Acute scrotal pain.
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Ultrasound of the testes demonstrates the right testis to be enlarged, heterogeneous in echotexture, and without evidence of any blood flow. Features are consistent with testicular torsion.
The patient went on to have an orchiectomy.
Macroscopic appearance: The specimen consists of a testis 45 x 30 x 30 mm with attached epididymis and spermatic cord. 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 hemorrhagic 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 varicocele.
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: testicular infarction, consistent with recent torsion and possible varicocele.