Segmental Infarction of the Testis: Report of Three Cases

Abstract

Segmental testicular infarction is a rare cause of acute scrotum and can easily masquerade as a tumor on ultrasonography and color Doppler imaging. The present report of three cases describes three patients with segmental testicular infarction, which were all suspicious for tumor on ultrasonography/color Doppler imaging. All of the cases were finally diagnosed by pathological examination. It is hypothesized that if the arterial flow is impaired because of abnormalities in arteries, excessive intrascrotal movement of testis, torsion and detorsion (which are all risks with the bell-clapper anomaly) or an unobserved interruption of an arterial blood flow during operations, predisposition to a partial infarct will result, mostly in the upper pole of the testis. In this report, first case of infarction was in the center of the testis, second one in the lower pole and third in the upper pole. Third case had a small concurrent seminoma which was discovered microscopically on the permanent HE slides of the intraoperative biopsy. We could not find such a case in the literature. It is debatable if the cause of the infarction in this case is because of an anomaly in some vessel or because of the possible cancer-associated thrombosis of the adjacent seminoma. Diagnosis of segmental testicular infarction is a radiological problem in standard practice and the final diagnosis still belongs to the pathologist. Intraoperative biopsy is a fiducial option for correct diagnosis of the segmental lesion in testis of unsure origin.