Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment

Scrotal calcinosis (SC) is a rare, benign entity defined as the presence of multiple calcified nodules within the scrotal skin. In most cases, there are no associated symptoms. We report the case of 27-year-old man with a massive SC. Treatment was surgical with complete excision of the affected part of the scrotum wall. Histopathologically, there was no epithelial lining around the calcified nodules and no cystic structure. Therefore, our case was considered idiopathic SC.     

Idiopathic Sporadic Tumoral Calcinosis of the Hip: Successful Oral Bisphosphonate Therapy

ObjectiveTo report the case of a woman with idiopathic sporadic tumoral calcinosis treated successfully with orally administered bisphosphonates.MethodsWe report the clinical, laboratory, and imaging findings and describe the clinical course of tumoral calcinosis. The literature was reviewed for the pathophysiologic features and strategies for treatment of tumoral calcinosis. In addition, we specifically reviewed the use of bisphosphonates in tumoral calcinosis and the possible pharmacologic basis for the therapeutic benefit.ResultsA 45-year-old woman presented with a 6-week history of left-sided pain in the hip in conjunction with stiffness after a trivial fall 4 weeks before the onset of symptoms. The findings on conventional radiology of the hip joint were consistent with tumoral calcinosis of the left hip. The biochemical profile of the patient was unremarkable. Oral treatment with alendronate, 70 mg once a week, yielded alleviation of symptoms within 12 weeks. Radiology of the left hip repeated after a period of 15 months revealed notable regression of the calcified lesion.ConclusionBisphosphonate therapy may be considered as an alternative to surgical treatment in patients with idiopathic sporadic tumoral calcinosis. (Endocr Pract. 2007;13:182-186)     

The evolutionary history of testicular externalization and the origin of the scrotum

This paper re-examines the evolution of the scrotum and testicular descent in the context of the recent phylogeny of mammals. The adaptive significance of testicular descent and scrotality is briefly discussed. We mapped four character states reflecting the position of testes and presence of scrotum onto recent mammalian phylogeny. Our results are interpreted as follows: as to the presence of testicondy in Monotremata and most of Atlantogenata, which represent the basal group of all eutherians, we argue that primary testicondy represents a plesiomorphic condition for Eutheria as well as for all mammals. This is in opposition to the previous hypothesis of Werdelin and Nilsonne that the scrotum may have evolved before the origin of mammals and then repeatedly disappeared in many groups including monotremes. We suggest that the scrotum evolved at least twice during the evolutionary history of mammals, within Marsupialia and Boreoeutheria, and has subsequently been lost by many groups; this trend is especially strong in Laurasiatheria. We suggest that the recent diversity in testicular position within mammals is the result of multiple selection pressures stemming from the need to provide conditions suitable for sperm development and storage, or to protect the male gonads from excessive physical and physiological disturbance.     

Care of the degloved penis and scrotum: a 25-year experience

Injuries to the penis and scrotum are both physically and mentally traumatic. If poorly managed in the acute setting, these injuries may become long-term problems or permanent disabilities. The purpose of this study was to review our approach to degloving injuries of the penis and scrotum and to present our experience. Over the past 25 years, we have cared for eight patients with complete degloving injuries of the genitalia. Farm equipment accidents were responsible for the majority of injuries. We attempted to close all wounds of the denuded penis and near-total avulsed scrotum at the initial operative intervention using the method of repair described. Postoperatively, all patients had an acceptable appearance and normal mictural and erectile function. We conclude that degloving injuries of the penis and scrotum can be best treated with this approach definitively in the acute setting with successful functional and aesthetic results.     

Total reconstruction of a two-compartment scrotum by tissue expansion

A case report is presented showing the reconstruction of a two-compartment scrotum out of hair-bearing perineal skin following a severe degloving injury of the scrotum and testicles. We feel that this is an appropriate procedure to be used in patients who have lost the testicles and scrotum traumatically, either one or both testicles, or in the situation where both testicles have been spared. Aesthetically, the result in this patient is superior to skin grafting and should be readily reproducible.     

Glycosylation pattern in the appendix testis in children with cryptorchidism

In humans, at about week 6, sex cords develop within the forming testes. Testes normally descend to the scrotum; cryptorchidism occurs when one or two testes do not descend to scrotum and in some case are accompanied by the appendix testis. The appendix testis is a small sessile or polypoid structure located at the antero superior pole of the testis, adjacent to the head of the epididymis. Glycans can be involved in development of the appendix testis and cryptorchidism. In this work, lectin histochemistry was used to evaluate glycans expression in appendix testis in children with cryptorchidism. Our results showed that lectin from Lens culinaris, Ulex europaeus I., Canavalia ensiformis, Artocarpus integrifolia, Glycine max, and Griffonia simplicifolia recognizes epithelial and estromal cells. Not interaction was observed with lectin from Amaranthus leucocarpus, while lectin from Dolichus biflorus lectin only recognizes epithelial cells. Our results suggest that O-glycans linked in some glycoproteins represent important elements in appendix testis development.     

Role of fine needle aspiration cytology in nonneoplastic testicular and scrotal lesions and male infertility

OBJECTIVE: To study the role of fine needle aspiration (FNA) in male infertility and in nonneoplastic lesions of the testis and scrotum. STUDY DESIGN: In a retrospective study over a 5-year period, 164 cases of FNA of testicular and scrotal nonneoplastic lesions were retrieved. Aspiration was performed with a 23-gauge needle on a 20-mL syringe. RESULTS: Of 164 cases, 27 (16%) remained inconclusive; they were mainly from epididymal lesions. The remaining 137 cases were categorized as inflammatory lesions, 52 (31.7%); noninflammatory lesions, 42 (25.6%); and infertility cases, 43 (26.2%). Among the inflammatory lesions, 33 cases had nonspecific inflammation, 13 had granulomatous epididymoorchitis, 3 cases were of spermatic granuloma, and 3 cases revealed microfilariae. Noninflammatory lesions included 25 cases of spermatocele, 8 of hematoma/torsion, 5 of hydrocele, 3 of benign epididymal cyst and 1 of calcinosis cutis. Among the patients investigated for infertility, 23 (53%) had normal spermatogenesis, 6 (14%) had Sertoli cells only, 5 (119%) had maturation arrest, 6 (14%) showed hypospermatogenesis, and 3 (7%) showed an atrophic pattern. CONCLUSION: FNA of the testis and scrotum is a simple, quick, minimally invasive and painless outpatient procedure. The sample obtained is more representative than biopsy as several separate punctures can be made, and there is no local scarring.     

A novel mitotic spindle pole component that originates from the cytoplasm during prophase

Several unique aspects of mitotic spindle formation have been revealed by investigation of an autoantibody present in the serum of a patient with the CREST (calcinosis, Raynaud's phenomenon, esophageal dysmotility, schlerodacytyly, and telangiectasias) syndrome. This antibody was previously shown to label at the spindle poles of metaphase and anaphase cells and to be absent from interphase cells. We show here that the serum stained discrete cytoplasmic foci in early prophase cells and only later localized to the spindle poles. The cytoplasmic distribution of the antigen was also seen in nocodazole-arrested cells and prophase cells in populations treated with taxol. In normal and taxol-treated cells, the microtubules appeared to emanate from the cytoplasmic foci and polar stain, and in cells released from nocodazole block, microtubules regrew from antigen-containing centers. This characteristic distribution suggests that the antigen is part of a microtubule organizing center. Thus, we propose that a prophase originating polar antigen functions in spindle pole organization as a coalescing microtubule organizing center that is present only during mitosis. Characterization of the serum showed reactions with multiple proteins at 115, 110, 50, 36, 30, and 28 kD. However, affinity-eluted antibody from the 115/110-kD bands was shown to specifically label the spindle pole and cytosolic foci in prophase cells.     

Polypeptide GalNAc-transferase T3 and familial tumoral calcinosis. Secretion of fibroblast growth factor 23 requires O-glycosylation

Mutations in the gene encoding the glycosyltransferase polypeptide GalNAc-T3, which is involved in initiation of O-glycosylation, were recently identified as a cause of the rare autosomal recessive metabolic disorder familial tumoral calcinosis (OMIM 211900). Familial tumoral calcinosis is associated with hyperphosphatemia and massive ectopic calcifications. Here, we demonstrate that the secretion of the phosphaturic factor fibroblast growth factor 23 (FGF23) requires O-glycosylation, and that GalNAc-T3 selectively directs O-glycosylation in a subtilisin-like proprotein convertase recognition sequence motif, which blocks processing of FGF23. The study suggests a novel posttranslational regulatory model of FGF23 involving competing O-glycosylation and protease processing to produce intact FGF23.     

The histochemistry of complex carbohydrates in the scrotum of the boar

Summary In the scrotal skin of the boar, the histochemistry of complex carbohydrates has been studied by means of a series of selected methods of light microscopy. The epidermis of the scrotal skin was found to contain neutral and acidic complex carbohydrates with different saccharide residues. The secretory epithelial cells and secretory substances of the saccular apocrine sweat glands contained sulfated, other acidic and neutral complex carbohydrates, whereas the secretory epithelial cells and secretory substances of the tubular apocrine sweat glands involved largely neutral complex carbohydrates. The two types of complex carbohydrates from the both glands were shown to contain commonly substantial amounts of various saccharide residues but were devoid of notable amounts of sialic acid residues. In addition, complex carbohydrates in the smooth muscle cells were reacted for relatively small amounts of saccharide residues. From the present results, the histophysiological significanses of complex carbohydrates in the particular histologic structures of the scrotum have been discussed with special reference to the functions of the skin in the boar.A major part of this work has been presented at the 6th International Histochemistry and Cytochemistry Congress, Brighton, United Kingdom, in 1980     

Sweat glands of the scrotum of the bull

Skin samples were taken post mortem from the scrotum, abdomen and neck of 4 mature bulls. The volume of sweat glands per unit skin surface area of the scrotum was greater than that of other body regions. Within the scrotum there was a gradient in sweat gland volume increasing from proximal through to distal parts of the scrotum. These results suggest a previously unidentified variable cooling capacity of the scrotum depending on testicular descent.     

阴囊黄癣痂样石膏样小孢子菌感染1例

报道1例石膏样小孢子菌感染引起阴囊黄癣痂样皮损。患者,男,20岁,阴囊黄色痂皮3周。皮损取材真菌镜检可见分隔菌丝,培养为石膏样小孢子菌。口服伊曲康唑200mg/d,连续2周。停药时皮损消退,真菌学检查阴性。     

Sex determination in the common marmoset (Callithrix jacchus).

The general morphology of the external genitalia was examined in 43 common marmosets (Callithrix jacchus) ranging in age from newborn to adult. At birth, the scrotum was a small irregular fold of skin on either side of the caudal aspect of the penis. The testes were not present in the scrotum until 8--11 months of age. The scrotum covered the penis in the adult male, was devoid of fur, was covered by pearly while nodules, and presented a median raphe. In the young female, the pudendal pad closely resembled the scrotum of the male. The vulva was pendulous, and the small vestibular opening was located near its most ventral aspect and closely resembled the preputial opening of the male. In the adult female, the pudendal pad was pendulous, was studded with white nodules, and closely resembled the scrotum of the male. Sex determination by casual observation resulted in numerous errors. Accurate sex determination was based on differences in the preputial and vestibular openings, demonstration of the glans penis in the prepuce, and palpation of the testes in the scrotum or inguinal region.     

Calcinosis cutis in chronic renal failure diagnosed by fine needle aspiration. A case report

BACKGROUND: Deposition of calcium salts in the skin and subcutis, referred to as calcinosis cutis, is a common complication in patients with end-stage renal disease. The lesion can present as a mass and is amenable to fine needle aspiration (FNA). CASE: A 48-year-old man undergoing hemodialysis following a failed renal transplant presented with a 1.5-cm neck nodule. A diagnosis of calcinosis cutis was made following FNA, which obtained semiliquid, chalky material. CONCLUSION: In cytologic preparations, deposits of calcium salts can be both amorphous and refractile on Diff-Quik and Papanicolaou stain. However, the material may not be birefringent with these stains. Alizarin red S stain for calcium will permit demonstration of the characteristic birefringence.     

Lactoferrin differently modulates the inflammatory response in epithelial models mimicking human inflammatory and infectious diseases

Conflicting data are reported on pro- or anti-inflammatory activity of bovine lactoferrin (bLf) in different cell models as phagocytes or epithelial cell lines infected by bacteria. Here we evaluated the bLf effect on epithelial models mimicking two human pathologies characterized by inflammation and infection with specific bacterial species. Primary bronchial epithelium from a cystic fibrosis (CF) patient and differentiated intestinal epithelial cells were infected with Pseudomonas aeruginosa LESB58 isolated from a CF patient and Adherent-Invasive Escherichia coli LF82 isolated from a Crohn’s disease patient. Surprisingly, bLf significantly reduced the intracellular bacterial survival, but differently modulated the inflammatory response. These data lead us to hypothesize that bLf differentially acts depending on the epithelial model and infecting pathogen. To verify this hypothesis, we explored whether bLf could modulate ferroportin (Fpn), the only known cellular iron exporter from cells, that, by lowering the intracellular iron level, determines a non permissive environment for intracellular pathogens. Here, for the first time, we describe the bLf ability to up-regulate Fpn protein in infected epithelial models. Our data suggest that the mechanism underlying the bLf modulating activity on inflammatory response in epithelial cells is complex and the bLf involvement in modulating cellular iron homeostasis should be taken into account.     

Isolation of chromosomal regions controlling intersex development in a marsupial

A marsupial (Sminthopsis douglasi) with bilateral intersexuality had a hemiscrotum on the right side and a hemi-pouch with nipples on the left. A normal female karyotype (2n = 14, XX) was present in cells from the right (male) side, while cells from the left (female) side initially had a female karyotype plus two dot-like chromosomes (2n = 14, XX + 2B). It is proposed that the dots represented a region deleted from the X chromosome that contains the "pouch-mammary/scrotum" (PMS) switch gene whose dosage determines development of a pouch and teats (two doses) or a scrotum (one dose). Mis-segregation early in embryonic development produced a lineage with one normal X and one deleted X (male side), and a lineage with a normal and deleted X, plus two copies of the deleted region (female side). The origin of the supernumerary elements was therefore investigated in the expectation that they may contain the long-sought pouch-mammary/scrotum switch gene. Several elements were microdissected, and amplified DNA was used for in situ hybridization, producing signals in five different chromosome regions including the X. This could represent a region of the X that contains, as well as PMS, repetitive DNA that is present also at other chromosomal sites.     

GLYCOSYLATION PATTERN IN THE APPENDIX TESTIS IN CHILDREN WITH CRYPTORCHIDISM

In humans, at about week 6, sex cords develop within the forming testes. Testes normally descend to the scrotum; cryptorchidism occurs when one or two testes do not descend to scrotum and in some case are accompanied by the appendix testis. The appendix testis is a small sessile or polypoid structure located at the antero superior pole of the testis, adjacent to the head of the epididymis. Glycans can be involved in development of the appendix testis and cryptorchidism. In this work, lectin histochemistry was used to evaluate glycans expression in appendix testis in children with cryptorchidism. Our results showed that lectin from Lens culinaris, Ulex europaeus I., Canavalia ensiformis, Artocarpus integrifolia, Glycine max, and Griffonia simplicifolia recognizes epithelial and estromal cells. Not interaction was observed with lectin from Amaranthus leucocarpus, while lectin from Dolichus biflorus lectin only recognizes epithelial cells. Our results suggest that O-glycans linked in some glycoproteins represent important elements in appendix testis development.     

VACTERL-H associated with central hypothyroidism: a case report

The VACTERL-H syndrome is a rare combination of vertebral anomalies, anal atresia, congenital heart defects, tracheo-esophageal fistula, abnormalities of kidneys and limb anomalies together with hydrocephalus. This condition is recognized as a hereditary entity with poor prognosis. We present a newborn weighing 3400 g, born by cesarean section to a 27 years old mother who had had an irregular antenatal follow-up. The patient had severe hydrocephalus, proximal esophageal atresia and distal tracheoesophageal fistula, gastric outlet obstruction, imperforated anus and recto-urethral fistula, patent ductus arterious, a bifid scrotum, a vertebral defect, sacral dimple and central hypothyroidism. The patient had no limb defects. The association of central hypothyroidism and VACTERL-H has previously not been reported.     

Calcinosis and metastatic calcification due to vitamin D intoxication. A case report and review.

Vitamin D, a fat-soluble vitamin, can be associated with significant morbidity when prescribed in large doses. We describe a hypoparathyroid patient with vitamin D intoxication who developed painful periarticular calcinosis, nephrocalcinosis with hypertension and chronic renal failure in addition to band keratopathy and hearing loss. He was treated with combination therapy including prednisone, phosphate-binding antacid, phenytoin and disodium etidronate. After 20 months of follow-up there was a significant reduction of periarticular calcinosis, but no improvement in renal function, band keratopathy or hearing loss and possible calcification of the ossicles. The clinicopathologic features of metastatic calcification and the various treatment modalities are reviewed.