Pathology > Study Images > Male Genitals > Testis > Vascular Disturbances
Objectives Anat & Hist Congenital Vascular Neoplasms

III. Vascular Disturbances

Objectives:

After completing this section you will be able to:

  • describe the common vascular disturbances that affect the testis
  • describe clinical features and importance of these lesions

  1. Torsion

The testis may become twisted on the spermatic cord. This results in venous occlusion while arterial blood flow is maintained so that intense vascular engorgement of the testis ensues leading to hemorrhagic infarction. The classic presentation is that of a young child with excruciating testicular pain, often after violent physical activity. Paradoxically, torsion may also occur during sleep. In most cases, torsion is associated with congenital abnormalities that increase the mobility of the testis within the scrotum e.g. high attachment of the tunica vaginalis on the spermatic cord, absence of scrotal ligaments, atrophy of the testis. In some cases, repeated, short-lived episodes of partial vascular occlusion occur. If rapidly diagnosed, the testis may be saved, but frequently it must be excised.

Depending on the duration of the torsion and completeness of vascular obstruction, the organ will vary in appearance from diffuse congestion through widespread interstitial hemorrhage to hemorrhagic infarction of the entire organ, which then forms a sac of hemorrhagic, soft, necrotic tissue. If recurrent episodes of torsion with incomplete venous obliteration occur, the testis becomes atrophic and fibrotic.


Testicular torsion. Bisected organ shows diffuse hemorrhage and necrosis.

Question: Which other organs may undergo torsion and develop hemorrhagic infarction?

  1. Varicocele

This is an abnormal enlargement of the venous plexus within the spermatic cord. This fairly common finding may be associated with infertility. The abnormally high blood flow through the venous plexus increases testicular temperature leading to decreased spermatogenesis. The great majority of varicocele occurs on the left side. The condition results in the formation of a swelling that feels like a "bag of worms" and appears bluish through the skin of the scrotum. It causes a constant pulling, dragging, or dull pain in the scrotum.

Question: What is the name of the venous plexus of the spermatic cord?

Question: Why is varicocele more common on the left than on the right side?

Rarely, renal cell carcinoma of the left kidney extends along the left renal vein and blocks the exit of the testicular vein. A rapidly developing left-sided varicocele should therefore always prompt examination of the left kidney.

Objectives Anat & Hist Congenital Vascular Neoplasms