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Genital Herpes ZosterA 70-year-old man with rheumatoid arthritis presented with painful, red lesions on the right side of his penis and scrotum and on his inner right thigh and a 1-day history of difficulty urinating.

Angiomyofibroblastoma is a rare benign mesenchymal tumor typically found in the genital region of adult females, but its occurrence in the male scrotum is exceptionally uncommon. This report presents two cases of angiomyofibroblastoma in the male scrotum to enhance the understanding of this rare condition. In the first case, a man in his early 60s with a recent rectal cancer diagnosis was found to have a palpable right scrotal mass. Imaging suggested metastasis, but radical resection and pathological analysis confirmed angiomyofibroblastoma, with no evidence of testicular malignancy. The patient remained tumor-free for 7 years. In the second case, a man in his early 40s presented with a nontender, slowly enlarging right inguinal mass extending into the scrotum. Surgical resection revealed a 6 × 4-cm angiomyofibroblastoma, with no recurrence for 7 years. These cases underscore the importance of considering angiomyofibroblastoma in the differential diagnosis of scrotal masses in males. Accurate diagnosis relies on understanding the clinical, imaging, and histopathologic features of angiomyofibroblastoma to ensure appropriate management and favorable outcomes.

ObjectivesThe Scrotal and Penile Imaging Working Group (SPI-WG) appointed by the board of the European Society of Urogenital Radiology (ESUR) has produced recommendations for magnetic resonance imaging (MRI) of the scrotum.MethodsThe SPI-WG searched for original and review articles published before September 2016 using the Pubmed and Medline databases. Keywords used were ‘magnetic resonance imaging’, 'testis or testicle or testicular', 'scrotum', 'intratesticular', 'paratesticular', 'extratesticular' 'diffusion-weighted', 'dynamic MRI'. Consensus was obtained among the members of the subcommittee. The expert panel proposed recommendations using Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence.ResultsThe recommended MRI protocol should include T1-, T2-weighted imaging, diffusion-weighted imaging and dynamic contrast-enhanced MRI. Scrotal MRI can be clinically applied for lesion characterisation (primary), including both intratesticular and paratesticular masses, differentiation between germ-cell and non-germ-cell neoplasms (evolving), characterisation of the histological type of testicular germ cell neoplasms (TGCNs, in selected cases), local staging of TGCNs (primary), acute scrotum (in selected cases), trauma (in selected cases) and undescended testes (primary).ConclusionsThe ESUR SPI-WG produced this consensus paper in which the existing literature on MRI of the scrotum is reviewed. The recommendations for the optimal imaging technique and clinical indications are presented.Key points• This report presents recommendations for magnetic resonance imaging (MRI) of the scrotum.• Imaging acquisition protocols and clinical indications are provided.• MRI is becoming established as a worthwhile second-line diagnostic tool for scrotal pathology.

Background An angiomyofibroblastoma (AMF) is a rare tumor that primarily occurs in the vulva of women. AMF rarely occurs in the inguinal region and scrotum of men. Case presentation A 59-year-old male was admitted to the hospital for evaluation of left scrotal enlargement for 2 years. A physical examination revealed no elevation in the bilateral renal or suprapubic region. The bladder was located below the pubic bone and was non- tender without pressure. Auscultation revealed no abnormalities in the right or left renal regions. The left scrotum was enlarged with a palpable mass measuring 25 × 15 cm in size. The mass was characterized by a tough, smooth surface with a clear boundary. The left testis was not palpable and the transillumination test result was negative. Magnetic resonance imaging included an abnormal signal in the scrotum, which was consistent with a space-occupying germ cell tumor but other diagnoses could not be ruled out. The preoperative preparation indicated no contraindications to surgery. Under lumbar anesthesia, the left scrotal lesion was resected. The postoperative pathologic evaluation confirmed an AMF. Currently, the patient has recovered fully without complications. Conclusion A large-sized AMF is relatively rare in the male scrotum, but reported in this case. A scrotal AMF often has an oval shape with no palpable pain. Imaging techniques can facilitate the hypervascular status of an AMF and pathologic findings can establish the diagnosis. However, reports of scrotal AMF are limited. A more thorough understanding should be achieved with additional cases and long-term follow-up.

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.

KAT6B sequence variants have been identified previously in both patients with the Say-Barber-Biesecker type of blepharophimosis mental retardation syndromes (SBBS) and in the more severe genitopatellar syndrome (GPS). We report on the findings in a previously unreported group of 57 individuals with suggestive features of SBBS or GPS. Likely causative variants have been identified in 34/57 patients and were commonly located in the terminal exons of KAT6B. Of those where parental samples could be tested, all occurred de novo. Thirty out of thirty-four had truncating variants, one had a missense variant and the remaining three had the same synonymous change predicted to affect splicing. Variants in GPS tended to occur more proximally to those in SBBS patients, and genotype/phenotype analysis demonstrated significant clinical overlap between SBBS and GPS. The de novo synonymous change seen in three patients with features of SBBS occurred more proximally in exon 16. Statistical analysis of clinical features demonstrated that KAT6B variant-positive patients were more likely to display hypotonia, feeding difficulties, long thumbs/great toes and dental, thyroid and patella abnormalities than KAT6B variant-negative patients. The few reported patients with KAT6B haploinsufficiency had a much milder phenotype, though with some features overlapping those of SBBS. We report the findings in a previously unreported patient with a deletion of the KAT6B gene to further delineate the haploinsufficiency phenotype. The molecular mechanisms giving rise to the SBBS and GPS phenotypes are discussed.

Myxofibrosarcoma of the spermatic cord is a rare form of para-testicular tumor that usually presents with painless scrotal or inguinal swelling. Ultrasonography revealed a solid mass in the scrotum, suggesting a para-testicular tumor, and exploration via a high inguinal incision revealed a large para-testicular mass. Finally, a pathologic examination revealed a low-grade sarcoma favoring myxoid fibrosarcoma. Here, we present the first reported case of myxofibrosarcoma of the spermatic cord in Ethiopia in a 54-year-old male patient and reviewed the available literature on the topic.

Extramammary Paget disease (EMPD) is a rare malignant neoplasm arising in apocrine gland-rich skin, which may be classified as either of primary or secondary origin. Management of this condition is predominantly surgical, and is often characterised by lengthy diagnostic delays. Complete surgical excision is challenging, and local recurrence is common. Herein, we discuss a subtle presentation of recurrent scrotal EMPD in a 77-year-old male and review the available literature. Although relatively rare, the indistinct nature of this pathology merits special attention from treating surgeons, who are frequently responsible for initial management and follow-up. The risk of distant metastasis and concomitant prognostic implications necessitate a high clinical index of suspicion, and low threshold for definitive biopsy in similar cases.

We describe a patient who presented with scrotal swelling followed by non-healing and discharging scrotal sinuses, following local trauma and was initially suspected to have an infected scrotal hematoma. An evaluation revealed it to be scrotal tuberculosis. He also complained of upper abdominal pain and on transabdominal ultrasonography was detected to have a mass in the head of the pancreas. Evaluation of the pancreatic mass revealed it to be pancreatic tuberculosis. Both lesions responded well to anti-tubercular therapy. This is an unusual case of two rare sites of extrapulmonary tuberculosis presenting simultaneously in the same individual. Care needs to be exercised while evaluating any non-healing ulcers or sinuses and mass lesions in countries endemic for tuberculosis as this disease can be a great masquerader.

Background Testicular descent is a physiological process regulated by many factors. Eventually, disturbances in the embryological/fetal development path facilitate the occurrence of scrotal hernia, a congenital malformation characterized by the presence of intestinal portions within the scrotal sac due to the abnormal expansion of the inguinal ring. In pigs, some genes have been related to this anomaly, but the genetic mechanisms involved remain unclear. This study aimed to investigate the expression profile of a set of genes potentially involved with the manifestation of scrotal hernia in the inguinal ring tissue. Methods and results Tissue samples from the inguinal ring/canal of normal and scrotal hernia-affected male pigs with approximately 30 days of age were used. Relative expression analysis was performed using qPCR to confirm the expression profile of 17 candidate genes previously identified in an RNA-Seq study. Among them, the Myosin heavy chain 1 ( MYH1 ), Desmin ( DES ), and Troponin 1 ( TNNI1 ) genes were differentially expressed between groups and had reduced levels of expression in the affected animals. These genes encode proteins involved in the formation of muscle tissue, which seems to be important for increasing the resistance of the inguinal ring to the abdominal pressure, which is essential to avoid the occurrence of scrotal hernia. Conclusions The downregulation of muscular candidate genes in the inguinal tissue clarifies the genetic mechanisms involved with this anomaly in its primary site, providing useful information for developing strategies to control this malformation in pigs and other mammals.