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We present a case of a 27-year-old man who referred to the Emergency Department complaining scrotal pain. He mentioned a sharp penetrating scrotal trauma occurred at work. Clinical examination showed mild scrotal tenderness. The patient underwent scrotal ultrasound that showed only a suspicious foreign body in the tunica vaginalis. A scrotal surgical exploration was performed and a nail was confirmed at the level of the tunica vaginalis.

Spermatocytic seminoma is a relatively rare testicular tumor and is characterized by a good prognosis. The discovery of a sarcomatous contingent modifies the prognosis of the indolent neoplasm. Only 20 cases being reported in English literature. We present the case of a 66-year-old man with a two-year history of left-sided scrotal pain and swelling. Tumor markers were normal. Ultrasound demonstrated a very large solid-cystic testicular mass. Orchidectomy was performed. Further imaging investigations revealed lung, vertebra, and retroperitoneal lymph node metastases. Histological examination and immunohistochemistry of the orchidectomy specimen concluded on spermatocytic seminoma associated with undifferentiated sarcoma component.

Segmental testicular infarction is a rare condition. Patients present with clinical features similar to torsion and testicular tumors, with most undergoing surgery. A 55-year-old male patient presented with left scrotal pain. We did a Doppler ultrasonogram and magnetic resonance imaging to diagnose his condition and rule out testicular torsion and tumor. We decided not to operate and asked the patient for follow-up. There was no pain in the left testis, and magnetic resonance imaging showed a reduction in the left testicular lesion after 4 months.

Objective: To evaluate the features of testicular torsion presenting with acute abdominal pain and to raise awareness of testicular torsion with specific symptoms. Methods: From October 2005 to June 2016, nine patients with testicular torsion who presented with isolated acute abdominal pain rather than scrotal pain as their primary symptom were retrospectively reviewed. Data, including the age of patients, season at admission, initial medical history, external genital examination, emergency ultrasound findings, operative findings, duration of abdominal pain, complications, and follow-up results, were collected. Results: The average age of patients was 14 years (range 10–17 years). Seven patients whose genitals were not initially examined externally were misdiagnosed as having ordinary abdominal diseases. Surgical exploration revealed that all the involved testes necrotized, and orchidectomy was performed. In the other two patients, scrotal and testicular abnormalities were detected immediately on admission, and emergency surgical exploration determined that the involved testis remained vital, so orchiopexy was performed. The mean duration from symptom onset to diagnosis was 4 h (3–5 h) in the orchiopexy group and 37 h (18–72 h) in the orchidectomy group. Six patients were psychologically affected during postoperative follow-up. Neither recurrence of testicular torsion nor testicular atrophy was recorded. Conclusion: Acute abdominal pain can be the initial and sole symptom of testicular torsion in young males. Physicians should pay close attention to the specific clinical presentation of testicular torsion. Keywords: Acute abdominal pain, Testicular torsion, Young males, Initial symptom, Retrospective analysis

Colorectal cancer is one of the most common cancers in the developed countries, and colon cancer is well documented. However, it is very rare for a primary colon cancer to exist in a scrotal hernia, and even rarer for the scrotal hernia to perforate. Here, we describe an unusual case where a 75-year-old patient with a colon tumor that perforated in a scrotal hernia. The teaching point is to highlight the computed tomography scan imaging characteristics of this rare finding in patients with both abdominal and scrotal pain. Keywords: Colon cancer, Scrotal hernia, CT

A 72 -year- old male patient presented to the clinic complaining of mild dragging scrotal pain and hanging scrotum interfering with his daily activity. Clinical examination revealed grade three left varicocele, enlarged hanging scrotum for more than 15 cm from the scrotal neck. The scrotum was explored and left varicocelectomy was done then scrotoplasty. Fifteen months post-operatively patient has an excellent outcome.

We describe a case of a 56 year-old male who presented to the hospital with pneumonia and bacteremia secondary to Streptococcus pneumoniae. After admission and initiation of appropriate antibacterial therapy he began to complain of scrotal pain. Ultrasound of the testes confirmed findings of left-sided epididymitis. Urine culture, urine gonorrhea and chlamydia nucleic acid amplification and HIV testing were negative. Clinical picture suggested seeding of the epididymis with Streptococcus pneumoniae and resulting infection.

Staphylococcus lugdunensis, originally identified in 1988, is a coagulase negative staphylococcus (CNS) that has become a significant human pathogen. It has been found as a source of skin and soft tissue infection, endocarditis, urogenital tract infection, joint infection, and meningeal infection. Rarely, it manifests as scrotal infections or complications. Correct identification of the bacterial organism and prompt treatment is crucial in these cases, as delayed intervention can lead to complications requiring orchiectomy. We describe a rare case of a young male who presented with scrotal pain and swelling and was found to have epididymo-orchitis with scrotal pyocele on imaging. He underwent scrotal exploration with incision and drainage and did not require an orchiectomy. Wound cultures grew S. lugdunensis, and the patient clinically improved after being treated with appropriate antibiotics. To our knowledge, this is the first reported case of scrotal abscess and epididymo-orchitis with pyocele formation caused by S. lugdunensis.

The leading cause of scrotal pain in the geriatric population is epididymitis. Testicular torsion is rare in adult men. This case report of an 82-year old man with acute scrotum represents the second oldest patient reported in published studies. Due to the long delay between the onset of clinical symptoms and surgical exploration, the testicular infarction with necrosis and orchiectomy ultimately occurred. The diagnosis of testicular torsion in the geriatric population is often delayed and lacks awareness for the diagnosis.

Testicular abscess is a rare disease, compared with other inflammatory diseases in the scrotum such as orchitis and epididymitis.1,2 It leads to severe inflammation of the scrotum and the whole body and is characterized by sustained fever and strong scrotal pain. We report an interesting case of scrotal abscess suspected as intrascrotal liposarcoma on image examination because of poor inflammatory findings.

Acute scrotal pain is a common urological emergency where clinical judgement plays pivotal role in making the diagnosis. Scrotal pain secondary to spontaneous pampiniform plexus thrombosis is rare, and we are the first who report in the Asian region.A 50-year-old gentleman presented with left-sided scrotal pain & swelling. The diagnosis of pampiniform plexus thrombosis was confirmed by the ultrasound Doppler. He was treated with anticoagulant and good clinical result was obtained.Uncomplicated thrombosis could be managed non-surgically with good clinical outcome and radiological resolution. Ultrasound doppler remains first-line investigation to establish diagnosis, monitor the progression and treatment outcome. Keywords: Scrotal pain, Pampiniform plexus thrombosis, Ultrasound Doppler, Anticoagulant

Fournier's gangrene is rapidly progressive necrotizing fasciitis that mainly affects the male perineum. Despite the advancement in surgical intervention, Fournier's gangrene carries high rates of mortality. Here, we present a 51-year-old male with hypertension and history of alcohol abuse presented to the emergency department with scrotal pain and swelling for a one-week period without preceding trauma to perineal area. He underwent emergent surgical debridement for and extensive necrotizing fasciitis. Early initiation of antibiotics, surgical intervention and good wound care postoperatively were cornerstone in his recovery. Keywords: Fournier's gangrene, Male urogenital diseases, Necrotizing fascitis

Adenomatoid tumors (ATs) are rare benign neoplasms that typically occur in the male and female genital tract. In men, the most common site of ATs is the epididymis and other paratesticular locations (tunica albuginea, spermatic cord, and ejaculatory ducts). However, intratesticular AT is exceedingly rare and may mimic a malignant neoplasm. We report a case of an AT occurring in a 27-year-old man with no prior medical, urologic or trauma history, who presented with right-sided scrotal pain of a few days' duration. Physical examination showed no skin change in the scrotum, a normal-sized, nontender left testis and an enlarged, tender right testis. Ultrasound images of the scrotum showed an eccentric, predominantly hypoechoic vascular mass in the posterior aspect of the right testis measuring 2.2×2.1×2.1cm. Tumor markers were within normal limits. His workup was negative for metastatic disease. A right radical orchiectomy was performed. Histological examination and immunohistochemical stains confirmed the diagnosis of adenomatoid tumor confined to the right testis. We report this rare, benign neoplasm of mesothelial origin that more often occurs in a paratesticular location, but rarely has been shown to involve the testicular parenchyma.

Idiopathic nephrotic syndrome (INS) is a kidney disease characterized by massive proteinuria. Protein loss leads to decreased oncotic pressure shifting the fluids into the interstitial space causing edema, complications such as infections and thromboembolism occur. We report a 7-year-old, diagnosed with NS presenting with a relapse. He developed ascites and scrotal edema followed by severe scrotal pain and redness, progressing rapidly to ecchymosis in the inguinal areas not in continuity with the scrotum. Ultrasound with color Doppler was inconclusive, scrotal exploration was done along with skin incision in the inguinal areas and scrotum, which appeared to relieve the condition rapidly.

Varicocele is an abnormal dilation of the pampiniform venous plexus in the spermatic cord, occurring in 15% of men. Varicocele has a higher prevalence in men with primary and secondary infertility, ~ 35% and 75% respectively. Evaluation of a suspected varicocele includes history, physical examination and lab testing. Suggested causes of varicocele include valve incompetence, angle of insertion of the left gonadal vein into the renal vein or external compression of the gonadal vein. Varicocele can be associated with abnormal semen parameters and scrotal pain. These effects are thought to be due to increased temperature, venous pooling, accumulation of oxidative species and altered cell function.

A 34-year-old man who presented with right scrotal pain, and who on subsequent ultrasound examination, was found to have an intratesticular hypoechoic mass. Based on the ultrasound appearance of this mass, a malignant germ cell tumor was thought to be the most likely diagnosis. Preoperative serum tumor markers, including lactate dehydrogenase, alpha-1-fetoprotein, and beta-human chorionic gonadotropin, were negative. Computed tomography imaging of the chest, the abdomen, and the pelvis revealed no evidence of metastasis. The patient underwent right orchiectomy, and final pathology demonstrated a benign hemangioma.