Testicular torsion

Case contributed by A.Prof Frank Gaillard

Presentation

20 year old male with acute scrotal pain

Patient Data

Age: 20
Gender: Male
Modality: Ultrasound

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Case Discussion

Ultrasound of the testes demonstrates the right testis to be enlarged, heterogeneous in echotexture, with without evidence of any blood flow. 

Features are consistent with testicular torsion

Pathology 

Macroscopic appearance

Specimen container  labelled 'right  testicle'. The  specimen consists of a  testis 45x30x30mm with  attached epididymis 40x15x15mm, and spermatic cord with adjacent soft tissue 15x15mm. There is an intact tunica vaginalis with an underlying, diffusely congested  tunica albuginea.  Sectioning reveals a completely infarcted testicular and  epididymal parenchyma with a diffusely haemorrhagic and congested  dusky red cut surface.  No discrete lesions are identified.

 Microscopic appearance

Sections of testis show extensive,  variable interstitial congestion.  Many  of the seminiferous  tubules have  preservation of  architecture and appear viable with active  spermatogenesis, but in areas  the seminiferous tubules appear necrotic.  There  are numerous ectatic,  thin-walled vascular spaces external to the testicular capsule in  the vicinity of the epididymis, with features suspicious for a varicocoele.  The spermatic cord resection margin is unremarkable and includes a normal vas deferens and some congested blood vessels.   There is no  evidence of  malignancy or  intratubular  germ cell neoplasia.

 Final diagnosis

Right testis -  testicular infarction,  consistent with  recent torsion and possible varicocoele.

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Case Information

rID: 10958
Case created: 4th Oct 2010
Last edited: 17th Nov 2015
System: Urogenital
Inclusion in quiz mode: Included

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