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CASE REPORT
Year : 2018  |  Volume : 45  |  Issue : 1  |  Page : 34-35

“Cricket ball in the scrotum:” Calcification of old hematoma


1 Department of Surgery, Subbiah Institute of Medical Sciences, Shimoga, Karnataka, India
2 Department of Pathology, Subbiah Institute of Medical Sciences, Shimoga, Karnataka, India

Date of Web Publication27-Jul-2018

Correspondence Address:
Suresh Birur Parmeshwarappa
Department of Surgery, Subbiah Institute of Medical Sciences, Shimoga - 577 222. Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_15_18

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  Abstract 


The intrascrotal calculus was first described during surgery by Kickham in 1935 as a “fibrinoid loose body” or “scrotal pearl.” The etiology of scrotal calculi is unclear. They may develop as a sequela to hematomas or inflammatory changes within the scrotum or loose bodies from torsion and infarction of the appendix testis or epididymis. Hardly few cases were reported in the literature. We present a case of painless right scrotal swelling since 6 years’ duration which gradually increased in size after following trauma. Finally, it is diagnosed as calcified hematoma and excision of the scrotal swelling was carried out after the exclusion of other causes (testicular malignancy) of scrotal swelling.

Keywords: Calcification, old hematoma, scrotal swelling


How to cite this article:
Parmeshwarappa SB, Vadde AR, Balappa IP, Aishwarya D. “Cricket ball in the scrotum:” Calcification of old hematoma. J Sci Soc 2018;45:34-5

How to cite this URL:
Parmeshwarappa SB, Vadde AR, Balappa IP, Aishwarya D. “Cricket ball in the scrotum:” Calcification of old hematoma. J Sci Soc [serial online] 2018 [cited 2018 Dec 12];45:34-5. Available from: http://www.jscisociety.com/text.asp?2018/45/1/34/237754




  Introduction Top


Scrotal calculi, also called scrotal pearls, are freely mobile calcified bodies lying between the layers of tunica vaginalis of the testes. It has been considered to be an infrequent disease.[1] The incidence of scrotal calculi is reported to be 4.3%.[2] They may develop as sequelae to hematomas or inflammatory changes within scrotum or loose bodies from torsion and infarction of the appendix testis or epididymis and from repeated microtrauma.[2] Most literature of intrascrotal lithiasis are case reports; most scrotal calculi are <1.0 cm in diameter and are considered benign and clinically insignificant.


  Case Report Top


Here, a 50-year-old male patient presented with a painless swelling in the right scrotum of 6 years’ duration which gradually increased in size [Figure 1]. The patient gave a history of trauma 6 years ago. There was no history of fever, loss of weight, and no loss of appetite. On examination, the swelling was 6 cm × 4 cm, smooth surface, borders regular, and well made out with no inflammatory signs. On palpation, there was no local rise of temperature or tenderness, hard in consistency, freely mobile, not reducible, penis deviated to the left and it was pure scrotal swelling. The testes, epididymis, and spermatic cords were found normal. There was no enlargement of inguinal or left supraclavicular lymph nodes or intra-abdominal mass. There was no significant history/comorbid illness.
Figure 1: (a) Right scrotal painless swelling. (b) X-ray of pelvis anteroposterior view- calcified mass in the right scrotum

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The X-ray of pelvis anteroposterior view showed calcified mass in the right scrotum, a size of cricket ball [Figure 1]. Ultrasonography revealed 6 cm × 6 cm, well-defined, thin-walled extratesticular calcified lesion at the right scrotal sac, suggestive of changes sequel due to old hematoma and long-standing bilateral minimal hydrocele. Clinically we diagnosed as calcified hematoma of scrotum because of previous trauma and painless swelling. The hard mass was excised from the scrotal incision. Intraoperative picture shows the hard calcified lesion [Figure 2]. The patient is doing well after the surgery. The specimen was sent for histopathological examination. Histopathology revealed fibro-osseous lesion with foci of calcification and hemosiderin macrophages [Figure 2].
Figure 2: (a and b) Intraoperative picture showing the hard calcified lesion. (c) Histopathology revealed fibro-osseous lesion with foci of calcification and hemosiderin macrophages (×10)

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  Discussion Top


Scrotal calcification has been considered to be an infrequent disease.[1] It occurs more commonly in the elderly. Most literature of intrascrotal lithiasis are case reports.[1] It is reported that the incidence of scrotal calculi is 4.3%,[2] and the prevalence was 81% in mountain bikers.[3] The prevalence of scrotal calculi is thought to be lower in the general population. The cause is unclear. It may result from inflammation of tunica vaginalis of testis and remnants of the appendix testis or appendix epididymis that have undergone torsion.[4] Larger molecules of calcium compounds, fibrin, cannot pass through the fibrotic tunica vaginalis of testis membranes and narrow lymphatics. Calculi result from the buildup of these deposits. Most common complaint of the patients with scrotal calculi is scrotal pain. Associated conditions were Hydrocele, varicocele, epididymis cyst, testicular cyst, epididymitis, and testicular microlithiasis. Ultrasound is the ideal method in diagnosing scrotal calculi.[2] What is fascinating in this case is scrotal calcification is of uncommon occurrence. The large size of the calcification in this case is 6 cm × 6 cm (usually they are <1 cm in diameter), presenting as painless swelling for >6 years.


  Conclusion Top


Extratesticular, large solitary calcifications are generally benign. Definitive preoperative diagnosis may be difficult. Diagnosis is based on clinical examination, supportive investigation, and confirmed by means of histopathology. Surgical excision is the treatment of choice.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kickham CT. Calcified hydrocele of the tunica vaginalis testis. N Engl J Med 1935;212:419.  Back to cited text no. 1
    
2.
Namjoshi SP. Calculi in hydroceles: Sonographic diagnosis and significance. J Clin Ultrasound 1997;25:437-41.  Back to cited text no. 2
    
3.
Frauscher F, Klauser A, Stenzl A, Helweg G, Amort B, Zur Nedden D, et al. US findings in the scrotum of extreme mountain bikers. Radiology 2001;219:427-31.  Back to cited text no. 3
    
4.
Sánchez Merino JM, Lancina Martín A, Grases Freixedas F, Parra Muntaner L, Gómez Cisneros SC, García Alonso J, et al. Intra-scrotal lithiasis. Crystallographic analysis. Arch Esp Urol 2002;55:523-6.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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