Genital Lesions: A Photo Essay-Part 2

Exploration of this acutely swollen testis in a 13-year old found it to be engorged and hemorrhagic. Torsion of the testis is caused by faulty fixation of the testis to the scrotum-the result of a redundant tunica vaginalis-and is a surgical emergency. The testis is untwisted and fixed to the scrotum. A contralateral orchiopexy is also typically performed.

Courtesy of Alexander K.C. Leung and C Pion Kao, MD.  

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A concealed penis (A) may be caused by excess peripubic fat; a deficiency of penile shaft skin; and poor attachment of the penile skin and dartos fascia to the Buck fascia and corporeal bodies. The penis typically becomes noticeable when pressure is applied to adjacent skin (B).

Courtesy of Alexander K.C. Leung and C Pion Kao, MD.  

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Any itchy penile rash should immediately suggest scabies. A scraping from one of the papules seen here disclosed an adult scabies mite and confirmed the diagnosis. The young man's hands were also affected.

Courtesy of Ted Rosen, MD  

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{C}

This 5-year old uncircumsized boy presented with penile pain and a yellow discharge from the penis. The foreskin and glans were warm, erythematous, tender, and suppurative, consistent with balanoposthitis-infection of the glans and foreskin. Recurrent balanoposthitis is an indication for circumcision.

Courtesy of Alexander K.C. Leung and C Pion Kao, MD.  

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{C}

This erythematous, fluctuant scrotal abscess was exquisitely tender. Lymph nodes in the groin also may be affected. Incision and drainage of the mass revealed frank pus and culture grew Staphylococcus aureus. A scrotal abscess may mimic testicular torsion (see image #1) in infants and neonates.

Courtesy of Alexander K.C. Leung and C Pion Kao, MD.  

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{C}

Desquamation of the skin of the genitalia is a characteristic feature of scarlet fever and may occur as the condition improves. The hyperpigmentation of the skin and the Pastia lines in the inguinal areas also are seen commonly in this disease. This 5-year old boy's recovery was uneventful.

Photo courtesy of Robert Blereau, MD  

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Sebaceous gland hyperplasia of the penis typically presents as soft, yellowish papules, 1 to 3 mm in diameter, on the dorsal surface of the distal penile shaft, as shown here. The clinical differential diagnosis includes sebaceous adenoma, milia, lichen planus, lichen nitidus, pearly penile papules, and warts. The condition asymptomatic and benign.

Courtesy of Alexander K.C. Leung and C Pion Kao, MD  

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The mass in the left side of this 12-year-old boy's scrotum felt like a bag of worms-a characteristic presentation of a varicocele. A varicocele results from incompetent valves in the spermatic vein. The slight discoloration seen in this case is a result of the distention and tortuosity of the pampiniform plexus.

Courtesy of Alexander K.C. Leung and C Pion Kao, MD.  

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