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\begin{document}

\title{Multiple nodules in the scrotal wall}



\author[1]{kouki chaima}%
\author[1]{mariem Amouri}%
\author[1]{Hamida Turki}%
\affil[1]{Hedi Chaker Hospital}%


\vspace{-1em}



  
  \date{May 21, 2024}


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\textbf{Title:} Multiple nodules in the scrotal wall

\textbf{Presentation:}

A 52-year-old male with no significant past medical history presented to
our department with multiple scrotal nodules. The lesions had gradually
increased in number and size during the last 2 decades without causing
any discomfort aside cosmetic concern. Physical examination (Fig. 1)
revealed prominent 2 to 20 mm yellowish or white firm papules or nodules
on the scrotum. There were no areas of ulceration, discharge or
infection. Laboratory examination including serum calcium, phosphorus,
thyroid hormone and alkaline phosphatase levels showed no abnormality.

What's your diagnosis?

Histological examination of an excised nodule reveals extensive
intradermal deposition of calcium surrounded by histiocytes without any
cystic structure. The diagnosis of idiopathic scrotal calcinosis (ISC)
was retained and the patient was referred to the surgical department for
wide excision.

Scrotal nodules and cysts are uncommon. Since they are often
asymptomatic, the diagnostic may be delayed for several years or
decades. The aesthetic discomfort represents the main complaint and may
severely affect sexual life. Herein, we repot a rare case of extensive
ISC. It affects dark colored skin men mainly aged from 20 to 40 years
old, suggesting an ethnic susceptibility.~\textsuperscript{1} Despite
many theories that have been developed over the years including
calcification of epidermoid cysts secondary to infections, eccrine
epithelial cysts or degenerated dartos muscle, pathogenesis of scrotal
calcinosis remains controversial. It arises either on pre-existing cysts
like sebaceous cysts or steatocystoma multiplex or develops de novo. The
latter is designated as idiopathic scrotal calcinosis (ISC). The major
difference from calcified cysts is the complete absence of a lining
epithelium.\textsuperscript{2}

There is no association with calcium metabolic diseases or other
systemic comorbidities. \textsuperscript{1} Surgery is the mainstay of
the treatment providing excellent results.\textsuperscript{2}

\textbf{References:}

1-Ahlam A, Hassam B. Scrotal calcinoses {[}in French{]}~\emph{Pan Afr
Med J.~} 2014;18:297.

2-Killedar MM,~Shivani AA,~Shinde U.~Idiopathic scrotal
calcinosis.~\emph{IndianJ Surg} ~2016;~78:~329--~30.

\textbf{Legend figure~:}

Fig1: Multiple yellowish firm nodules on the scrotal wall\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/calcinose-scrotale-1-eonw59uz/calcinose-scrotale-1-eonw59uz}

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\end{figure}

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