Case Report |
Corresponding author: Tony George Jacob ( tonygeorgejacob@gmail.com ) © 2024 Dibakar Borthakur, Rima Dada, Rajesh Kumar, Tony George Jacob.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Borthakur D, Dada R, Kumar R, Jacob TG (2024) Scrotoliths in the testicular tunica vaginalis in an elderly male cadaver: clinical implications. Folia Medica 66(4): 574-577. https://doi.org/10.3897/folmed.66.e121058
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Scrotoliths, or “scrotal pearls,” are calcified fibrous loose bodies found within the tunica vaginalis, often seen during radiological evaluation or autopsies. Chronic inflammation due to trauma, parasitic infestations, and torsion and subsequent detachment of the appendices of the testis or epididymis are postulated mechanisms suggested for their formation. They are benign but can mimic a tumor. Scrotoliths can be diagnosed with high-resolution ultrasonography. Here, we report a case in which, during routine dissection, two scrotoliths were found within the tunica vaginalis of the left testis in an elderly male cadaver. Histologically, the central portion of the scrotoliths exhibited concentric collagen lamellae that enclosed calcified remains of tissue debris. There were no arterioles, venules, or microfilarial larvae seen within them. Awareness about the histological findings can help understand the mechanism that led to their formation.
scrotolith, scrotal pearl, scrotal calculus
Scrotoliths, or ‘scrotal pearls’ are calcified fibrous loose bodies found within the tunica vaginalis of the testis; they are often associated with hydrocele. They are found attached to the parietal layer of the tunica vaginalis. They are usually smaller than 1×1 cm in dimension, with a reported incidence of 3.0%–4.3% across the literature.[
Here, we present a case in which two small, hard masses were found within the cavity of the tunica vaginalis (TV) of the left testis during routine cadaveric dissection of a 63-year-old male cadaver. The masses were lying in the small fossae of the left TV cavity near the inferior pole. One was pyramidal in shape, and the other was ovoid (Figs
Gross and micro-anatomical features of scrotal pearls. A. Location of scrotal pearls in the tunica vaginalis cavity marked with red asterisk; B. Scrotal pearls seen as hard, glistening, whitish to pearly white coloured, pyramidal and oval bodies; C, D. H&E stained sections of the scrotal pearls where concentric fibrous lamellae were seen ensheathing smaller similar lamellar bodies with calcified contents in the core of the lamellae appearing as purplish black flakes; a: scrotum; b: glans penis; c: shaft of the penis; d: visceral layer of the left tunica vaginalis; e: tunica vaginalis cavity; f: parietal of the left tunica vaginalis; g: spermatic cord; h: pyramidal scrotal pearl; i: ovoid scrotal pearl; j: outer concentric fibrous lamellae; k: larger lamellar body; l: smaller lamellar bodies; m: calcified necrotic contents.
Size | Weight | |
Small pyramidal | 0.23 cm × 0.17 cm | 0.17 g |
Large ovoid | 0.42 cm × 0.35 cm | 0.29 g |
The tissue was processed for paraffin embedding without subjecting it to the decalcification process. Histological examinations were performed using hematoxylin and eosin (H&E), periodic acid-Schiff (PAS), and Masson’s trichrome (MT) staining techniques. [
A, B. Photomicrographs of periodic acid-Schiff stained section of a scrotal pearl showing concentric fibrous lamellae in light pink and heterogeneous calcified core in dark purple colour; C, D. photomicrographs of Masson’s trichrome stained section of scrotal pearl showing fibrous lamellae in green and calcified contents in dark purple. Black asterisks denote the outermost cellular layer.
During routine cadaveric dissection, we found two scrotoliths in the tunica vaginalis of the left testis. Scrotoliths have been recorded in medical literature for nearly a century, but their etiopathogenic mechanisms are still mostly unknown. During the early 20th century, Kickcham described a giant scrotolith that he had found in a patient.[
In our case, the cells in the fibrous capsule of the scrotoliths were likely to have been fibroblasts and fibrocytes, as per their morphology.[