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A 12-month-old boy presented with left scrotal swelling. The mass was irregular, soft, fleshy, and nontender. It adhered to the scrotal skin and gradually enlarged. Operative findings revealed a mass fixed to the scrotal fundus and diagnosed as angiomyolipoma. This is apparently the first report of scrotal angiomyolipoma in infancy.

On 99 testes of corpses (death had occurred between 26 und 86 years) comparative volumetry was done. In the left surrounding capsules (without scrotal skin and tunica dartos) the testes were measured via real time sonography in a waterbath (7.5 MHz linear-scan), afterwards length, breadth and height were measured by a sliding calibre, the largest diameter (the length) of the testis was determined by Schirren's circle and finally the size of the testis was measured via Prader's orchidometer. After all the testes were surgically exposed, their volume (by litres) was determined according to Archimedes' principle. As for the Archimedes' principle a random mean error of 7% must be accepted, sonographic determination of the volume showed a random mean error of 15%. Whereas the accuracy of measurement increases with increasing volumes, both methods should be used with caution if the volumes are below 4 ml, since the possibilities of error are rather great. According to Prader's orchidometer the measured volumes on average were higher (+ 27%) with a random mean error of 19.5%. With Schirren's circle the obtained mean value was even higher (+ 52%) in comparison to the "real" volume by Archimedes' principle with a random mean error of 19%. The measurements of the testes in the left capsules by sliding calibre can be optimized, if one applies a correcting factor f (sliding calibre) = 0.39 for calculation of the testis volume corresponding to an ellipsoid. Here you will get the same mean value as in Archimedes' principle with a standard mean error of only 9%. If one applies the correction factor of real time sonography of testis f (sono) = 0.65 the mean value of sliding calibre measurements would be 68.8% too high with a standard mean error of 20.3%. For measurements via sliding calibre the calculation of the testis volume corresponding to an ellipsoid one should apply the smaller factor f (sliding calibre) = 0.39, because in this way the left capsules of testis and the epididymis are considered.

A variety of neoplasms derived from mesechymal elements may arise on the tunica dartos, the tunica albuginea or, more rarely, within the testis or the epididymis. The authors report a case of leiomyoma of the scrotum in a 33-year-old man. This rare and benign tumour is localized in the tunica dartos in 8% of cases. The positive diagnosis is based on histological examination after conservative treatment by local excision which gives excellent results.

Experimental evidence suggests that transparenchymal suture fixation may risk testicular damage. Even very small sutures can result in inflammation and tubular damage. An alternative to transparenchymal suture fixation of the testis is presented.

Six dartos musculocutaneous flaps have been used to resurface proximal penile defects. The vascular anatomy of the flap, surgical technique and complications are described in detail.

Leiomyoma may originate at any anatomic location of smooth muscle in the genitourinary system. The kidney capsule is the most common site for the genitourinary leiomyomas. Leiomyoma origination from the scrotum is rare. The previous reported cases presented as small, firm, nontender, slowly enlarging freely movable masses within the scrotum. We report a case of leiomyoma of the tunica dartos, a benign lesion arising from the wall of the left scrotum. It presented as a pedunculated lesion with a surface ulceration, which need to be differentiated from squamous carcinoma of the scrotum. It was treated with a simple surgical excision.

Leiomyoma is a benign tumor derived from smooth muscle. Leiomyoma of the scrotum arising from the tunica dartos is exceedingly rare. We describe the case of a 51-year-old Japanese man with this disease entity.

We report a case of acquired smooth muscle hamartoma (ASMH) of tunica dartos, believed to be only the fifth so far reported. A 24-year-old man had a 6-month history of an asymptomatic tight and thickened scrotum. The skin was difficult to pinch. A biopsy specimen from the skin showed increased and proliferated smooth-muscle bundles composed of well-differentiated and uniform spindle cells that showed typical features of acquired smooth muscle hamartoma. Interestingly, dilatations of the lymph vessels were noted in the upper dermis above the proliferated smooth muscles. It has been reported recently that long-standing severe lymphoedema may cause histological features mimicking ASMH. As the present case was not preceded by oedema of the scrotum, we consider this case to be true ASMH.

Scrotal leiomyomas of the tunica dartos are extremely rare and usually misdiagnosed. A case of a pedunculated mass observed expectantly over thirty years demonstrates the benign oncologic natural history of this lesion despite its capability for substantial growth. Only limited local surgical management of such lesions is indicated.

Scrotal leiomyomas with atypical bizarre nuclei are rare, which might be misdiagnosed as malignant tumor. We describe a case of scrotal bizarre leiomyoma in a 65-yr-old man. The tumor was a 1 cm-sized, well circumscribed, oval mass arising from the tunica dartos muscle. Histologically, it was formed by whorling bundles of fusiform cells with occasional atypical, pleomorphic nuclei and pseudo-inclusions. Mitosis was not found. Although morphologically atypical, scrotal bizarre leiomyomas take on a biologic behavior not different from that of conventional leiomyoma, they should be distinguished from leiomyosarcoma to avoid unnecessary treatment.

Of 127 patients with primary neoplasms of the scrotal wall 10 had a solitary leiomyoma arising from the tunica dartos. These benign asymptomatic lesions occur in middle-age white men and are often incorrectly diagnosed. Simple surgical excision is curative. The 11th case is described because of the malignant course that followed irradiation. A cell arising from single smooth muscle cells within the corium is proposed as the cell of origin.

A case of leiomyoma of the tunica dartos, a benign lesion arising from the wall of the scrotum and not attached to the epididymis, testicular tunics, or adjacent structures, is presented.

Leiomyomas arising from the tunica dartos scroti are rare tumors. We report the first case of bilateral leiomyomas of the scrotum.