Tumors of the scrotum are neoplasms originating from the epithelium, connective or muscular tissue of the organ. The only manifestation in most cases are nodes of various sizes, colors and consistency. Some benign tumors can reach significant sizes, cause a gross cosmetic defect and cause inconvenience when walking. With the progression of malignant tumors of the scrotum, ulceration, germination of nearby organs and metastasis to the lymph nodes are possible. In the later stages, exhaustion, weakness and hyperthermia are observed. The diagnosis is established on the basis of examination and additional research data. The treatment is surgical.
General information
Scrotal tumors are a group of primary and secondary tumors of the scrotal region. Primary benign tumors are an extremely rare pathology (with the exception of cysts and papillomas), single lipomas, fibromyomas, chondrofibromas, hemangiomas and lymphangiomas and some other neoplasms are described in the American literature. Primary malignant tumors of the scrotum are detected more often than benign ones, but also belong to the category of few common diseases. In most cases, secondary tumors of the scrotum are detected due to the aggressive growth of malignant neoplasms located in nearby organs and tissues (for example, during the germination of testicular cancer, penile cancer or prostate cancer). The treatment is carried out by specialists in the field of oncology and andrology.
Classification of scrotal tumors
The scrotum is a sac–like formation in the perineum area in men. It is a protrusion of the abdominal wall, consists of skin, fleshy shell, fascia and muscles. It is a receptacle for testicles, appendages of testicles and spermatic cords. Benign and malignant tumors of the listed organs are considered separately, the category of tumors of the scrotum includes only lesions of the integumentary soft tissues. Taking into account the origin and histological structure, the following neoplasms of the scrotum are distinguished:
- Epithelial tumors.
- Pigmented tumors.
- Neoplasms and tumor-like lesions of soft tissues.
- Neoplasms and tumor-like lesions of lymphoid and hematopoietic tissue.
- Secondary foci that have arisen during the spread of malignant cells from other organs.
- Unclassifiable tumors.
Benign tumors of the scrotum
The most common benign tumors of the scrotum are epidermal cysts (atheromas) and papillomas. Fibroids, lipomas, epitheliomas, basal cell carcinomas and leiomyomas are less common. Lymphangiomas, hemangiomas, teratomas and dermoid cysts are very rarely diagnosed. Epidermal cysts occur in adolescents or young men, usually they are multiple. They are tense tumors of the scrotum of yellowish color with a diameter from 1 mm to 2 cm . In most cases, they are asymptomatic, less often accompanied by itching. Small holes may appear on the surface of cysts, from which yellowish-white contents are released when pressed. Possible inflammation. Long-term existing cysts can calcify. Treatment is surgical removal of the scrotum by atheroma.
Papillomas are tumors of the scrotum of epithelial origin. They can be single or multiple. Sometimes they are combined with papillomas of the perineum, inguinal areas and penis. They are small nodes of a solid, pinkish or brownish color. Treatment – electroexcision or electrocoagulation. The remaining tumors of the scrotum, as a rule, are single, asymptomatic and do not reach significant sizes. The exceptions are large lymphangiomas and hemangiomas, which can cause a pronounced cosmetic defect and create difficulties while walking. Treatment of benign tumors of the scrotum is operative.
Malignant tumors of the scrotum
Neoplasms of epidermal origin are more often diagnosed. Liposarcomas, neurofibrosarcomas, liiomyosarcomas and rhabdomyosarcomas of the scrotum are less common. Scrotal cancer can be squamous or basal cell. Squamous cell tumors of the scrotum are more common, as a rule, develop against the background of long–existing ulcers and fistulas. With prolonged professional contact with tar, soot, fuel oil and some other carcinogenic substances, they can occur on unchanged skin. It was found that scrotal tumors are more often diagnosed 10-15 years after contact with a carcinogen. The average age of patients is 40-60 years.
In the early stages, squamous cell skin cancer of the scrotum is a dense, painless node. Subsequently, ulceration and infiltration of surrounding tissues are observed. The tumor of the scrotum quickly metastasizes to the inguinal-femoral lymph nodes. Due to the meager clinical symptoms, patients often go to the doctor for the first time only after the appearance of ulcers or the development of pain syndrome caused by the spread of the process to nearby anatomical formations.
Basal cell tumors of the scrotum are diagnosed very rarely, only about 30 cases of this oncological disease are described in the literature. The causes of development and risk factors have not been established. The tumor of the scrotum grows slowly and shows a low tendency to metastasis. The diagnosis of squamous and basal cell scrotal cancer is made on the basis of anamnesis, external examination data, results of ultrasound of the scrotum, ultrasound of the penis, prostate ultrasound, prostate MRI and other studies.
The purpose of these studies is to determine the size and prevalence of scrotal tumors, assess the involvement of regional lymph nodes and nearby organs, as well as differential diagnosis of primary and secondary malignant lesions of the scrotum. The final diagnosis is made after an aspiration biopsy or surgical removal of the scrotum tumor followed by histological examination.
Treatment tactics are determined depending on the prevalence of the oncological process. With local nodes, the scrotal tumor is excised from 2-3 cm of healthy tissue along the periphery and the underlying fleshy layer. In case of major defects, plastic surgery is performed. In the presence of metastases in regional lymph nodes, lymphadenectomy is performed. Indications for preventive removal of lymph nodes have not yet been determined due to the small number of cases of malignant tumor of the scrotum.
Most oncologists, in the absence of obvious signs of metastasis of the scrotum tumor, perform an open or aspiration biopsy of the lymph nodes followed by histological examination, and remove the lymph nodes only when malignant cells are detected in the resulting material. The prognosis is determined by the type and stage of the scrotal tumor. The five–year survival rate for local processes is 75%, with damage to the lymph nodes and nearby organs – 8%.
