (hematoxylin and eosin stain, 40x).

Figure 3. Calcinosis cutis

A specimen of calcinosis cutis shows an irregular, bosselated scrotal mass. The cut surface shows multiple nodules with homogenous, whitish areas.

Figure 4. Epididymal cyst

A photomicrograph reveals a fibrous cyst wall lined by flattened to cuboidal cells (hematoxylin and eosin stain, 40x).

Figure 5. Testicular seminoma

Specimen of seminoma testis showing tumor mass involving the entire testis; the cut surface is homogenous.

Figure 6. Histopathology of testicular seminoma

A photomicrograph shows sheets of tumor cells separated by thin fibrous septa. The cells have clear cytoplasm with prominent nucleoli (hematoxylin and eosin stain, 40x).