Differential diagnoses: Scrotal lesions

Dr Nigel Stollery outlines differential diagnosis of scrotal lesions including inguinal scrotal hernia, hydrocoele, angiokeratomas of Fordyce, and steatocystoma multiplex.

Inguinal scrotal hernia

Presentation

  • Scrotal swelling which extends up into the body
  • Soft, fluctuant and usually non-tender
  • May be reducible when patient is lying flat
  • Bowel sounds may be present
  • Does not transilluminate when light applied
  • May be bilateral or unilateral
  • Strangulation may occur, leading to severe pain

Management

  • Surgery is the treatment of choice in large, symptomatic cases
  • Laparoscopic repair increasingly common
  • Support/truss may help where surgery not an option

Hydrocoele

Presentation

  • Swelling within the scrotum which is localised and does not extend into the body
  • Testes cannot be felt separately as lie within the hydrocoele
  • Usually soft, non-tender, cystic
  • Transilluminates when light applied
  • Caused by excess fluid in tunica vaginalis
  • May be congenital or develop later in life

Management

  • Most only require reassurance
  • Larger ones can be aspirated
  • If tumour suspected, aspiration should be avoided - it increases risk of metastatic spread
  • In very large or recurrent cases, surgery is usually curative

Angiokeratomas of Fordyce

Presentation

  • Small red/purple papules in scrotal skin
  • Also found in penile shaft, inner thighs and lower abdomen
  • Histologically, composed of ectatic thin-walled vessels in superficial dermis with overlying epidermal hyperplasia
  • Scaly surface often present
  • Usually 2-5 mm in diameter, although size can vary
  • Generally multiple
  • May bleed with minimal trauma, otherwise usually asymptomatic

Management

  • Treatment not usually required
  • Where bleeding occurs, cautery, hyfrecation or laser effective

Steatocystoma multiplex

Presentation

  • Uncommon disorder of pilosebaceous unit
  • Typically produces multiple sebum-containing dermal cysts
  • Can be inherited as autosomal dominant condition, but most cases are sporadic
  • Cysts usually non-tender and asymptomatic
  • Size can vary from 3mm to 3cm
  • Cysts lack punctum and more common in sebum-rich areas
  • Secondary infection may occur

Management

  • Treatments include cryotherapy, aspiration and surgical excision
  • If secondary infection occurs, tetracyclines can be effective
  • Dr Stollery is a GP in Kibworth, Leicestershire

Click here to take a test on this article and claim a certificate on MIMS Learning

This is an updated version of an article that was first published in November 2014

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

LMCs demand renegotiation of COVID-19 enhanced service deal

LMCs demand renegotiation of COVID-19 enhanced service deal

LMCs have called for a renegotiation of funding for the COVID-19 vaccination enhanced...

LMCs demand ballot of profession on PCN DES ahead of next contract talks

LMCs demand ballot of profession on PCN DES ahead of next contract talks

LMCs have demanded a ballot of GPs on the primary care network (PCN) DES before BMA...

Lack of support left locums at physical and financial risk in pandemic, say LMCs

Lack of support left locums at physical and financial risk in pandemic, say LMCs

Locum GPs have faced significant physical and financial risk because of a lack of...

LMCs demand NHS England apology over ‘abhorrent' claims about general practice

LMCs demand NHS England apology over ‘abhorrent' claims about general practice

LMCs have called on NHS England to apologise for ‘abhorrent and insulting’ suggestions...

CCGs to be stripped of commissioning role under reforms backed by NHS England

CCGs to be stripped of commissioning role under reforms backed by NHS England

CCGs could be stripped of their commissioning role under plans set out by NHS England,...

Shielding advice updated to reflect return to tiered system on 2 December

Shielding advice updated to reflect return to tiered system on 2 December

The government has updated its guidance for patients on the shielding list to reflect...