A 47-year-old male presented with progressive abdominal pain for 1 month. Imaging of the scrotum and testes is discussed. The document outlines anatomy, imaging modalities including ultrasound, MRI and CT. Common pathologies are discussed such as testicular masses including different types of cancers like seminoma, embryonal carcinoma, yolk sac tumor, teratoma and choriocarcinoma. Staging and tumor markers are also mentioned.
This document provides an overview of imaging techniques used to evaluate the large bowel and various pathologies that can affect it. It discusses anatomy, investigations like barium enema and CT colonography. Conditions covered include large bowel obstruction, colorectal tumors like polyps and adenomas, and polyposis syndromes. Imaging findings for various lesions are presented along with descriptions of features seen on barium enema, CT, and colonoscopy.
Ultrasound of the urinary tract - Renal infectionsSamir Haffar
Ultrasound can detect various renal infections including:
1) Acute pyelonephritis seen as renal enlargement, decreased echogenicity, and loss of corticomedullary differentiation on ultrasound.
2) Renal abscesses appear as hypoechoic masses with thick irregular walls that increase in distinctness over time.
3) Pyohydronephrosis is infection of the obstructed collecting system seen as echogenic debris and fluid-fluid levels.
4) Emphysematous pyelonephritis involves gas in the renal parenchyma seen as high amplitude echoes and dirty shadowing.
Anorectal malformations (ARMs) are congenital anomalies involving the distal anus and rectum. ARMs can involve the urinary and genital tracts in many cases and the spine is often involved as well. ARMs occur due to abnormalities in the development of the embryonic cloaca. Imaging studies like ultrasound and MRI are important for evaluating ARMs and any associated anomalies. Pelvic floor musculature anatomy is key to understanding ARMs and their surgical treatment.
The document discusses primary retroperitoneal neoplasms. It notes that 70-80% of primary retroperitoneal neoplasms are malignant in nature. The retroperitoneum contains mesodermal neoplasms, neurogenic tumors, germ cell and sex cord tumors, and lymphoid neoplasms. The most common primary retroperitoneal sarcomas are liposarcoma, leiomyosarcoma, and malignant fibrous histiocytoma. Neurogenic tumors such as schwannomas and neurofibromas are usually benign and occur in a younger age group. Teratomas are germ cell tumors that may contain fat, calcium, or sebum levels on imaging.
This document provides an overview of ultrasound for evaluating hernias. It describes the anatomy of the inguinal region and sites of common hernias. Inguinal hernias can be indirect or direct. Spigelian hernias occur along the spigelian fascia. Femoral hernias are located in the femoral canal. Linea alba hernias occur through the abdominal wall. Umbilical and incisional hernias also are reviewed. Ultrasound is useful for diagnosing hernia contents and complications like incarceration, obstruction, and strangulation. Findings suggestive of strangulation include hyperechoic fat, thickened sac walls, fluid within the sac, and
This document discusses imaging of the pancreas. Ultrasound and CT scan are the primary modalities used. Ultrasound is useful as a screening tool due to its availability, low cost and lack of radiation. CT scan is the gold standard modality as it can accurately detect pancreatic abnormalities and complications. MRCP and MRI provide additional information and are used as problem-solving tools. The document reviews imaging features of various pancreatic pathologies such as acute pancreatitis, chronic pancreatitis, tumors and trauma.
This document provides an overview of ultrasonography in hepatobiliary diseases. It begins with basic knowledge about ultrasound waves and transducers. It then discusses how to evaluate the liver, including size, focal lesions, diffuse diseases, vasculature, and biliary radicles. Specific conditions like portal hypertension and bile duct obstruction are also addressed. The aim is to provide tips and tricks for ultrasonography of the liver and biliary system.
This document provides an overview of scrotal ultrasound techniques and findings. It describes the anatomy seen on ultrasound and Doppler evaluation of the testes and epididymis. Common pathologies are discussed such as epididymitis, torsion, trauma, varicoceles, hydroceles, and germ cell tumors. Scanning protocols and minimum images required are outlined. Findings associated with different conditions like torsion and tumors are also detailed.
Presentation1.pptx, ultrasound examination of the urinary bladder and prostate.Abdellah Nazeer
This document provides information on ultrasound examination of the urinary bladder and prostate. It begins with descriptions of normal ultrasound images of the bladder and prostate. It then discusses the role of ultrasound in assessing these structures. Common pathologies that can be identified include trabeculation, diverticula, calculi, ureterocele, infections, and cancers. Scanning techniques for bladder and prostate ultrasound are outlined. The document concludes with ultrasound images demonstrating various normal and abnormal findings of the bladder and prostate.
The pancreas normally has a head, body, tail, and uncinate process. It develops from two anlagen that fuse during embryological development. The pancreatic duct typically drains the entire pancreas. Acute pancreatitis is diagnosed based on abdominal pain, elevated pancreatic enzymes, and imaging findings of pancreatic swelling, decreased echogenicity, and heterogeneity. Sonography can detect pancreatic enlargement, duct dilation, peripancreatic fluid collections, and decreased echogenicity in acute pancreatitis.
The document provides information on performing and interpreting an ultrasound of the liver. It discusses normal liver anatomy and Doppler assessments of the hepatic vessels. Key findings of a normal liver ultrasound include evaluating the size, shape, echogenicity and echotexture of the liver. Doppler ultrasound can assess blood flow in the hepatic arteries, portal veins and hepatic veins which branch throughout the liver and should demonstrate continuous flow in the expected directions. Spectral analysis of waveforms can help identify abnormalities associated with conditions like portal hypertension.
Presentation1.pptx, radilogical imaging of ovarian lesions.Abdellah Nazeer
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is a common complication of sexually transmitted diseases. It can cause long-term issues like chronic pelvic pain, infertility, and ectopic pregnancy due to scarring and adhesions. PID includes conditions like endometritis, salpingitis, and tubo-ovarian abscess. Prompt diagnosis and treatment are important to prevent life-threatening complications due to the varied presentation and sometimes difficultly in detection of PID. Radiological imaging can help identify signs of PID and related conditions like tubo-ovarian abscesses.
Presentation1.pptx, radiological imaging of scrotal diseases.Abdellah Nazeer
This document provides an overview of radiological imaging of scrotal diseases. It begins with the anatomy of the scrotum and its layers. It then discusses congenital diseases like cryptorchidism, which is the absence of one or both testes from the scrotum. Cryptorchidism can occur if the testes fail to descend from the abdomen into the scrotum. The document presents various imaging examples of cryptorchidism showing undescended testes in the inguinal canal or abdomen. It also discusses inflammatory diseases, trauma, testicular torsion, masses, and other pathologies that can be imaged and evaluated radiologically.
The document discusses the radiological anatomy of the scrotum, including normal gross anatomy, radiological anatomy using ultrasound and MRI, and various disorders. It covers the embryology of the scrotum and provides details on ultrasound assessment of the testis and epididymis, noting that testicular echogenicity and vascularity can help identify disorders. The role of ultrasound in testicular and scrotal trauma is also examined, alongside extratesticular scrotal masses. Diagrams and images are included to illustrate anatomical structures and various conditions.
Ultrasound is used to map the internal structures of the breast using high-frequency sound waves. While it cannot replace mammography for screening, ultrasound can detect cancers not seen on mammograms, particularly in dense breasts. Benign lesions usually appear smooth, well-circumscribed, and hypoechoic or isoechoic compared to breast tissue. Malignant lesions tend to be irregularly shaped, hypoechoic, with angular margins and posterior shadowing. Ultrasound criteria help characterize breast abnormalities detected on other imaging as benign or warranting biopsy.
This document provides a summary of kidney anatomy and ultrasound appearance in 3 paragraphs:
The kidneys have a complex internal architecture visible on ultrasound, including echogenic renal sinuses containing vessels and collecting systems. Each kidney contains lobes with a medullary pyramid, cortex, and vessels. In adults there are typically 11 pyramids and 9 calices. The kidneys have a slightly ovoid shape viewed longitudinally from the front or back. Normal kidney size varies by individual but is around 10.5-11cm on average.
Ultrasound is used to image the kidneys using curvilinear probes from various approaches. The native kidneys are best seen from the back using adjacent organs as an acoustic window.
Ultrasound is useful for evaluating adnexal masses to determine if they are physiologic cysts, benign tumors, or malignant. Features like size, contents, walls, and blood flow help characterize masses. For example, dermoid cysts appear mixed and contain shadows, while endometriomas look ground glass. Scoring systems combine ultrasound findings with clinical factors to estimate cancer risk and guide management decisions between observation and surgery. Precise terminology and standardized exams are important for accurate assessment and diagnosis of adnexal lesions.
Multilocular cystic nephroma is a rare, benign kidney tumor that appears as a well-defined, multicystic mass. It contains multiple noncommunicating fluid-filled cysts separated by fibrous septa and surrounded by a thick, fibrous capsule. Imaging such as CT, MRI, and ultrasound are useful in characterizing the multicystic structure and delineating the tumor from normal kidney tissue. The cysts have slightly higher density than water on CT and appear as high signal intensity areas separated by low signal intensity septa on MRI.
Presentation1.pptx, imaging of the lower urnary systemAbdellah Nazeer
This document summarizes imaging techniques used to evaluate the lower urinary tract, including the urinary bladder and urethra. It discusses anatomy, common abnormalities like tumors, infections, and injuries. A variety of imaging modalities are used including ultrasound, CT, MRI, retrograde urethrography and cystography. Common pathologies addressed include bladder cancer, tumors, infections, fistulas, urethral strictures, injuries, and diverticula. Imaging findings for many examples are provided through labeled images.
This document discusses ovarian tumours, including their epidemiology, embryology, risk factors, classification, staging, pathology, screening, management, and various treatment options. It addresses how ovarian cancer accounts for nearly 4% of cancers in women and is a leading cause of death from female genital tract malignancies. Various types of ovarian tumours are described, such as epithelial tumours including serous, mucinous and endometrioid tumours, as well as sex cord-stromal tumours and germ cell tumours. Risk factors, prevention strategies, and challenges with screening for early detection are also summarized.
This document provides an overview of breast anatomy, development, hormones, cancer epidemiology, risk factors, diagnosis, staging, pathology, and management. It discusses the following:
- Breast anatomy and development in relation to hormones like estrogen and progesterone.
- Breast cancer is the most commonly diagnosed cancer in women worldwide, with incidence rates increasing rapidly between ages 30-50.
- Risk factors include genetic, hormonal, dietary, and environmental factors.
- Diagnosis involves physical examination, mammography, and biopsies. Staging uses the TNM system to classify cancer extent and severity.
- Management depends on cancer type and stage, and may include surgery, radiation, chemotherapy, hormone therapy,
This document discusses endometriosis, defined as the presence of functioning endometrial tissue outside the uterus. It most commonly involves the ovaries and pelvic peritoneum. Theories for its development include retrograde menstruation and celomic metaplasia. Symptoms include pelvic pain and infertility. Diagnosis involves laparoscopy and histological examination of biopsied lesions. Staging uses the revised American Fertility Society classification from I to IV. Treatment aims to manage pain and preserve fertility, and may involve surgery, medical therapy such as hormonal contraceptives, or assisted reproduction.
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshRajesh Sinwer
This document discusses testicular tumors, including:
- Germ cell tumors are the most common type, comprising 95% of cases. Seminomas and non-seminomatous germ cell tumors are the main subtypes.
- Important biomarkers for testicular cancer include AFP, HCG, LDH, and PLAP. Elevated levels can indicate the presence of a non-seminoma.
- Staging is important and is based on whether the cancer is confined to the testis or has spread to lymph nodes or other organs. Spread beyond the retroperitoneum is considered stage III.
- Diagnostic workup involves imaging like ultrasound, CT, MRI and PET scans
This document discusses malignant disorders of the esophagus, specifically esophageal cancer. It provides details on the two main types - squamous cell carcinoma and adenocarcinoma. Squamous cell carcinoma is still more common worldwide, while adenocarcinoma is becoming more prevalent in the US and Europe. Risk factors include tobacco and alcohol consumption as well as conditions like Barrett's esophagus. Symptoms typically include dysphagia and weight loss. Diagnosis involves endoscopy with biopsy as well as imaging studies like CT and PET scans to stage the cancer.
This document discusses benign tumors of the ovaries and fallopian tubes. It describes various types of functional cysts such as follicular cysts, lutein cysts, and theca-lutein cysts. It also discusses inflammatory conditions, metaplastic conditions like endometriosis, and various neoplastic tumors including epithelial, sex cord-stromal, and germ cell tumors. Diagnosis and management are discussed for different types of ovarian tumors based on factors like size, symptoms, and patient's desire for future fertility. Surgical exploration and microscopic examination are usually needed for definitive diagnosis and treatment.
This document discusses benign tumors of the ovaries and fallopian tubes. It describes different types of functional and non-functional ovarian cysts such as follicular cysts, lutein cysts, and theca-lutein cysts. It also discusses epithelial, sex cord-stromal, and germ cell ovarian neoplasms. The diagnosis, management, and treatment options for different benign ovarian tumors are provided depending on factors like the patient's age and desire for future fertility. Surgical exploration including cystectomy or salpingo-oophorectomy may be used for treatment.
Vaginal cancer is a rare malignancy representing 1-2% of gynecologic cancers. Most cases are metastatic from cervical or endometrial cancer. Risk factors include HPV infection and prior pelvic radiation. Symptoms include abnormal bleeding and discharge. Diagnosis involves biopsy of any suspicious lesions. Treatment typically involves radiation therapy, with surgery reserved for early stage or recurrent disease. Prognosis depends on stage, with 5-year survival rates of 70-80% for stage I but dropping to 0% for stage IV disease. Recurrence rates after radiation range from 10-45% depending on stage.
A pelvic mass of ovarian or adnexal origin can have several potential causes including ovarian tumors, which can be benign cysts, physiological cysts, or malignant neoplasms. Other possible causes are adnexal masses such as endometriomas, hydrosalpinges, or tubo-ovarian abscesses. A thorough differential diagnosis and examination is required to determine the origin and characteristics of the pelvic mass.
The document discusses pathology of the cervix, including:
1. Benign diseases like inflammations (acute and chronic cervicitis), metaplasias, hyperplasias, and benign tumors like endocervical polyps and leiomyomas.
2. Precancerous lesions like squamous intraepithelial lesions and glandular intraepithelial lesions.
3. Cancerous tumors including invasive carcinomas, mesynchymal tumors, mixed epithelial mesynchymal tumors, and other rare tumor types. Chronic cervicitis is most often caused by sexually transmitted pathogens like Chlamydia trachomatis and Neisseria gonorrhoeae. Squamous metaplasia and other
1) Tumors of the testis occur in 1-8 new cases per 100,000 males per year and are predominantly germ cell tumors.
2) Seminomas and non-seminomatous germ cell tumors are the most common types and survival rates have improved dramatically with treatment.
3) Evaluation involves medical history, physical exam, tumor markers, imaging, and surgical staging/pathology with treatment depending on tumor type and stage.
This document provides an overview of benign lesions of the ovary. It discusses non-neoplastic cysts and benign neoplastic tumors, including their clinical features, diagnosis, differential diagnosis, and management. The majority (80%) of ovarian tumors are benign, with the most common being functional cysts, dermoid cysts, and serous and mucinous cystadenomas. Benign ovarian lesions are generally diagnosed through clinical examination, ultrasound, and tumor markers. Surgical removal is often the treatment for symptomatic cysts or growing lesions.
This document discusses benign ovarian tumors, including functional ovarian cysts and benign neoplastic ovarian tumors. It describes the main types of functional cysts such as follicular, lutein and hemorrhagic cysts. It also outlines the main types of benign neoplastic ovarian tumors, including epithelial tumors, sex cord-stromal tumors, germ cell tumors and mixed tumors. The diagnosis, management and treatment options for different types of benign ovarian tumors are provided.
This document provides information about testicular tumors. It discusses that testicular cancer is most common in men aged 15-35 and has three peaks in incidence. The most common types are seminomas and non-seminomas. Risk factors include cryptorchidism, Klinefelter's syndrome, and trauma. Diagnosis involves physical exam, ultrasound, serum tumor markers, and radiology. Treatment depends on the type and stage but generally includes radical orchidectomy followed by chemotherapy, radiation, or surveillance. Prognosis is excellent even for metastatic disease due to chemosensitivity.
This document provides an overview of bladder cancer presented by Dr. Vikas Kumar. Some key points:
- Bladder cancer is the 9th most common cancer worldwide and the 13th most common cause of death. Risk factors include smoking, occupational exposures, infections, and genetic factors.
- At initial presentation, 80% of bladder cancers are non-muscle invasive. Staging involves evaluating the extent of primary tumor invasion and spread to lymph nodes and distant organs.
- Diagnosis involves cystoscopy, urine cytology, and imaging tests. Random bladder biopsies are also recommended to detect cancers that cannot be seen.
- For non-muscle invasive cancers, the main treatment is transure
This document summarizes premalignant lesions. It defines a premalignant lesion as one that is not itself malignant but has a greater probability of becoming so than normal tissue. Cancer evolves through a series of intermediate lesions with increasing premalignant potential. Examples of premalignant lesions discussed include hyperplasia, metaplasia, dysplasia, and carcinoma in situ. Specific examples of premalignant lesions in the cervix, endometrium, breast, and other organs are provided along with their characteristics, classifications, and risk of progression to invasive cancer.
This document discusses thyroid cancer, including its various types and treatment. It notes that thyroid cancer accounts for less than 1% of all cancers. The main types are differentiated (papillary and follicular) and undifferentiated (anaplastic and medullary) cancers. Risk factors include radiation exposure, genetic mutations, and autoimmune thyroiditis. Symptoms include a thyroid mass or enlarged lymph nodes in the neck. Treatment involves surgical resection of the thyroid and potentially lymph nodes, with total thyroidectomy performed for differentiated cancers. Prognostic factors help determine cancer risk and guide further treatment.
Urology gynecology anapath et imagerie c balleyguierJFIM
This document discusses how to assess benignity in rare ovarian tumors using imaging and pathology. It notes that imaging alone can nearly never determine benignity, except for some functional ovarian lesions, fibrous tumors, and mature teratomas. Pathology is nearly always needed to avoid misdiagnosis, especially for functional lesions. The document provides examples of imaging findings that suggest benignity for certain tumor types like ovarian fibromas and dermoid cysts. It also discusses imaging features that may indicate malignancy and provides examples of rare malignant ovarian tumors.
This document discusses bladder cancer including its background, epidemiology, risk factors, symptoms, diagnosis and imaging. Some key points:
- Bladder cancer incidence is rising in Western countries, with over 50,000 cases in the US and over 10,000 in Europe in 1996.
- Risk factors include exposure to aromatic amines (certain industrial jobs) and smoking. Symptoms often include hematuria but can also include urinary irritation.
- Diagnosis involves cystoscopy, transurethral resection of tumors, and imaging like CT, MRI and ultrasound to determine tumor stage, presence of metastases, and response to treatment. Over 90% of cases are transitional cell carcinoma.
A medical treatment that uses high doses of radiation to kill cancer cells or shrink tumors by damaging their DNA. When the DNA is damaged, cancer cells can no longer divide and grow, and they eventually die.
Genetic deletion of HVEM in a leukemia B cell line promotes a preferential in...MARIALUISADELROGONZL
Introduction: A high frequency of mutations affecting the gene encoding Herpes
Virus Entry Mediator (HVEM, TNFRSF14) is a common clinical finding in a wide
variety of human tumors, including those of hematological origin.
Methods: We have addressed how HVEM expression on A20 leukemia cells
influences tumor survival and its involvement in the modulation of the antitumor
immune responses in a parental into F1 mouse tumor model of hybrid
resistance by knocking-out HVEM expression. HVEM WT or HVEM KO leukemia
cells were then injected intravenously into semiallogeneic F1 recipients and the
extent of tumor dissemination was evaluated.
Results: The loss of HVEM expression on A20 leukemia cells led to a significant
increase of lymphoid and myeloid tumor cell infiltration curbing tumor
progression. NK cells and to a lesser extent NKT cells and monocytes were the
predominant innate populations contributing to the global increase of immune
infiltrates in HVEM KO tumors compared to that present in HVEM KO tumors. In
the overall increase of the adaptive T cell immune infiltrates, the stem cell-like
PD-1- T cells progenitors and the effector T cell populations derived from them
were more prominently present than terminally differentiated PD-1+ T cells.
Conclusions: These results suggest that the PD-1- T cell subpopulation is likely
to be a more relevant contributor to tumor rejection than the PD-1+ T cell subpopulation. These findings highlight the role of co-inhibitory signals delivered
by HVEM upon engagement of BTLA on T cells and NK cells, placing HVEM/BTLA
interaction in the spotlight as a novel immune checkpoint for the reinforcement
of the anti-tumor responses in malignancies of hematopoietic origin.
Anthelmintics or antihelminthics are a group of antiparasitic drugs that expel parasitic worms and other internal parasites from the body by either stunning or killing them and without causing significant damage to the host. They may also be called vermifuges or vermicides
Hemodialysis: Chapter 10, AVF and AVG - Complications (Diagnosis and Manageme...NephroTube - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/akgMSyA06Qg
- Video recording of this lecture in Arabic language: https://youtu.be/HAR3QLj0Q5A
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
PICTURE TEST IN OBSTETRICS AND GYNAECOLOGY-Aloy Okechukwu Ugwu.pptxAloy Okechukwu Ugwu
This picture test will help medical students preparing for their final exams.
It will also be useful for resident doctors preparing for part 1 exam of National Postgraduate medical college of Nigeria and West African college of surgeons in Obstetrics and Gynaecology
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn J...rightmanforbloodline
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis, All Chapters 1 - 32 Full Complete.pdf
TEST BANK Physical Examination and Health Assessment 9th Edition by Carolyn Jarvis, All Chapters 1 - 32 Full Complete.pdf
Subcutaneous nodules in rheumatic diseases Ahmed Yehia Assistant Professor of internal Medicine, Immunology, rheumatology and allergy
How to use subcutaneous nodules as a clue for diagnosis by completing the puzzle
These lecture slides, by Dr Sidra Arshad, offer a comprehensive look into cardiac arrhythmias.
Learning objectives:
1. Summarise how an electrocardiogram is read
2. Discuss the electrocardiographic interpretation of:
3. Abnormal voltages of the QRS complex
4. Abnormal sinus rhythms
5. Heart blocks
6. Myocardial ischemia and infarction
7. Electrolytes abnormalities
8. Explain the following terms: reentry, and circus movement
9. Describe the electrical alteration in conduction responsible for fibrillation and flutter
10. Differentiate between fibrillation and flutter based on ECG findings
11. Describe the significance of defibrillation in emergency cardiac situations
Study Resources:
1. Chapter 12, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, https://geekymedics.com/how-to-read-an-ecg/
The impact of CD160 deficiency on alloreactive CD8 T cell responses and allog...MARIALUISADELROGONZL
CD160 is a member of the immunoglobulin superfamily with a pattern of expression
mainly restricted to cytotoxic cells. To assess the functional relevance of the HVEM/
CD160 signaling pathway in allogeneic cytotoxic responses, exon 2 of the CD160
gene was targeted by CRISPR/Cas9 to generate CD160 deficient mice. Next, we
evaluated the impact of CD160 deficiency in the course of an alloreactive
response. To that aim, parental donor WT (wild-type) or CD160 KO (knock-out) T
cells were adoptively transferred into non-irradiated semiallogeneic F1 recipients,
in which donor alloreactive CD160 KO CD4 T cells and CD8 T cells clonally
expanded less vigorously than in WT T cell counterparts. This differential proliferative
response rate at the early phase of T cell expansion influenced the course of CD8 T
cell differentiation and the composition of the effector T cell pool that led to a significant
decreased of the memory precursor effector cells (MPECs) / short-lived effector
cells (SLECs) ratio in CD160 KO CD8 T cells compared to WT CD8 T cells. Despite
these differences in T cell proliferation and differentiation, allogeneic MHC class I
mismatched (bm1) skin allograft survival in CD160 KO recipients was comparable
to that of WT recipients. However, the administration of CTLA-4.Ig showed an
enhanced survival trend of bm1 skin allografts in CD160 KO with respect to WT recipients.
Finally, CD160 deficient NK cells were as proficient as CD160 WT NK cells in
rejecting allogeneic cellular allografts or MHC class I deficient tumor cells. CD160
may represent a CD28 alternative costimulatory molecule for the modulation of
allogeneic CD8 T cell responses either in combination with costimulation blockade
or by direct targeting of alloreactive CD8 T cells that upregulate CD160 expression
in response to alloantigen stimulation
कायाकल्प क्लिनिक: पटना के अग्रणी सेक्सोलॉजिस्ट और स्किन केयर विशेषज्ञ
पटना का एक शानदार स्वास्थ्य सेवा प्रदाता, कायाकल्प क्लिनिक, आपके स्वास्थ्य और त्वचा की देखभाल में विशेषज्ञता प्रदान करता है। हमारे नवीनतम तकनीकी समाधानों और अनुभवी विशेषज्ञों के साथ, हम पुरुष और महिलाओं के स्वास्थ्य सम्बंधित मुद्दों को हल करते हैं। यहां पर हम प्रदान करते हैं:
Expert Treatment for Sex Issues at Kaya Kalp Clinic in Patna -best sexologist in patna
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Discover the Best Sexologist in Patna: Expert Care at Kayakalp Clinic
Kayakalp Clinic - Best Sexologist in Patna
Kayakalp Clinic - Best Sexologist in Patna
When it comes to sexual health, finding the right expert is essential for effective diagnosis and treatment. At Kayakalp Clinic in Patna, we pride ourselves on providing exceptional care for a wide range of sexual health issues. If you’re searching for the best sexologist in Patna, look no further. Our team of highly skilled professionals is here to help you navigate and resolve your concerns with confidentiality and compassion.
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Our sexologists are highly trained and experienced in dealing with various sexual health issues. They stay updated with the latest advancements in the field to provide the best care possible.
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An exciting session emphasizing the timely intervention and management of obstetric sepsis for better patient outcomes.
This presentation highlights risk factors, diagnosis, management, and some interesting cases of obstetric sepsis.
this presentation is all about vital force . this is the useful information for the students of homeopathy streamhyddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddddjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjjvgggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggggg .
Yoga talk & yoga slides by Flametree Yoga 11 July 2024.pdfStuart McGill
Yoga talk and yoga slides on the benefits of yoga and meditation, how it works, and how to get more very low cost yoga, or meditation, or both, in your life.
2024 07 12 Do you share my autistic traits_ - Google Sheets.pdfCarriePoppy
I made this spreadsheet when I was waiting for my autism assessment. It helped me determine that I probably have autism. When I did get tested, they (UCLA) told me I do, indeed, have Type 1 autism. You can use this spreadsheet to compare your experience to mine. I am a white woman, AFAB. My diagnosis is Type 1 autism with a pragmatic language deficit.
6. Scrotum - AnatomyScrotum - Anatomy
ScrotumScrotum
layers of fascia, muscle andlayers of fascia, muscle and
connective tissueconnective tissue
Tunica VaginalisTunica Vaginalis
– visceral and parietal layersvisceral and parietal layers
– potential space around thepotential space around the
testestestes
Tunica AlbugineaTunica Albuginea
– thick layer of fascia investingthick layer of fascia investing
the testesthe testes
– Along the posterior surface ofAlong the posterior surface of
the testis, the tunica albugineathe testis, the tunica albuginea
thickens to form thethickens to form the
mediastinummediastinum
– The mediastinum projectsThe mediastinum projects
inward into the testisinward into the testis
7. Testes –Testes –
Embryology andEmbryology and
AnatomyAnatomy
TestesTestes
– 2X3X5 cm2X3X5 cm
– mediastinummediastinum
contain rete testis - spermcontain rete testis - sperm
containing channelscontaining channels
– Appendix of testesAppendix of testes
Mullerian duct remnantMullerian duct remnant
EpididymisEpididymis
Attatched to posterolateral testisAttatched to posterolateral testis
head, body and tailhead, body and tail
Appendix of the head and tailAppendix of the head and tail
paradidymisparadidymis
Spermatic cordSpermatic cord
vas, artery, veins and lymphaticsvas, artery, veins and lymphatics
Note: testicular lymphatics drainNote: testicular lymphatics drain
to paraaortic; while scrotum toto paraaortic; while scrotum to
inguinalinguinal
8. Testes - HistologyTestes - Histology
Connective tissueConnective tissue frameworkframework
– tunica albugineatunica albuginea
– mediastinum testismediastinum testis
– septa which divide the organ into lobules.septa which divide the organ into lobules.
Within theWithin the lobulelobules, the seminiferouss, the seminiferous
tubules produce sperm. Thetubules produce sperm. The
seminiferous tubulesseminiferous tubules consist of germconsist of germ
cells and Sertoli cells.cells and Sertoli cells.
– Germ cells (spermatogonia,Germ cells (spermatogonia,
spermatocytes, etc) -spermatocytes, etc) -
develop into spermatozoadevelop into spermatozoa
– sertoli cells - supporting cellssertoli cells - supporting cells
Between the tubules, theBetween the tubules, the interstitialinterstitial
tissuetissue includes connective tissue cellsincludes connective tissue cells
and fibers, vessels, and Leydig cellsand fibers, vessels, and Leydig cells
– Leydig cells -Leydig cells - produceproduce
testosterone.testosterone.
9. Imaging ModalitiesImaging Modalities
UltrasoundUltrasound
Modality of choiceModality of choice
– 99% sensitive99% sensitive
– 98% accurate at98% accurate at
intratesticular vsintratesticular vs
extratesticularextratesticular
techniquetechnique
– support scrotum onsupport scrotum on
toweltowel
– highest MHzhighest MHz
transducer (8 or 15)transducer (8 or 15)
– color and dopplercolor and doppler
– Do normal side first ifDo normal side first if
painpain
NormalNormal
– homogeneoushomogeneous
– bright mediastinumbright mediastinum
– TransmediastinalTransmediastinal
artery or appendixartery or appendix
testistestis
10. Imaging ModalitiesImaging Modalities
MRIMRI
problem solverproblem solver
when US inconclusivewhen US inconclusive
cryptorchidismcryptorchidism
TechniqueTechnique
support scrotum with warmsupport scrotum with warm
towelstowels
surface coil; small fovsurface coil; small fov
T1W and FSET2W (SSFSE),T1W and FSET2W (SSFSE),
several planesseveral planes
3mm3mm
Gd?Gd?
Screen abd/pelvis for nodesScreen abd/pelvis for nodes
NormalNormal
homogeneous, intermediatehomogeneous, intermediate
on T1W and bright on T2Won T1W and bright on T2W
tunica albiginea andtunica albiginea and
mediastinum darkmediastinum dark
11. Imaging ModalitiesImaging Modalities
CTCT
used for staging of testicular cancer and forused for staging of testicular cancer and for
inguinal hernias and infection (Fourniersinguinal hernias and infection (Fourniers
gangrene)gangrene)
Nuclear MedicineNuclear Medicine
?PET/CT?PET/CT
12. MassesMasses
Key: intra vs extratesticular; solid vs cystKey: intra vs extratesticular; solid vs cyst
IntratesticularIntratesticular
solid - most malignant and germ cell originsolid - most malignant and germ cell origin
mimics/tumor like lesions - infarcts,mimics/tumor like lesions - infarcts,
orchitis/abscess and hematomaorchitis/abscess and hematoma
– Orchiectomy for benign disease will occurOrchiectomy for benign disease will occur
cystcyst
ExtratesticularExtratesticular
solid - most are benignsolid - most are benign
CysticCystic
CalcificationsCalcifications
13. Testicular CancerTesticular Cancer
#1 cancer killer of young men#1 cancer killer of young men
peak age 20 -45; 90% whitepeak age 20 -45; 90% white
– Incidence of GCT increased inIncidence of GCT increased in
cryptorchidismcryptorchidism
PresentationPresentation
– painless mass, mild pain or heavinesspainless mass, mild pain or heaviness
– 10% present with acute scrotum10% present with acute scrotum
US study of choiceUS study of choice
95% survival rate95% survival rate
15. Testicular Cancer - GCTTesticular Cancer - GCT
SpreadSpread
– LymphaticLymphatic
follows veinsfollows veins
1st echelon nodes1st echelon nodes
– retroperitoneal at kidneysretroperitoneal at kidneys
Further tumorFurther tumor
– iliac nodesiliac nodes
– supraclavicularsupraclavicular
epididymal & skin involvementepididymal & skin involvement
lead to inguinal nodeslead to inguinal nodes
– hematogeneous and directhematogeneous and direct
invasion later (x chorio)invasion later (x chorio)
lung>liver and brainlung>liver and brain
17. Testicular Cancer - GCTTesticular Cancer - GCT
Tumor markersTumor markers
alpha-fetoprotein, human chorionicalpha-fetoprotein, human chorionic
gonadotropingonadotropin
well-established role in the diagnosis,well-established role in the diagnosis, staging,staging,
prognosis, and follow-up of germ cell tumorsprognosis, and follow-up of germ cell tumors
18. Testicular Cancer -Testicular Cancer -
ImagingImaging
UltrasoundUltrasound
hypoechoic masshypoechoic mass
heterogeneous, echogenic, calcification,heterogeneous, echogenic, calcification,
cystic, multiple or completely replace thecystic, multiple or completely replace the
testistestis
may show increased vascularitymay show increased vascularity
Small tumors usually hypovascularSmall tumors usually hypovascular
MRIMRI
Isointense on T1W and hypointense on T2WIsointense on T1W and hypointense on T2W
19. SeminomaSeminoma
Most common GCTMost common GCT
slightly older ageslightly older age
– does not occurdoes not occur
before pubertybefore puberty
uniform,uniform,
hypoechoichypoechoic
(hypointense), esp(hypointense), esp
when smallwhen small
excellent prognosisexcellent prognosis
23. Embryonal carcinomaEmbryonal carcinoma
In 90% of mixedIn 90% of mixed
GCT, rarely inGCT, rarely in
pure formpure form
MoreMore
aggressiveaggressive
Less wellLess well
defined and lessdefined and less
homogeneoushomogeneous
24. Yolk Sac TumorYolk Sac Tumor
(endodermal sinus(endodermal sinus
tumor)tumor)
80% of pediatric80% of pediatric
testicular tumorstesticular tumors
(Most common in(Most common in
children <2yo)children <2yo)
occurs in mixedoccurs in mixed
GCT in adultsGCT in adults
Elevated Alpha-Elevated Alpha-
fetoproteinfetoprotein
25. TeratomaTeratoma
#2 tumor in kids#2 tumor in kids
common in mixed GCTcommon in mixed GCT
in adultsin adults
tend to be benign in kidstend to be benign in kids
more unpredictable inmore unpredictable in
adultsadults
complex, cysticcomplex, cystic
appearanceappearance
controversial recontroversial re
epidermoid cystepidermoid cyst
26. ChoriocarcinomaChoriocarcinoma
Rare but mostRare but most
aggressive GCTaggressive GCT
EarlyEarly
hematogeneoushematogeneous
mets commonmets common
elevated HcGelevated HcG
Poor prognosisPoor prognosis
HeterogeneousHeterogeneous
massmass
27. Mixed Germ Cell TumorMixed Germ Cell Tumor
More common thanMore common than
any other testicularany other testicular
tumor excepttumor except
seminomaseminoma
Any combination ofAny combination of
cell typescell types
variety of cell typesvariety of cell types
expressed inexpressed in
variablevariable
appearanceappearance
28. ““burned out” Germ Cellburned out” Germ Cell
TumorTumor
Phenomenon of patientPhenomenon of patient
presents with widespreadpresents with widespread
metastatic disease withmetastatic disease with
involuted primary tumorinvoluted primary tumor
?etiology. ?outgrown blood?etiology. ?outgrown blood
supplysupply
Primary tumors have a variablePrimary tumors have a variable
appearance. Small and can beappearance. Small and can be
hypoechoic, hyperechoic, orhypoechoic, hyperechoic, or
merelymerelyan area of focalan area of focal
calcification.calcification.
Histologic analysis may revealHistologic analysis may reveal
minute amounts of residualminute amounts of residual
tumor or only dense depositstumor or only dense deposits
of collagenof collagen with scatteredwith scattered
inflammatory cellsinflammatory cells
22 yo presented with back pain and
lower extremity weakness. Initial
work-up showed an extradural mass,
retroperitoneal adenopathy, and lung
metastases. Physical examination of
the testes was negative. After biopsy
of a cervical node revealed
metastatic germ cell tumor, scrotal
sonography was performed
22 yo presented with back pain and
lower extremity weakness. Initial
work-up showed an extradural mass,
retroperitoneal adenopathy, and lung
metastases. Physical examination of
the testes was negative. After biopsy
of a cervical node revealed
metastatic germ cell tumor, scrotal
sonography was performed
29. CryptorchidismCryptorchidism
6% of full term neonates; 1% at one6% of full term neonates; 1% at one
year; 10% bilateralyear; 10% bilateral
Increased risk of:Increased risk of:
– Testicular carcinoma (most seminomas)Testicular carcinoma (most seminomas)
– InfertilityInfertility
Disordered embryogenesisDisordered embryogenesis
Associated with other GU anomalies:Associated with other GU anomalies:
agenesis/ectopy of kidney andagenesis/ectopy of kidney and
absence/cyst of SVabsence/cyst of SV
Risk of cancer increased in contra-lateralRisk of cancer increased in contra-lateral
testis, even if descendedtestis, even if descended
Risk of cancer not reduced appreciablyRisk of cancer not reduced appreciably
with orchiopexywith orchiopexy
– Note: single post-pubertal bxNote: single post-pubertal bx
recommended to identify intratubularrecommended to identify intratubular
germ cell neoplasm (cis) as marked riskgerm cell neoplasm (cis) as marked risk
factorfactor
30. CryptorchidismCryptorchidism
Clinical Problem: nonpalpableClinical Problem: nonpalpable
testistestis
– DDX: cryptorchidism vs agenesisDDX: cryptorchidism vs agenesis
– Important distinctionImportant distinction
Agenesis: no txAgenesis: no tx
Cryptorchidism: orchiopexy atCryptorchidism: orchiopexy at
2yrs; close exam and bx post-2yrs; close exam and bx post-
pubescentpubescent
– Role of imaging:Role of imaging:
MRI study of choice (US and CTMRI study of choice (US and CT
lack specificity)lack specificity)
– Laporoscopy: Many feel study ofLaporoscopy: Many feel study of
choice (dx and tx)choice (dx and tx)
31. Retractile TestisRetractile Testis
(Hyper)active cremasteric reflex, prompted(Hyper)active cremasteric reflex, prompted
by anxiety, trauma, etc., may pull the testisby anxiety, trauma, etc., may pull the testis
out of the scrotum (prescrotal orout of the scrotum (prescrotal or
intracanalicular)intracanalicular)
Not uncommon in trauma setting, especiallyNot uncommon in trauma setting, especially
in boys (2-3%).in boys (2-3%).
Recommend PE to differentiate retractileRecommend PE to differentiate retractile
testis from true cryptorchidismtestis from true cryptorchidism
33. MicrolithiasisMicrolithiasis
US diagnosisUS diagnosis
5 or more5 or more
calcificationcalcification
may be bl andmay be bl and
diffuse or focaldiffuse or focal
Risk or coexistentRisk or coexistent
or subsequentor subsequent
carcinomacarcinoma
controversialcontroversial
as is need andas is need and
duration of us followduration of us follow
upup
34. Non-Germ cell tumorsNon-Germ cell tumors
5% of testicular cancer5% of testicular cancer
higher in pedshigher in peds
Sertoli (sex cord) and LeydigSertoli (sex cord) and Leydig
(interstitial) cell(interstitial) cell
Also other rare cell linesAlso other rare cell lines
90% benign90% benign
Indistinguishable from GCTIndistinguishable from GCT
Calcifying Sertoli Cell TumorCalcifying Sertoli Cell Tumor
pediatric age grouppediatric age group
multiple calcified massesmultiple calcified masses
PJ and Carney syndromePJ and Carney syndrome
35. LymphomaLymphoma
5% of testicular tumor5% of testicular tumor
#1 in over 50 y/o#1 in over 50 y/o
only 1% of lymphomaonly 1% of lymphoma
patientspatients
May beMay be
only site of diseaseonly site of disease
along with other diseasealong with other disease
site of recurrencesite of recurrence
AppearanceAppearance
Indistinguishable fromIndistinguishable from
GCTGCT
Multiple, bl hypoechoicMultiple, bl hypoechoic
nodulesnodules
36. Leukemia and MetsLeukemia and Mets
Common site of recurrenceCommon site of recurrence
primary disease uncommon hereprimary disease uncommon here
Appearance variableAppearance variable
uni or bluni or bl
focal or diffusefocal or diffuse
hypo or hyperechoichypo or hyperechoic
Solid organ metsSolid organ mets
rare; usually disease widespreadrare; usually disease widespread
prostate and lungprostate and lung
37. Tumor-like lesionsTumor-like lesions
““intratesticular mass is cancer untilintratesticular mass is cancer until
proven otherwise”proven otherwise”
Traditional teaching: 95% malignantTraditional teaching: 95% malignant
BUT, more benign lesions being identifiedBUT, more benign lesions being identified
Not all testicular lesions are tumorsNot all testicular lesions are tumors
As many as 30% of orchiectomies for testicular lesionsAs many as 30% of orchiectomies for testicular lesions
end up being benignend up being benign ((Haas GP, Shumaker BP, Cerny JC. The high incidence ofHaas GP, Shumaker BP, Cerny JC. The high incidence of
benign testicular tumors. J Urolbenign testicular tumors. J Urol 19861986;136:1219 -1220);136:1219 -1220)
recognition of these entities may prevent needlessrecognition of these entities may prevent needless
orchiectomyorchiectomy
Still, rather needless orchiectomy thanStill, rather needless orchiectomy than
missed cancer. Thus will havemissed cancer. Thus will have
orchiectomy for benign disease.orchiectomy for benign disease.
38. Tumor-like lesionsTumor-like lesions
DDX:DDX:
orchitisorchitis
Hematoma/contusionHematoma/contusion
infarctinfarct
cyst (see next)cyst (see next)
– mimics teratomamimics teratoma
adrenal restsadrenal rests
– 2% of adults have2% of adults have
– Enlarged in CAH orEnlarged in CAH or
rarely Cushingsrarely Cushings
– BL hypo massesBL hypo masses
sarcoidosissarcoidosis
sperm extractionsperm extraction
39. Sperm Extraction*Sperm Extraction*
Sperm extraction forSperm extraction for
infertility are becominginfertility are becoming
more commonmore common
In a % (varies from20-In a % (varies from20-
80%) Focal testicular80%) Focal testicular
lesions can resultlesions can result
?hematoma, infarct?hematoma, infarct
FindingsFindings
anterior andanterior and
subcapsularsubcapsular
hypoechoichypoechoic
hyperechoic, calcifichyperechoic, calcific
History may allow closeHistory may allow close
F/UF/U *S Strauss, AJR 2001 176: 113
41. Tunica Albuginea CystTunica Albuginea Cyst
?etiology?etiology
Middle ageMiddle age
Key to diagnosisKey to diagnosis
peripheral locationperipheral location
simple cystsimple cyst
usually 2-5 mmusually 2-5 mm
42. Simple CystSimple Cyst
Usually >40 yoUsually >40 yo
2mm to 2cm2mm to 2cm
single or multiplesingle or multiple
Usually nearUsually near
mediastinummediastinum
43. EpidermoidEpidermoid
Keratonizing squamousKeratonizing squamous
epithelium filled withepithelium filled with
cheesy laminated stuffcheesy laminated stuff
appearanceappearance
echogenic rimechogenic rim
““onion skinned” due toonion skinned” due to
layerslayers
““solid” appearingsolid” appearing
avascularavascular
44. EpidermoidEpidermoid
Unable to totallyUnable to totally
exclude solid lesionexclude solid lesion
usually andusually and
orchiectomy oftenorchiectomy often
neededneeded
MRIMRI
high signal on T1high signal on T1
and T2and T2
45. Cystic Transformation ofCystic Transformation of
the Rete Testisthe Rete Testis
Due to obstruction of efferentDue to obstruction of efferent
ductules with resultant ectasiaductules with resultant ectasia
older menolder men
FindingsFindings
uni or bluni or bl
tubular cystic areastubular cystic areas
in/near mediastinumin/near mediastinum
epididymal cystsepididymal cysts
DDX: cystic GCT (esp teratoma)DDX: cystic GCT (esp teratoma)
usually has soft tissueusually has soft tissue
not tubularnot tubular
MRI can may be helpfulMRI can may be helpful
47. Intras-testicularIntras-testicular
VaricoceleVaricocele
?etiology. ??etiology. ?
significancesignificance
May cause painMay cause pain
(+-)extratesticular(+-)extratesticular
varicocelesvaricoceles
FindingsFindings
tubular, serpigineoustubular, serpigineous
structures withstructures with
venous doppler/colorvenous doppler/color
flow which increasesflow which increases
with valsalvawith valsalva
48. Testicular TorsionTesticular Torsion
Most common in adolescentsMost common in adolescents
Acute scrotumAcute scrotum
DDXDDX
– torsiontorsion
– orchitisorchitis
– traumatrauma
– tumortumor
Due to “bell and clapper”Due to “bell and clapper”
deformitydeformity
lackof normal fixation in thelackof normal fixation in the
scrotumscrotum
Urologic EmergencyUrologic Emergency
salvage rate related to timesalvage rate related to time
– 90%-100% detorsion within 690%-100% detorsion within 6
hours of painhours of pain
– 20%-50% after 12 hours20%-50% after 12 hours
– 0%-10% if detorsion greater0%-10% if detorsion greater
than 24 hoursthan 24 hours
consider doing own USconsider doing own US
49. Testicular TorsionTesticular Torsion
FindingsFindings
Early, testis is normal; laterEarly, testis is normal; later
becomes enlarged andbecomes enlarged and
hypoechoichypoechoic
Lack ofLack of SignificantSignificant
detectable flowdetectable flow
reactive hydrocelereactive hydrocele
51. Scrotal TraumaScrotal Trauma
2 Categories2 Categories
penetrating (surgery)penetrating (surgery)
blunt (imaging)blunt (imaging)
TesticularTesticular
Fracture/ruptureFracture/rupture
disruption of t. albugineadisruption of t. albuginea
with bleeding andwith bleeding and
extrusion of S.T.extrusion of S.T.
surgical emergencysurgical emergency
Trauma inducedTrauma induced
torsion/Infarct a knowtorsion/Infarct a know
complicationcomplication
Types of injury:
Contusion
Hematoma
Fracture/rupture
hematocele
Types of injury:
Contusion
Hematoma
Fracture/rupture
hematocele
52. Scrotal TraumaScrotal Trauma
UltrasoundUltrasound
Normal - excludes seriousNormal - excludes serious
injuryinjury
hematoma - echogenic orhematoma - echogenic or
hypoechoic; roundedhypoechoic; rounded
Hematocele - extratesticularHematocele - extratesticular
fluid; echoes or echogenicfluid; echoes or echogenic
Infarct - absent flowInfarct - absent flow
FractureFracture
– Heterogeneous testicle;Heterogeneous testicle;
diffuse or focaldiffuse or focal
– irregular or ill-defined contourirregular or ill-defined contour
or bulgeor bulge
– often just a “often just a “messmess””
53. Scrotal TraumaScrotal Trauma
MRIMRI
– May play future roleMay play future role
in detection ofin detection of
disruption of thedisruption of the
tunica albuginea (ietunica albuginea (ie
rupture)rupture)
54. Scrotal Trauma:Scrotal Trauma: extremeextreme
mountain bikersmountain bikers..
Krauscher F Radiology 2001May;219(2):427-31USKrauscher F Radiology 2001May;219(2):427-31US
55. Inflammatory DiseaseInflammatory Disease
Epididymitis/orchitisEpididymitis/orchitis
usually retrotrade infection from bladder and prostateusually retrotrade infection from bladder and prostate
rarely traumatic, surgical, etcrarely traumatic, surgical, etc
orchitis from epididymitis (except mumps)orchitis from epididymitis (except mumps)
““acute scrotum” in adolescents (kids,acute scrotum” in adolescents (kids,
elderly)elderly)
testicular torsiontesticular torsion
traumatrauma
infectioninfection
torsion of epididymal or testicular appendagestorsion of epididymal or testicular appendages
Imaging is to confirm diagnosis andImaging is to confirm diagnosis and
excluded complication (surgery)excluded complication (surgery)
abscessabscess
infarctioninfarction
60. Extratesticular VariantsExtratesticular Variants
Appendix of theAppendix of the
epididymisepididymis
Isoechoic to epididymisIsoechoic to epididymis
May calcifyMay calcify
Appendix of the testesAppendix of the testes
Isoechoic to testesIsoechoic to testes
Cyst of MorgagniCyst of Morgagni
Dilation of theDilation of the
paradidymisparadidymis
Cystic; can appearCystic; can appear
solidsolid
61. Spermatocele andSpermatocele and
epididymal cystepididymal cyst
very commonvery common
usually within/near head ofusually within/near head of
epididymisepididymis
usually asymptomatic andusually asymptomatic and
present incidently or aspresent incidently or as
palpable masspalpable mass
Epididymal CystEpididymal Cyst
Cystic on USCystic on US
SpermatoceleSpermatocele
UltrasoundUltrasound
– Cystic (may not be ableCystic (may not be able
to differentiate fromto differentiate from
epididymal cyst)epididymal cyst)
– Low level echoesLow level echoes
– Rarely hyperechoicRarely hyperechoic
62. Sperm GranulomaSperm Granuloma
Sperm extravasationSperm extravasation
can result in granulomacan result in granuloma
formationformation
Often occurs afterOften occurs after
vasectomyvasectomy
Painful (unlike tumor)Painful (unlike tumor)
UltrasoundUltrasound
Isoechoic toIsoechoic to
hyperechoic mass inhyperechoic mass in
the epididymisthe epididymis
Rarely may calcifyRarely may calcify
63. VaricoceleVaricocele
Dilated intrascrotal veinsDilated intrascrotal veins
incompetent valvesincompetent valves
in testicular veinsin testicular veins
rarely due to mass,rarely due to mass,
etcetc
Worry about unilateralWorry about unilateral
right sided varicoceleright sided varicocele
Infertility, heavinessInfertility, heaviness
Common (15-20%)Common (15-20%)
FindingsFindings
L>R, bl commonL>R, bl common
veins > 2-3mmveins > 2-3mm
dilation excacerbateddilation excacerbated
by valsalva andby valsalva and
standingstanding
64. Hydrocele (hematoceleHydrocele (hematocele
& pyocele& pyocele
Fluid w/I tunica vaginalisFluid w/I tunica vaginalis
HydroceleHydrocele
– Small amount of fluid normalSmall amount of fluid normal
– EtiologiesEtiologies
congenital - persistent peritonealcongenital - persistent peritoneal
communicationcommunication
AcquiredAcquired
– Reactive(trauma, infection, torsion)Reactive(trauma, infection, torsion)
– In adults, not uncommon withIn adults, not uncommon with
unknown etiology (diminishedunknown etiology (diminished
reabsorbtion)reabsorbtion)
HematoceleHematocele
– Echogenic fluid; trauma, tumor orEchogenic fluid; trauma, tumor or
surgerysurgery
PyocelePyocele
– Echogenic collection; septations andEchogenic collection; septations and
debrisdebris
65. HerniaHernia
Via patentVia patent
processus vaginalisprocessus vaginalis
complex masscomplex mass
look for peristalsislook for peristalsis
66. Extratesticular tumorExtratesticular tumor
Rare, mostly benignRare, mostly benign
Adenomatoid tumorAdenomatoid tumor
Only tumor with anyOnly tumor with any
frequencyfrequency
HamartomatousHamartomatous
lesionlesion
Adolescents andAdolescents and
young adultsyoung adults
Tail of epididymisTail of epididymis
most common sitemost common site
Isoechoic toIsoechoic to
hyperechoichyperechoic
Seminoma in an Undescended Testis -- Woodward 231 (2): 388 -- Radiology (Radiology 2004;231:388-392.) Diagnosis Please A 47-year-old man presented with a 1-month history of progressive abdominal pain. He was in good health until this time, and he had not previously undergone surgery. A right lower-quadrant mass was noted at physical examination. A computed tomographic (CT) examination was performed. Figure a. Transverse CT scans obtained after administration of intravenous and oral contrast material. (a) CT scan obtained through the level of the kidneys shows bowel within the right renal fossa (arrow) because the right kidney is absent. Note the small amount of free fluid. (b, c) Large right-sided soft-tissue attenuation mass with some areas of peripheral enhancement superiorly (white arrow in b) and necrosis inferiorly (white arrow in c). Note compressed inferior vena cava (black arrow). (d) CT scan obtained through the bladder base shows a normal left seminal vesicle (arrow) with absence of the right seminal vesicle. (e) Absent right spermatic cord and normal left spermatic cord (arrow). the right spermatic cord is absent, which indicates either incomplete descent or agenesis of the right testis. The differential diagnoses for a retroperitoneal mass are many and include both benign and malignant entities. Benign lesions include retroperitoneal fibrosis, which on occasion can make bulky masses, and extramedullary hematopoiesis. The large size and focal nature of this mass makes these diagnoses unlikely. Lymphoma and metastatic adenopathy are two of the most common soft-tissue masses seen in the retroperitoneum and should be considered. In addition, primary tumors of either neurogenic or mesenchymal origin should be included in the differential diagnoses. These tumors most commonly include paraganglioma (patients are usually symptomatic), liposarcoma (visible fat may not be depicted with CT in aggressive high-grade tumors), leiomyosarcoma, and malignant fibrous histiocytoma. There is a great deal of overlap in the imaging findings of many of these masses. None of the above diagnoses would account for the other findings, which include absence of the right spermatic cord, kidney, and seminal vesicle. One potential explanation would be a tumor within an ectopic kidney associated with agenesis of the right seminal vesicle and testis. None of the images, however, show normal renal parenchyma. Even with a very large or infiltrating renal tumor, some normal parenchyma can usually be identified. Given the lack of any identifiable kidney on the right side, it is more likely congenitally absent than ectopic. The findings of an absent right spermatic cord, kidney, and seminal vesicle—in combination with the soft-tissue mass located along the path of testicular descent—make the most likely diagnosis tumor within an undescended testis. Cryptorchidism results from the abnormal formation and descent of the testes. The testes form from genital ridges, which lie on both sides of the midline and extend from T6 through S2 vertebrae in the developing embryo. Between the 7th and 12th weeks of gestation, the testes contract and become more ovoid as they begin their descent into the pelvis. They remain near the deep inguinal ring until the 7th month of gestation, when they begin their descent through the inguinal canal into twin scrotal sacs. Passage through the inguinal canal is aided by both the processus vaginalis and the shortening of the gubernaculum. The processus vaginalis is a sock-like evagination of peritoneum that elongates caudally through the abdominal wall into the scrotum and creates a path for the descending testis. The gubernaculum is a ligamentous cord that extends from the testis to the scrotum. The testes remain retroperitoneal throughout their descent but are intimately associated with the posterior wall of the processus vaginalis (1,2). At approximately 8 weeks gestational age, the Leydig cells begin to secrete testosterone, thus inducing this process. In addition, because of this hormonal influence, the mesonephric (wolffian) ducts differentiate into the epididymis, vas deferens, seminal vesicles, and ejaculatory ducts. Concurrently, the Sertoli cells secrete müllerian inhibiting factor, which results in regression of the paramesonephric (müllerian) ducts. A vestigial remnant of this system may persist as the appendix testis (1,2). Cryptorchidism is present in approximately 6% of full-term neonates and approximately 0.8% of infants at 1 year of age. It can be bilateral in 10% of patients (3,4). Because of its association with other urinary tract abnormalities, cryptorchidism is thought to be one manifestation of a generalized defect in genitourinary embryogenesis. Other associated malformations include renal agenesis or ectopias, ureteral duplications, seminal vesicle agenesis or cysts, and hypospadias (5–9). Cryptorchidism is also associated with infertility and is a well-recognized risk factor for testicular carcinoma. Approximately 90% of these tumors are seminomas, especially those that occur in the abdominally located testis. Although the overall incidence of cryptorchidism is low (<1%), a history of an undescended testis is present in 3.5%–14.5% of patients with testicular tumors (9). The pathophysiology of malignant transformation in these testes is not completely understood. One hypothesis is that cryptorchidism is not merely incomplete descent of the testis, but that it reflects a generalized defect in embryogenesis and results in bilateral dysgenetic gonads. An embryologic defect in testicular formation is supported by several important clinical observations. The most compelling of these is that risk for testicular carcinoma is not limited to the undescended testis but extends to the contralateral testis, even if it is normally descended. Thus, the increased risk of carcinoma cannot be attributed to local environmental factors, such as increased temperature in the abdomen versus the scrotum. While it is true that the risk of carcinoma increases with the degree of ectopy (intraabdominal testes are at greater risk than those in the inguinal canal), this also supports the theory if it is assumed that the greatest degree of ectopy reflects the greatest perturbation of embryogenesis. The defective embryogenesis hypothesis is further supported by the observation that orchiopexy, even at an early age, does not appreciably decrease the risk of developing a tumor (9). The majority of cryptorchid testes lie distal to the external inguinal ring and are palpable. Nonpalpable testes are most commonly located within the inguinal canal, but they can be located anywhere along the path of descent from the abdomen. Testicular agenesis has been reported to be present in 15%–63% of patients with a nonpalpable testis (4,10). The distinction between agenesis and maldescent is critical, as orchiopexy should be performed in all patients with undescended testes. This is usually performed between 1 and 2 years of age. If performed later, the testis will have undergone marked morphologic change, with fibrosis and collagen deposition adversely affecting spermatogenesis and fertility (11). While orchiopexy improves fertility, it does not alter the risk of developing a carcinoma. Because of this increased risk, testicular biopsies have been recommended to aid in the identification of intratubular germ cell neoplasia of the unclassified type (carcinoma in situ). If the biopsy results are positive for intratubular neoplasia, the patient has a 50% chance of developing invasive carcinoma; however, if the biopsy results are negative for intratubular neoplasia, the patient does not have an increased risk for developing carcinoma. A single postpubertal biopsy of each testis at 18–20 years of age is suggested and appears to be adequate for identification of high-risk patients (9,12). Imaging can be helpful in localizing a nonpalpable testis. An undescended testis will appear hypoechoic with ultrasonography (US), and a mediastinum testis should be identified for confident diagnosis. There are many potential pitfalls, including possible confusion with lymph nodes and the pars infravaginalis gubernaculi, which is a bulbous termination of the gubernaculum (4,13). More importantly, agenesis cannot be discriminated from atrophy with US (3,4). CT also lacks the specificity and sensitivity that are needed to diagnose agenesis. Magnetic resonance (MR) imaging has the advantage of improved soft-tissue contrast, but reports have varied as to its usefulness (11,14). The results of a study by Lam et al (15) showed that gadolinium-enhanced MR venography performed in conjunction with routine pelvic MR imaging increased sensitivity for differentiation of agenesis from ectopia. Because surgery is obviated only if the testis can be proved to be absent, many urologists feel that the treatment of choice is laparoscopy, which can be both diagnostic and therapeutic (16,17). Some cases, however, will still require open inguinal exploration and abdominal laporotomy (18). Preoperative imaging may help in surgical planning in these patients.