Scrotal disorders are relatively common. In a man with scrotal swelling, a careful history and a thorough physical examination often provide histiocytoma dog removal cost enough information for a correct diagnosis. Intrascrotal masses are common findings on physical examination. Although most masses are benign, testicular cancer is the leading solid malignancy in men younger histiocytoma dog removal cost than 35 years of age.
The most common pathologic disorders in the category of acute, non-neoplastic lesions include testicular torsion, epididymitis, and trauma. Testicular torsion is a surgical emergency in which a twisting histiocytoma dog removal cost of the testis leads to venous obstruction, edema, and eventual arterial obstruction. Prompt recognition (within 10 to 12 hours) of this condition enables physicians to salvage the testis in histiocytoma dog removal cost 70% to 90% of cases. Torsion is most commonly seen in adolescents from 12 to histiocytoma dog removal cost 18 years of age. Patients complain of acute, unilateral testicular pain that is often
Epididymitis is the most common cause of acute scrotal swelling. It accounts for more than 600,000 visits to physicians annually in the united states. It occurs in young, sexually active men and in older men with associated genitourinary histiocytoma dog removal cost problems. Patients usually complain of recent onset of testicular pain that histiocytoma dog removal cost is associated with fever, dysuria, and scrotal swelling. On examination, the epididymis is tender and indurated. The testis may also be enlarged and tender;this variant is called epididymo-orchitis.
The most common types of intrascrotal pathologic conditions are the histiocytoma dog removal cost nonacute, non-neoplas-tic lesions. These include hydrocele, spermatocele, and varicocele. A hydrocele (see fig. 18-28) is a collection of fluid within layers of the tunica histiocytoma dog removal cost vaginalis. It manifests as a painless swelling of the scrotum. A hydrocele may be congenital, acquired, or idiopathic. Acquired hydroceles may result from trauma, infection, renal transplantation, and neoplasm. Idiopathic hydroceles are the most common; patients may have no symptoms or may complain of a histiocytoma dog removal cost dull ache or scrotal heaviness. In general, hydroceles are anterior to the testis. They are smooth walled and can be transilluminated. Figure 18-29 depicts a transilluminated hydrocele.
A varicocele is a common intrascrotal mass resulting from abnormal histiocytoma dog removal cost dilatation of the veins of the pampiniform plexus. A man with a varicocele is usually asymptomatic but may histiocytoma dog removal cost have a history of infertility or a sensation of heaviness histiocytoma dog removal cost in the scrotum. The varicocele can best be visualized by observing the patient histiocytoma dog removal cost in a standing position. A mass resembling a bag of worms may be seen histiocytoma dog removal cost and palpated superior to the testis. These varicosities typically enlarge during a valsalva maneuver and are histiocytoma dog removal cost reduced when the patient lies down. Varicoceles are found predominantly on the left side. A right-sided varicocele suggests some obstruction of the inferior vena cava, whereas an acute left-sided varicocele may indicate a left-sided hypernephroma or other left renal tumor. Figure 18-27 shows a patient with a varicocele. Notice the markedly dilated veins in the scrotum.
Most testicular neoplasms are asymptomatic, but some patients may seek medical attention because of acute histiocytoma dog removal cost pain related to trauma, hemorrhage, hydrocele, and epididymitis. Other men may present with weight loss, fever, abdominal pain, lower extremity edema, or bone pain resulting from advanced metastatic disease. A history of cryptorchidism is important because of a high histiocytoma dog removal cost association between this condition and testicular malignancies. The most common finding on physical examination is a nodule histiocytoma dog removal cost or a painless swelling of one testicle. About 1% to 3% of testicular neoplasms are bilateral. If found early, testicular carcinoma is almost always curable. Extratesticular tumors are uncommon and are usually benign. Pure seminomas constitute approximately 40% of all testicular cancer cases. Forty percent of testicular cancers have mixed histologic characteristics.
Sexually transmitted diseases are common. Of every 100 outpatient visits to a venereal disease clinic, 25% of men have gonorrhea, 25% have nongonococcal urethritis, 4% have venereal warts, 3.5% have herpes, 1.7% have syphilis, and 0.1% have chancroid. The incidence of both gonococcal and nongonococcal urethritis has increased histiocytoma dog removal cost dramatically since the early 1980s. On college campuses, 85% of urethritis is nongonococcal in origin.
Genital lesions of venereal diseases may be ulcerative or nonulcerative. The incidence of genital lesions has changed greatly since the histiocytoma dog removal cost 1950s. At one time, chancroid was common, and herpes was rare;today, herpes simplex virus type 2 (HSV-2) infection is common, and chancroid is rare. Figure 18-34 shows the vesicular stage of a herpetic infection. Another example of HSV-2 infection is shown in figure 18-35. Anal ulcerative lesions are becoming more common, particularly among gay men.
Large DNA poxvirus. Adults can acquire the infection through sexual contact with infected histiocytoma dog removal cost adults. The characteristic lesions are flesh-colored papules that range in size from pinpoint to 0.4 inch (1 cm) in diameter. The central depression is the most important diagnostic sign. The painful lesions may occur anywhere on the body: on the face and trunk in children and around the histiocytoma dog removal cost genitals of adults. Any adult with this disease must be screened for other histiocytoma dog removal cost sexually transmitted diseases. The lesions, as the name indicates, are highly contagious. As the lesions develop, there may be a surrounding patch of eczema. In patients with AIDS, the lesions become widespread, attaining sizes up to 0.8 inch (2 cm) in diameter. Figure 18-36 shows lesions of molluscum contagiosum of the penis. Figure 18-37 is a close-up photograph of the classic, umbilicated lesions of molluscum contagiosum. Table 18-3 lists a differential diagnosis of genital papular lesions.
The primary lesion of syphilis is the chancre (see fig. 18-13), which occurs from 10 days to 3 weeks after infection histiocytoma dog removal cost at the site of the inoculation. The chancre is a painless ulcer with an indurated edge. It usually heals spontaneously within a month. If the patient is not treated for syphilis, the disease may evolve to the secondary stage. This occurs about 2 months after the appearance of the histiocytoma dog removal cost chancre. The patient may present with a widespread, nonpruritic, maculo-papular rash over the genitalia, trunk, palms, and soles. There is a tendency for cropping of the lesions. The healed chancre may still be evident. There is also generalized lymphadenopathy. In the genital and perianal areas, the papules may coalesce and erode. These large, moist, painful papules, which look as if they were ”pasted” on the skin, are called condylomata lata. They are covered with an exudate and are teeming with histiocytoma dog removal cost active spirochetes. If untreated, the patient may recover but may have a relapse of histiocytoma dog removal cost the eruption within 2 years. After this period, there is a long latent period during which the disease histiocytoma dog removal cost may progress to cardiovascular syphilis or neurosyphilis, a condition known as tertiary syphilis.
Human papillomavirus ( HPV) infection of the genital tract is one of the most histiocytoma dog removal cost common sexually transmitted diseases among young adults and is the histiocytoma dog removal cost cause of venereal warts. In the united states, it is estimated that 20 million people have genital HPV histiocytoma dog removal cost infections at any one time, with 5.5 million acquiring it annually. Risk factors associated with HPV infection include younger age, belonging to an ethnic minority, alcohol consumption, and a high frequency of anal or vaginal sexual encounters. The annual cost burden in the united states of genital histiocytoma dog removal cost HPV infection is $6 billion, which makes it the second most costly sexually transmitted disease histiocytoma dog removal cost after human immunodeficiency virus (HIV) infection. Condylomata acuminata are typically caused by HPV type 6 or histiocytoma dog removal cost HPV type 11, which are considered low-risk HPV types because these strains are rarely found in histiocytoma dog removal cost association with genital dysplasias or invasive cancer. Patients with immunodeficiencies are at higher risk for persistent HPV histiocytoma dog removal cost infection and progressive disease. Figure 18-40 shows the classic cauliflower lesions of condylomata acuminata on histiocytoma dog removal cost the penis of a renal transplant recipient (see also figs. 18-15 and 18-21).
Reiter’s syndrome is defined as the classic triad of nongonococcal histiocytoma dog removal cost urethritis, arthritis, and conjunctivitis. It most often affects men (20:1) during the third decade of life, and there is a high prevalence of human leukocyte antigen histiocytoma dog removal cost (HLA)-B27. It is one of the most common causes of acute histiocytoma dog removal cost inflammatory arthritis in men. Approximately one third of patients with reiter’s syndrome have a prodromal enteric or urethral inflammation. The most common enteric pathogens are shigella, salmonella, yersinia, and campylobacter; the most common urogenital
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