PAINLESS SCROTAL MASSES IN THE PEDIATRIC POPULATION - PREVALENCE AND AGE DISTRIBUTION OF DIFFERENT PATHOLOGICAL CONDITIONS - A 10-YEAR RETROSPECTIVE MULTICENTER STUDY

Purpose: In the pediatric population a broad spectrum of intrascrotal pathology ranging from congenital to neoplastic lesions can present as a painless scrotal mass. The aim of our 10-year retrospective study w as to review 71 pediatric cases of a painless scrotal mass to determin e the overall and age specific prevalence of diseases manifesting as s uch masses. Materials and Methods: From 1980 to 1991, 71 patients 1 da y to 16 years old with a painless scrotal mass underwent evaluation us ing 7.5 or 10 MHz. ultrasound probes with transverse and longitudinal sections. Results: The painless scrotal mass was testicular in 61 case s (86%, 28 neoplasms, 27 congenital malformations, and 6 posttraumatic /inflammatory lesions) and extratesticular in 10 (14%, 5 neoplasms, 2 hematoceles, 2 pachyvaginitis and 1 sebaceous cyst). Patient age distr ibution showed 2 peaks at 0 to 1-year and 13 to 14-year intervals. Mor e than a third of the painless scrotal masses (24 cases) were found du ring the first year of life, predominantly congenital anomalies (in ut ero torsion) and neoplasia. A total of 45 patients (63%) underwent sur gery (orchiectomy in 39 and conservative treatment in 6) and a pathogn omonic echo pattern allowed nonsurgical treatment in 26 (37%). Conclus ions: Testicular ultrasound proved to be highly reliable in differenti ating intratesticular from extratesticular lesions but it demonstrated poor specificity because of extensive overlap between benign and mali gnant pathologies. Therefore, testicular ultrasound changed the manage ment of a few select cases of a painless scrotal mass (epididymal cyst s/spermatoceles and in utero torsion).