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Lin Z, Lin R, Wu H, Wu L, Zeng J, Xu J, Dong F. Elastography for the differential diagnosis of malignant versus benign testicular lesions: a meta-analysis. Ultrasonography 2021; 40:465-473. [PMID: 33966362 PMCID: PMC8446503 DOI: 10.14366/usg.20191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the value of elastography in the differential diagnosis of benign versus malignant testicular lesions. METHODS The PubMed, Cochrane Library, and Embase databases were searched for relevant studies. The diagnostic accuracy of elastography was evaluated using pooled sensitivity, specificity, likelihood ratio, post-test probability, diagnostic odds ratio, and by summarizing the area under the hierarchical summary receiver operating characteristic (HSROC) curve. RESULTS Seven studies with 568 lesions were included. The pooled sensitivity and specificity were 87% (95% confidence interval [CI], 81% to 92%) and 81% (95% CI, 65% to 90%), respectively. The pooled estimates of the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 4.48 (95% CI, 2.37 to 8.47), 0.16 (95% CI, 0.10 to 0.25), and 28.11 (95% CI, 11.39 to 69.36), respectively. The area under the HSROC curve was 90% (95% CI, 88% to 93%). CONCLUSION Elastography is useful for assessing the stiffness of testicular lesions and for differentiating benign from malignant lesions. Elastography can be an effective supplement to conventional ultrasonography.
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Affiliation(s)
- Ziwei Lin
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Rui Lin
- Department of Ultrasound, Shenzhen Luohu Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Huaiyu Wu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Linghu Wu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jieying Zeng
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
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Almassry HN, Basha MAA, Zaitoun MMA, Abdelazim M, Harb OA, Aly SA. The validity of grayscale and color Doppler ultrasound in assessment of scrotal swellings: a retrospective study in a large case series. Acta Radiol 2021; 62:266-275. [PMID: 32336118 DOI: 10.1177/0284185120916836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Scrotal swellings have a non-specific clinical picture, so their clinical diagnosis is challenging. Scrotal grayscale and color Doppler ultrasound are non-invasive methods used in both adult and childhood groups and act as accurate screening and diagnostic modalities. PURPOSE To evaluate the diagnostic validity of grayscale and color Doppler ultrasound in the assessment of scrotal swelling to reach accurate diagnosis. MATERIAL AND METHODS A retrospective study included 181 patients (mean age = 35.5 ± 7.3, age range = 1-71 years) with scrotal swelling. Examinations were performed by an experienced radiologist using grayscale and color Doppler ultrasound. The diagnostic validity of grayscale and color Doppler ultrasound for diagnosing scrotal swelling were estimated using surgical findings, histopathological results, and imaging and clinical follow-up as reference standards. RESULTS Overall, 202 scrotal swellings were detected. The final diagnoses were 13 (6.4%) malignant and 189 (93.6%) benign alterations. Varicocele was the most common scrotal swelling (26%), followed by hydrocele (23.8%). Matched to the reference standards, grayscale and color Doppler ultrasound represented a sensitivity of 84.6% (95% confidence interval [CI] = 54.6-98.1), a specificity of 76.2% (95% CI = 69.5-82.1), a positive predictive value of 19.6% (95% CI = 10.2-32.4), and a negative predictive value of 98.6% (95% CI = 95.1-99.8) for diagnosing scrotal tumors. CONCLUSION Scrotal grayscale and color Doppler ultrasound provide high diagnostic validity for assessment of scrotal swellings.
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Affiliation(s)
- Hosam Nabil Almassry
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed MA Zaitoun
- Department of Radiodiagnosis, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Abdelazim
- Department of Urology, Faculty of Human Medicine, Benha University, Benha, Egypt
| | - Ola A Harb
- Department of Pathology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Sameh Abdelaziz Aly
- Department of Radio-diagnosis, Faculty of Human Medicine, Benha University, Benha, Egypt
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Deeg KH. Differential Diagnosis of Acute Scrotum in Childhood and Adolescence with High-Resolution Duplex Sonography. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:10-38. [PMID: 33530122 DOI: 10.1055/a-1325-1834] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acute testicular pain in childhood can be caused by testicular torsion, torsion of the appendix testis, or epididymo-orchitis. Quick and reliable diagnosis is essential for determining the further course of action (surgery or conservative approach). The diagnostic tool of choice is high-resolution sonography with a linear transducer (> 10 MHz) combined with color and spectral Doppler sonography. The Doppler device settings should include a low pulse repetition frequency (< 4 cm/s), a low wall filter (< 100 Hz), and adequate gain. Comparison with the unaffected healthy testis is essential. The most important of the three diseases is torsion of the spermatic cord because it requires immediate surgical intervention and detorsion. The affected testis is enlarged and has an inhomogeneous echotexture with hypoechoic and hyperechoic areas as well as an associated hydrocele. In testicular torsion, color Doppler shows reduced or absent intratesticular vessels in comparison with the healthy contralateral testis. Spectral Doppler shows decreased flow velocities especially during diastole in intratesticular arteries and an increased resistance index. The investigation should always include imaging of the spermatic cord from the outer inguinal ring to the upper pole of the testis. In contrast to a normal finding, the vessels and the ductus deferens are not displayed as linear tubular structures but in form of a spiral twist. Ultrasound shows a target-like structure with multiple concentric rings. Color Doppler sonography shows the typical whirlpool sign. In torsion of the appendix testis, the appendix testis is enlarged in the groove between the testis and epididymis. The longitudinal diameter of the appendix testis can be greater than 5 mm. The echogenicity of the torsed appendage can vary between hypoechoic (acute torsion) and hyperechoic (prior torsion). An associated hydrocele of varying size is usually seen. Color Doppler sonography reveals a lack of perfusion of the enlarged appendix testis and increased vascularity of the testis and primarily the epididymis. Epididymo-orchitis is characterized by an enlarged epididymis and/or testis with inhomogeneous echogenicity (hypoechoic - hyperechoic). Color Doppler sonography shows increased vascularity in comparison with the unaffected testis. Spectral Doppler reveals increased diastolic flow velocities and a decreased resistance index. Idiopathic scrotal edema and an incarcerated inguinal hernia must be ruled out in the differential diagnosis.
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Affiliation(s)
- Karl-Heinz Deeg
- Pediatric Clinic, University of Erlangen-Nuremberg, Erlangen, Germany
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Ehman D, Mugarab Samedi V, Kalaniti K, Daspal S. Neonatal Escherichia coli infection in twins: clinical spectrum and management dilemma. BMJ Case Rep 2021; 14:14/1/e238470. [PMID: 33504527 PMCID: PMC7843350 DOI: 10.1136/bcr-2020-238470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The clinical manifestation of Escherichia coli could vary from asymptomatic bacteraemia to systemic bloodstream infection and meningitis. We describe an unusual course of E. coli infection in twins, emphasising commencement of appropriate antimicrobial therapy. A set of male dichorionic diamniotic twins were delivered at 34 weeks of gestation by caesarian section. Pregnancy was complicated by diabetes, pre-eclampsia and cholestasis. Antenatal ultrasounds noted a congenital pulmonary airway malformation in twin A. Following delivery, twin A developed respiratory distress, but twin B was asymptomatic. Partial septic work-up at admission in the neonatal intensve care unit was done. Twin A's blood culture grew E. coli, while twin B's blood culture was negative. Twin A was treated with 7 days of intravenous antibiotics. At 11 days of age, twin B acutely developed a scrotal swelling. On suspicion of testicular torsion, he was taken for urgent surgery, which revealed a scrotal abscess positive for E. coli The scrotum was irrigated and successfully treated with 4 weeks of antibiotics. Both twins were doing well at 3 months of follow-up.
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Affiliation(s)
- Dylan Ehman
- Royal University Hospital, Saskatoon, Saskatchewan, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Veronica Mugarab Samedi
- Royal University Hospital, Saskatoon, Saskatchewan, Canada .,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kaarthigeyan Kalaniti
- Royal University Hospital, Saskatoon, Saskatchewan, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sibasis Daspal
- Royal University Hospital, Saskatoon, Saskatchewan, Canada.,College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Garolla A, Pizzol D, Carosso AR, Borini A, Ubaldi FM, Calogero AE, Ferlin A, Lanzone A, Tomei F, Engl B, Rienzi L, De Santis L, Coticchio G, Smith L, Cannarella R, Anastasi A, Menegazzo M, Stuppia L, Corsini C, Foresta C. Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple. Front Endocrinol (Lausanne) 2021; 11:591837. [PMID: 33542705 PMCID: PMC7851076 DOI: 10.3389/fendo.2020.591837] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023] Open
Abstract
Capsule This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems. Background Infertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply. Objective The aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems. Methods Prominent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called "InfertilItaly group", used available evidence to develop this expert position. Outcomes Starting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures. Conclusions This expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.
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Affiliation(s)
- Andrea Garolla
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Damiano Pizzol
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
- Italian Agency for Development Cooperation, Public Health, Jerusalem, Israel
| | - Andrea Roberto Carosso
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Torino, Italy
| | - Andrea Borini
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | | | - Aldo Eugenio Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Lanzone
- Department of Woman’s Health Sciences of the Child and Public Health, Unit of Obstetrics Pathology, University Clinic Foundation “A Gemelli” IRCCS, Rome, Italy
- Clinic of Obstetrics and Gynecology, Catholic University Sacro Cuore, Rome, Italy
| | - Francesco Tomei
- Assisted Reproductive Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Bruno Engl
- Donna Salus, Center for Women’s Health and Fertility, Bolzano, Italy
| | - Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Lucia De Santis
- IVF Unit, Gynaecological-Obstetric Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
- Italian Society of Embryology, Reproduction and Research (SIERR), Giarre, Italy
| | - Giovanni Coticchio
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | - Lee Smith
- The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Attilio Anastasi
- Center for Physiopathology of Human Reproduction, Delta Hospital, Lagosanto, Italy
| | - Massimo Menegazzo
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Christian Corsini
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
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Le MT, Nguyen TTT, Nguyen DN, Tran TNQ, Nguyen VQH. Endocrine Tests and/or Testicular Volume are Not Predictive of Successful Sperm Retrieval by Conventional Multiple Testicular Sperm Extraction in Nonobstructive Azoospermia. FERTILITY & REPRODUCTION 2020. [DOI: 10.1142/s266131822050019x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives: This study aimed to determine the role of presurgical markers in the prediction of sperm retrieval by conventional Multiple Testicular Sperm Extraction in infertile Vietnamese men with nonobstructive azoospermia (NOA). Patients and Methods: Retrospective descriptive analysis of 136 infertile men with azoospermia, examined from August 2014 to July 2018. Patients underwent stepwise surgical sperm retrieval via percutaneous epididymal sperm aspiration, testicular sperm aspiration, then conventional multiple testicular sperm extraction in up to three locations, and procedures stopped as soon as sperm were detected. Factors were analyzed to determine the prediction of the likelihood of successful sperm retrieval, in men with NOA. Results: The overall success rate of sperm retrieval in men with azoospermia was 49.3%, but it was only 18.4% in NOA group. The difference in testicular volume between men with successful sperm retrieval and unsuccessful sperm retrieval was not statistically significant in NOA group (5.68 ± 2.37 vs. 4.46 ± 2.83, p = 0.138). The differences in the endocrine tests between the two groups were also not significant in terms of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone (p [Formula: see text] 0.05). Multivariable analysis of predictive factors of sperm retrieval in NOA groups found no significant difference, except testicular density (p = 0.015). Conclusions: In infertile men with NOA, neither an endocrine test nor testicular volume should be used for predicting the results of surgical sperm retrieval by conventional multiple testicular sperm extraction.
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Affiliation(s)
- Minh Tam Le
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Vietnam
- Department of OBGYN, Hue University of Medicine and Pharmacy, Hue University, Vietnam
| | - Thi Thanh Tam Nguyen
- Department of Diagnostic Imaging, Hue University of Medicine and Pharmacy, Hue University, Vietnam
| | - Dac Nguyen Nguyen
- Department of OBGYN, Hue University of Medicine and Pharmacy, Hue University, Vietnam
| | - Thi Nhu Quynh Tran
- Center for Reproductive Endocrinology and Infertility, Hue University of Medicine and Pharmacy, Hue University, Vietnam
| | - Vu Quoc Huy Nguyen
- Department of OBGYN, Hue University of Medicine and Pharmacy, Hue University, Vietnam
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Liu MY, Gray E, Hahn ME, Shiehmorteza M. Scrotal Ultrasound: Updates on Testicular Microlithiasis, Incidental Non-Palpable Lesions, Varicoceles and Testicular Infarction. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yang DM, Choi HI, Kim HC, Kim SW, Moon SK, Lim JW. Small testes: clinical characteristics and ultrasonographic findings. Ultrasonography 2020; 40:455-463. [PMID: 33455146 PMCID: PMC8217805 DOI: 10.14366/usg.20133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/03/2020] [Indexed: 11/09/2022] Open
Abstract
The purpose of this pictorial essay is to describe the ultrasonographic and clinical findings of patients with small testes due to a wide range of causes. We retrospectively reviewed the ultrasonographic and clinical findings of various causes of small testes. We present various causes of small testes on ultrasonography including Klinefelter syndrome, testicular torsion, mumps orchitis, inguinal hernia, cryptorchidism, varicocele, and trauma. On ultrasonography, small testes in patients with testicular torsion, mumps orchitis, and trauma usually showed heterogeneous echogenicity. Atrophic testes were homogeneously hypoechoic in patients with cryptorchidism and inguinal hernia and were isoechoic to the normal testis in patients with varicocele. Klinefelter syndrome patients had small hyperechoic or hypoechoic nodules, but the echogenicity of the remnant portion of the testes was homogeneous. Ultrasonography is helpful for detecting small testes and for the differential diagnosis of the various possible causes of small testes.
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Affiliation(s)
- Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyeon-Il Choi
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sung Kyung Moon
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Joo Won Lim
- Department of Radiology, Kyung Hee University Hospital, Seoul, Korea
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Lodha M, Badkur M, Garg P, Puranik A, Chaudhary R, Rodha MS, Prakash S. Does laparoscopic hernia repair affect the vascularity of testis? J Family Med Prim Care 2020; 9:2465-2468. [PMID: 32754521 PMCID: PMC7380808 DOI: 10.4103/jfmpc.jfmpc_203_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/13/2020] [Accepted: 03/27/2020] [Indexed: 11/04/2022] Open
Abstract
Context Laparoscopic hernia repair, despite its safety and effectivity is related to some drawbacks. Testicular complications are uncommon but serious among them. Testicular atrophy occurs in 0% to 2% of patients after hernioplasty. Aim In this study, we tried to evaluate the effects of laparoscopic total extraperitoneal (TEP) repair on testicular blood flow in Indian population by comparing the testicular perfusion in preoperative and postoperative status. Settings and Design A prospective study. Subjects and Methods A prospective study was conducted among adult male patients having an uncomplicated inguinal hernia. Preoperative and postoperative CDUS evaluation of testicular blood flow was done for each patient. Statistical Analysis Used Data were analyzed using the SPSS (SPSS, Chicago, IL, USA) software program. Results The resistive indexes of testicular, capsular, and intratesticular arteries of the operated and nonoperated side were similar preoperatively and did not differ ominously postoperatively. Conclusion Laparoscopic hernia surgery does not have any significant effect on testicular blood supply and can be advocated safely without any added risk of testicular atrophy.
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Affiliation(s)
- Mahendra Lodha
- Department of General Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Mayank Badkur
- Department of General Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Pavan Garg
- Department of Radiodiagnosis, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Ashok Puranik
- Department of General Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | | | - Mahaveer S Rodha
- Department of Trauma and Emergency, AIIMS Jodhpur, Jodhpur, Rajasthan, India
| | - Satya Prakash
- Department of General Surgery, AIIMS Jodhpur, Jodhpur, Rajasthan, India
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Pozza C, Kanakis G, Carlomagno F, Lemma A, Pofi R, Tenuta M, Minnetti M, Tarsitano MG, Sesti F, Paoli D, Anzuini A, Lenzi A, Isidori AM, Gianfrilli D. Testicular ultrasound score: A new proposal for a scoring system to predict testicular function. Andrology 2020; 8:1051-1063. [PMID: 32445591 PMCID: PMC7497152 DOI: 10.1111/andr.12822] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
Background Testicular ultrasound (US) is routinely employed in the evaluation of reproductive and sexual function. However, its use for characteristics other than testicular volume is hampered by a lack of information on the prognostic value of its findings, which to date have only been incorporated in a score proposed by Lenz et al in 1993. Objectives We sought to explore whether testicular US examination can predict the quality of spermatogenesis and provide information on testicular endocrine function. Materials and methods We retrospectively reviewed 6210 testicular US examinations, finally selecting examinations from 2230 unique men. The following variables were considered: bitesticular volume and testicular asymmetry, parenchymal echotexture, echogenicity and presence of microlithiasis, solid lesions and varicocoele. Concurrent fasting hormonal data were available for 1160 men, while 979 had a semen sample available from the same day as the US examination. Results We derived a new US score, termed TU score, that can predict both impaired spermatogenesis (AUC 0.73, sensitivity 72%, specificity 61%, P < .001) and hypogonadism (AUC 0.71, sensitivity 71%, specificity 53%, P < .001) more accurately than the Lenz's score. In a multivariate analysis, a reduced sperm composite index (defined as total spermatozoa × total motility × normal forms) was independently predicted by bitesticular volume and by inhomogeneous echotexture, while hypogonadism was independently predicted also by reduced echogenicity and presence of microlithiasis. Discussion and conclusions We describe the testicular US characteristics that are independently associated with impaired spermatogenesis and hypogonadism and propose the TU score as a simple screening method for use in subjects referred for testicular US.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - George Kanakis
- Department of Endocrinology, Athens Naval & VA Hospital, Athens, Greece
| | | | - Andrea Lemma
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marta Tenuta
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Maria G Tarsitano
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Donatella Paoli
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Anzuini
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
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Peng Y, Ouyang L, Lin Z, Zhang F, Wang H, Guan J. MRI findings of nonobstructive azoospermia: lesions in and out of pelvic cavity. Abdom Radiol (NY) 2020; 45:2213-2224. [PMID: 31552463 DOI: 10.1007/s00261-019-02232-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nonobstructive azoospermia (NOA) can be caused by various diseases, including congenital disorders, endocrine disorders, infections, tumor or tumor-like diseases, vascular diseases, etc. Diagnosis of the underlying cause of NOA is complicated and challenging. In this study, we introduce an MR examination protocol for the etiological diagnosis of NOA, and demonstrate a series of NOA patients with different causes and imaging findings. Except for lesions of testes, the patients may also combine abnormalities of adrenal glands and central nervous system. In such cases, the patients could benefit from additional abdominal and intracranial scans.
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Affiliation(s)
- Yang Peng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Longyuan Ouyang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Zhi Lin
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Fan Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshanerlu Road, Guangzhou, Guangdong, People's Republic of China.
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Sweet DE, Feldman MK, Remer EM. Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders. Abdom Radiol (NY) 2020; 45:2063-2081. [PMID: 31748822 DOI: 10.1007/s00261-019-02333-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Imaging of the scrotum in the setting of acute symptoms such as pain or swelling is commonly performed emergently to differentiate between patients who require immediate surgery and those that do not. Acute scrotal symptoms are generally caused by infectious, traumatic or vascular etiologies. Rapid diagnosis and initiation of treatment is vital for testicular salvage in cases of acute testicular torsion, testicular rupture, and Fournier gangrene. Epididymitis, epididymo-orchitis, torsed testicular appendage, segmental testicular infarction, scrotal hematomas, testicular neoplasms, and acute idiopathic scrotal edema can have similar clinical presentations, but these conditions do not require immediate surgery. Ultrasound is the well-established first-line imaging modality for the acute scrotum. Contrast-enhanced ultrasound and magnetic resonance imaging can be useful as problem-solving tools when ultrasound studies are inconclusive or equivocal. This review describes normal scrotal anatomy and a wide range acute scrotal disorders, with emphasis on the imaging and clinical features that can minimize the risk of misdiagnosis.
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Affiliation(s)
- David E Sweet
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Myra K Feldman
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Erick M Remer
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Schwarze V, Marschner C, Rübenthaler J, Negrão de Figueiredo G, Clevert DA. Overview of ultrasound applications for assessing scrotal disorders. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1047-1056. [PMID: 31840876 DOI: 10.1002/jum.15197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
The scrotum may be affected by a plethora of different disorders such as infections, vasculopathies, trauma, and manifestations of primary and secondary malignant masses. In addition to the patient's medical history and clinical examination, ultrasound represents the imaging modality of choice to assess scrotal disorders. Time-consuming contrast-enhanced ultrasound and elastography can provide further information to distinguish between benign and malignant testicular mass lesions. The following invited Special Communication gives a comprehensive overview of differential diagnoses of the scrotum and their corresponding sonomorphologic correlates based on representative cases of the Interdisciplinary Ultrasound Center of the University Hospital Munich.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | | | - Dirk-Andre Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
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Thinking beyond hernia: a review of non-hernia groin lumps. Abdom Radiol (NY) 2020; 45:1929-1949. [PMID: 31786622 DOI: 10.1007/s00261-019-02351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With increasing reliance on imaging, a large number of patients presenting with a groin lump are being referred to radiology to confirm the diagnosis of hernia, usually with an ultrasound in the first instance (occasionally MRI or CT). However, when imaging of the groin was performed, we have encountered many different kinds of non-hernia lesions in our practice. Such lesions can be categorized based on their tissue of origin and pathology. A specific diagnosis can often be reached using ultrasonography, MRI or a combination of imaging modalities. This review article will help general, musculoskeletal and abdominal radiologists to understand the anatomy of the groin, diagnose and characterise soft tissue lesions that may present as a groin lump, provide guidance for further imaging and insight into imaging features which may need specific investigations like core biopsy, tertiary referral and review at multidisciplinary meetings.
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Huang DY, Pesapane F, Rafailidis V, Deganello A, Sellars ME, Sidhu PS. The role of multiparametric ultrasound in the diagnosis of paediatric scrotal pathology. Br J Radiol 2020; 93:20200063. [PMID: 32271626 PMCID: PMC10993215 DOI: 10.1259/bjr.20200063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
Multiparametric ultrasound (MPUS), combining conventional techniques (greyscale and colour Doppler ultrasound), ultrasound strain elastography, and contrast-enhanced ultrasound (CEUS), has been successfully used in the assessment of adult scrotal pathology. Contrast-enhanced ultrasound can confidently establish testicular tissue vascularity even in the small-volume paediatric testis. Elastography provides further assessment of tissue stiffness, potentially adding useful diagnostic information. In children, ultrasonography is particularly advantageous, being safe, radiation-free and negating the need for sedation or general anaesthesia during the imaging evaluation. In this review article, we aim to familiarise readers with the MPUS scanning protocol used for paediatric scrotal examination and provide an overview of scrotal MPUS features, with particular focus to clinical indications where MPUS may be advantageous over conventional ultrasonography.
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Affiliation(s)
- Dean Y. Huang
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Filippo Pesapane
- Breast Imaging Division, IEO European Institute of Oncology
IRCCS, Via Giuseppe Ripamonti 435, 20141,
Milan, Italy
| | - Vasileios Rafailidis
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Annamaria Deganello
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Maria E. Sellars
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
| | - Paul S Sidhu
- Department of Radiology, King’s College Hospital,
London. Denmark Hill, London SE5 9RS
U.K, United Kingdom
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Schwarze V, Marschner C, Sabel B, de Figueiredo GN, Marcon J, Ingrisch M, Knösel T, Rübenthaler J, Clevert DA. Multiparametric ultrasonographic analysis of testicular tumors: a single-center experience in a collective of 49 patients. Scand J Urol 2020; 54:241-247. [PMID: 32449437 DOI: 10.1080/21681805.2020.1765863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Purpose: The aim of the present retrospective single-center study is to evaluate the diagnostic performance of multiparametric ultrasonography for characterizing testicular tumors.Method: Forty-nine patients with testicular tumors, 36 of malignant vs 13 of benign entity, were included in this retrospective single-center study on whom multiparametric sonography, encompassing native B-mode, Color Doppler, contrast-enhanced ultrasound (CEUS) and elastography, was performed between 2011-2018. In 48 of 49 patients, findings from multiparametric analysis were correlated with histopathological results. The applied contrast agent for CEUS was a second-generation blood pool agent. Ultrasonography examinations were performed and interpreted by a single experienced radiologist with more than 15 years of experience (EFSUMB Level 3).Results: Multiparametric ultrasonography was successfully performed in all included patients without any adverse effects. Concomitant testicular microlithiasis, rapid arterial wash-in, elevated values for perfusion quantification - Peak Enhancement (PE), Wash-in Area Under the Curve (WiAUC) and Wash-in Perfusion Index (WiPI) - and higher shear wave velocities were significantly associated with malignancy.Conclusions: Multiparametric ultrasonography depicts a non-ionizing, directly accessible and cost-effective imaging modality that allows for the extensive characterization of testicular tumors, thereby helping to discriminate between malignant and benign entity of testicular tumors.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Bastian Sabel
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | | | - Julian Marcon
- Department of Urology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Michael Ingrisch
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich - Grosshadern Campus, Munich, Germany
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Fan C, Min X, Feng Z, Cai W, Li B, Zhang P, You H, Xie J, Wang L. Discrimination between benign and malignant testicular lesions using volumetric apparent diffusion coefficient histogram analysis. Eur J Radiol 2020; 126:108939. [DOI: 10.1016/j.ejrad.2020.108939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 12/19/2022]
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Cai Q, Chen Y, Zhang D, Pan J, Xie Z, Xu C, Li S, Zhang X, Gao Y, Hou J, Guo X, Zhou X, Zhang B, Ma F, Zhang W, Lin G, Xin Z, Niu Y, Wang Y. Estimates of over-time trends in incidence and mortality of testicular cancer from 1990 to 2030. Transl Androl Urol 2020; 9:182-195. [PMID: 32420124 PMCID: PMC7215014 DOI: 10.21037/tau.2020.02.22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background This study aims to explore and project the temporal trends in incidence and mortality of testicular cancer. Moreover, it can provide theoretical guidance for the rational allocation of health resources. Methods This study analyzed existing data on testicular cancer morbidity and mortality from 1990 to 2016 and predicted time-varying trends of age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR) from 2017 to 2030 in different ages, regions and sociodemographic index (SDI) quintile sub-groups. Result Globally, numbers of testicular cancer cases in 2016 [66,833; 95% uncertainty interval (UI), 64,487–69,736] are 1.8 times larger than in 1990 (37,231; 95% UI, 36,116–38,515). The testicular cancer-related death cases increased slightly from 8,394 (95% UI, 7,980–8,904) in 1990 to 8,651 (95% UI, 8,292–9,027) in 2016. In aspect of ASIR, the data showed an up-trend from 0.74 (95% UI, 0.72–0.77) in 1990 to 0.88 (95% UI, 0.85–0.92) in 2016. The ASDR of testicular cancer declined from 0.18 (95% UI, 0.17–0.19) in 1990 to 0.12 (95% UI, 0.11–0.12) in 2016. From 2017 to 2030, predictions of trends in testicular cancer indicate that the ASIRs of most SDI countries are rising, but the ASDRs trends in testicular cancer will decrease. Conclusions By analyzing the available and reliable data in different ages, regions and SDI, this study shows a significant upward trend in incidence and a slow upward trend in mortality of testicular cancer from 1990 to 2016, and simultaneously, predicts the increase of ASIR and the downward trend of ASDR in 2017–2030.
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Affiliation(s)
- Qiliang Cai
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China.,School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Yegang Chen
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Dingrong Zhang
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Jiancheng Pan
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Zunke Xie
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Chenjie Xu
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Shu Li
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Xinyu Zhang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Ying Gao
- Department of Health Management, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jie Hou
- School of Basic Medical Sciences, Tianjin Medical University, Tianjin 300070, China
| | - Xuemei Guo
- Library of Tianjin Medical University, Tianjin Medical University, Tianjin 300070, China
| | - Xiaodong Zhou
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Baoshuai Zhang
- Scientific Research Department, the Second Hospital of Tianjin Medical University, Tianjin 300070, China
| | - Fei Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Wei Zhang
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA, USA
| | - Zhongcheng Xin
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China.,Andrology Center, Peking University First Hospital, Peking University, Beijing 100034, China
| | - Yuanjie Niu
- Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Tianjin 300211, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin 300070, China
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Sheehan M, Briody H, O'Neill DC, Bowden D, Davis NF, Given M, Mohan P, Lee MJ. Pain relief after varicocele embolization: The patient's perspective. J Med Imaging Radiat Oncol 2020; 64:215-219. [PMID: 32048477 DOI: 10.1111/1754-9485.13001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Long-term efficacy of treatment with varicocele embolization is poorly documented from the patient's perspective. This study assessed patients' perceived changes in pain scores pre- and post-testicular vein embolization. In addition, the effect of testicular vein embolization on quality of life (QoL) parameters was assessed. METHODS All patients treated with embolization for varicocele-related orchalgia were analysed (2009-2015). A standardized pain impact questionnaire was used to assess pain scores pre- and post-procedure. The primary outcome was to assess patients' pain relief post-varicocele embolization. The secondary outcome was patients' perceived efficacy of the embolization procedure in terms of improvement in QoL parameters. RESULTS Sixty patients underwent varicocele embolization due to persistent orchalgia; of which 44 responded to the questionnaire. The mean pre-procedural pain score was 5.4/10 (range of 1.5-9). Post-procedure questionnaire was performed at a median of 58 months (range 28-106 months). At 1, 6 and 12 months post-procedure, the mean pain score was 1.57, 0.55 and 0.3, respectively. 50% (n = 22) reported complete pain relief 1-month post-embolization while 89% (n = 39) of patients reported complete resolution of pain at 1 year. Among the measured QoL parameters; varicocele embolization resulted in significant improvement in return to work, housework, socializing, exercise, sexual relations, and sleeping post-embolization (P < 0.01). CONCLUSION Varicocele embolization results in a durable reduction in pain scores compared to their pre-operative values. Information from this study will allow clinicians to convey the potential improvements in pain parameters to patients undergoing embolization of symptomatic varicoceles.
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Affiliation(s)
- Mark Sheehan
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Hayley Briody
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | | | - Dermot Bowden
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Niall F Davis
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons (RCSI), Dublin, Ireland
| | - Mark Given
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland
| | - Ponnusamy Mohan
- Department of Urology and Transplant Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin 9, Ireland.,Royal College of Surgeons (RCSI), Dublin, Ireland
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Wang X, Zhang Z, Fang LK, Chen D, Peng N, Thakker PU, Schwartz MZ, Zhang Y. Challenges in the diagnosis of testicular infarction in the presence of prolonged epididymitis: Three cases report and literature review. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2020; 28:809-819. [PMID: 32474478 DOI: 10.3233/xst-200671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Testicular infarction is a rare complication of prolonged epididymitis and may be misdiagnosed as testicular torsion. In this study, we present three cases of testicular infarction and discuss their clinical characteristics, imaging features and clinical management. PATIENTS AND METHODS Three adult males with prolonged epididymitis presented with chronic unilateral testicular pain, tenderness, and palpable swelling, including left varicocele in one case and hydrocele in the other two cases. Patient's symptoms were not relieved after antibiotic therapy. We analyzed the diagnosis, management, and outcome of these three cases of testicular infarction resulting from prolonged epididymitis. This includes the clinical characteristics, features of color doppler ultrasound imaging for diagnosis, and treatment strategy for testicular infarction from prolonged epididymitis. RESULTS Complete blood count (CBC) indicated a small leukocytosis (10.6±0.4×109/L; normal arrange 3.5-9.5 WBC×109/L). Color doppler images demonstrated appropriate blood flow to areas of interest at patient's initial visit. At follow up visit several months later, the increased blood flow was detected at the edges of the involved testes with no blood flow to the center. The sizes of the involved testis (27±4 ml) was significantly larger compared to the non affected side (17±2 ml) (p < 0.05). Unilateral simple orchiectomy was performed on the involved testis in all three cases. Grossly, abscess cavities with caseous necrosis were found at the center of the testicle and epididymis in two patients. Histopathologic examination showed chronic inflammation with lymphocytic and macrophage infiltration of the involved testicle in two cases. The third case stained positive for acid fast bacteria. Left varicocele disappeared postoperatively in one patient. No pain, wound infection or other discomfort were noted 12 months after surgery. COMMENTS This series revealed that testicular infarction may result from inappropriately treated prolonged epididymitis. Epididymal tuberculosis should be considered in cases with epididymitis not responding to broad spectrum antibiotics. Testicular infarction induced by prolonged epididymitis is easily missed due to a lack of symptom changes. Color doppler images are helpful in the diagnosis. This usually presents as a decrease in blood flow at the center of the testis with the increased flow at the periphery differentiating this from testicular torsion.
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Affiliation(s)
- Xisheng Wang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Zejian Zhang
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Lie Kui Fang
- Urinary Surgery Department of the Second Affiliated Hospital of Southern University Of Science And Technology, Shenzhen Third People's Hospital, Shenzhen, Guangdong Province, China
| | - Dong Chen
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Naixiong Peng
- Department of Urology, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, Guangdong Province, China
| | - Parth Udayan Thakker
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Marshall Zane Schwartz
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Yuanyuan Zhang
- Department of Urology and Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Lerchbaumer MH, Auer TA, Marticorena GS, Stephan C, Hamm B, Jung EM, Fischer T. Diagnostic performance of contrast-enhanced ultrasound (CEUS) in testicular pathologies: Single-center results. Clin Hemorheol Microcirc 2019; 73:347-357. [DOI: 10.3233/ch-190579] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Markus Herbert Lerchbaumer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Timo Alexander Auer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Garcia Stephan Marticorena
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Carsten Stephan
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Urology and Berlin Institute for Urologic Research, Berlin, Germany
| | - Bernd Hamm
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Ernst-Michael Jung
- University Medical Center Regensburg, Department of Radiology, Regensburg, Germany
| | - Thomas Fischer
- Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Radiology, Berlin, Germany
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Zhang P, Feng Z, Cai W, You H, Fan C, Lv W, Min X, Wang L. T2-Weighted Image-Based Radiomics Signature for Discriminating Between Seminomas and Nonseminoma. Front Oncol 2019; 9:1330. [PMID: 31850216 PMCID: PMC6901122 DOI: 10.3389/fonc.2019.01330] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/14/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: To evaluate the performance of a T2-weighted image (T2WI)-based radiomics signature for differentiating between seminomas and nonseminomas. Materials and Methods: In this retrospective study, 39 patients with testicular germ-cell tumors (TGCTs) confirmed by radical orchiectomy were enrolled, including 19 cases of seminomas and 20 cases of nonseminomas. All patients underwent 3T magnetic resonance imaging (MRI) before radical orchiectomy. Eight hundred fifty-one radiomics features were extracted from the T2WI of each patient. Intra- and interclass correlation coefficients were used to select the features with excellent stability and repeatability. Then, we used the minimum-redundancy maximum-relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) algorithms for feature selection and radiomics signature development. Receiver operating characteristic curve analysis was used to evaluate the diagnostic performance of the radiomics signature. Results: Five features were selected to build the radiomics signature. The radiomics signature was significantly different between the seminomas and nonseminomas (p < 0.01). The area under the curve (AUC), sensitivity, and specificity of the radiomics signature for discriminating between seminomas and nonseminomas were 0.979 (95% CI: 0.873–1.000), 90.00 (95% CI: 68.3–98.8), and 100.00 (95% CI: 82.4–100.0), respectively. Conclusion: The T2WI-based radiomics signature has the potential to non-invasively discriminate between seminomas and nonseminomas.
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Affiliation(s)
- Peipei Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaoyan Feng
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Cai
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huijuan You
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chanyuan Fan
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Xiangde Min
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Wang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Liu R, Lei Z, Li A, Jiang Y, Ji J. Differentiation of testicular seminoma and nonseminomatous germ cell tumor on magnetic resonance imaging. Medicine (Baltimore) 2019; 98:e17937. [PMID: 31702681 PMCID: PMC6855626 DOI: 10.1097/md.0000000000017937] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Magnetic resonance imaging (MRI) has excellent soft tissue resolution, as well as multidirectional and multisequence scanning technology, making it an important supplementary method in the diagnosis of testicular tumor.To explore the utility of preoperative MRI for the differential diagnosis of testicular seminoma and nonseminomatous germ cell tumors (NSGCTs).The medical records from 39 patients with testicular tumors that were examined preoperatively with MRI and treated with urologic surgery at our institution between January 2015 and March 2019 were retrospectively reviewed. Testicular tumors were confirmed by pathology and classified as seminoma (n = 20) or NSGCT (n = 19). Two radiologists analyzed the testicular tumors on preoperative MRI for morphology: multiple nodules or a single mass; presence/absence of a capsule; signal compared to the normal contralateral testicle (isointense, hypointense, hyperintense, or mixed); enhancement; septa; and hemorrhagic or cystic degeneration. Characteristics of seminomas and NSGCT were compared using the Chi-square or Fischer exact test.MRI showed that the majority (95%; 19/20) of seminomas were nodular. There were significant differences in the presence/absence of a capsule (P = .001), T1-weighted imaging (T1WI) signal intensity (P = .047), T2-weighted imaging (T2WI) signal intensity (P < .001), septa (P < .001), and hemorrhagic or cystic degeneration (P < .001) between seminomas and NSGCT.Seminomas were more likely to have no capsule, isointensity on T1WI, hypointensity on T2WI, and had narrow obviously enhanced fibrovascular septa without hemorrhagic or cystic degeneration; NSGCT was more likely to have a capsule, a mainly mixed signal on T1WI and T2WI, most of them had no fibrovascular septa, and hemorrhagic or cystic degeneration was common in malignant NSGCT.This study suggests that preoperative MRI can distinguish seminoma from NSGCT. We propose that preoperative MRI of the scrotum is an effective technique that should be widely adopted for the management of scrotal disease.
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Affiliation(s)
- Renwei Liu
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
| | - Zhengxian Lei
- Department of Radiology, The University of Hong Kong, Shenzhen Hospital, Shenzhen, China
| | - Aibo Li
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
| | - Yixiang Jiang
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
| | - Jiayin Ji
- Urogenital System Group, Department of Radiology, People's Hospital of Long Hua District
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74
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Almadaly EA, Ashour MA, El-Kon II, Heleil BA. Traditional and non-traditional methods used for discrimination among Ossimi rams with different field fertility. Small Rumin Res 2019. [DOI: 10.1016/j.smallrumres.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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75
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Reginelli A, D'Andrea A, Clemente A, Izzo A, Urraro F, Scala F, Nardone V, Guida C, Scialpi M, Cappabianca S. Does multiparametric US improve diagnostic accuracy in the characterization of small testicular masses? Gland Surg 2019; 8:S136-S141. [PMID: 31559180 DOI: 10.21037/gs.2019.04.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Recent advances in ultrasonography (US) have produced new innovative techniques for the non-invasive assessment of testicular masses. The aim of this study was to investigate the diagnostic performance of multiparametric US, including gray-scale, Color-power Doppler and real-time elastography (RTE) analysis, in the characterization of testicular lesions. Methods Fifty-four patients (median 42.2 years; range, 10-64 years) with testicular lesions detected with gray-scale US and power Doppler US were evaluated with RTE. The tissue elasticity was assessed in all lesions. Hard lesions were suspected of being malignant while testicular lesions with normal or decreased tissue stiffness (soft lesions) were considered benign. Intraoperative findings were the standard of reference. Sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy were calculated for each US method and in combination. Results Forty-six of the 54 lesions (85.2%) were testicular malignant tumors. Thirty-five out of 46 (76%) were ≥2 cm [seminomas (n=18), mixed seminomatous and/or nonseminomatous tumors (n=9), embryonal carcinomas (n=2), immature teratomas (n=3) and Leydig cell tumors (n=3)] while the remaining 11 tumors were <2 cm [seminomas (n=5), mixed germinal cells tumors (n=2), immature teratomas (n=2) and Leydig cell tumors (n=2)]. Eight out of 54 lesions (14.8%) were benign lesions (orchitis n=2, dermoid cyst n=1, adrenal rest n=1, papillary cystadenoma n=1, sclero-hyaline nodule n=1, focal fibrosis n=1 and post-traumatic focal fibrosis n=1). RTE showed the presence of hard pattern in 40 out of 46 (87%) malignant tumors and in 2 out of 8 (25%) of benign lesions. The combination of gray-scale US, Color-power Doppler and RTE aided a sensitivity of 100%, a specificity of 83%, a negative predictive value of 100%, a positive predictive value of 91% and accuracy of 90%. Conclusions RTE demonstrated to increase the diagnostic accuracy of conventional US in the characterization of testicular lesions providing additional information on tissue stiffness. The multiparametric US evaluation has proven to increase the diagnostic performance in the characterization of testicular lesions.
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Affiliation(s)
- Alfonso Reginelli
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alfredo D'Andrea
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Izzo
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Fabrizio Urraro
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Fernando Scala
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valerio Nardone
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Cesare Guida
- Unit of Radiation Oncology, Ospedale del Mare, Naples, Italy
| | - Michele Scialpi
- Section of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, S. Maria della Misericordia Hospital, Perugia University, S. Andrea delle Fratte, Perugia, Italy
| | - Salvatore Cappabianca
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
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76
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Ayaz E, Ayaz M, Önal C, Yıkılmaz A. Seeing the Unseen: Evaluating Testicular Vascularity in Neonates by Using the Superb Microvascular Imaging Ultrasound Technique. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1847-1854. [PMID: 30548880 DOI: 10.1002/jum.14882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate testicular vascularity in neonates by using the novel Superb Microvascular Imaging (SMI; Toshiba Medical Systems Corporation, Tokyo, Japan) ultrasound (US) technique and to compare this technique to conventional Doppler US techniques. METHODS A total of 140 healthy neonates between 2 and 60 days old who were admitted for routine screening were included in the study. However, in 9 cases, the Doppler study could not be completed. In the remaining 131 cases, color Doppler imaging (CDI), power Doppler imaging (PDI), Advanced Dynamic Flow (ADF; Toshiba Medical Systems), and monochrome SMI (mSMI) techniques were performed on a single representative testicle. Real-time cine images were captured for 5 to 10 seconds for each technique by using a high-frequency (7.2-14-MHz) linear transducer. The images were evaluated by 3 observers using a grading system to quantify the degree of vascularity and artifact interference. RESULTS A total of 131 testicles (74 right and 57 left) were evaluated, and vascularity was shown in 110 (84%) testicles with CDI, 109 (83%) with PDI, 94 (72%) with ADF, and 128 (98%) with mSMI by the consensus of all observers. The Doppler techniques were ranked from highest to lowest in the following order based on the degree of vascularity detected: mSMI > PDI > CDI > ADF (P < .001). Based on the presence of artifacts, the Doppler techniques were ranked as follows from high to low: ADF > CDI > PDI > mSMI (P < .001). CONCLUSIONS Superb Microvascular Imaging is a promising US technique that appears to detect testis vascularity better than conventional Doppler US techniques; however, further research is needed to support the results of this study.
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Affiliation(s)
- Ercan Ayaz
- Department of Radiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Muzaffer Ayaz
- Department of Radiology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - Canver Önal
- Department of Radiology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - Ali Yıkılmaz
- Department of Radiology, Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
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77
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A Paratesticular Angiolipoma: A Case Report of a Rare Benign Scrotal Mass and Review of Literature. Case Rep Urol 2019; 2019:1478573. [PMID: 31321115 PMCID: PMC6609340 DOI: 10.1155/2019/1478573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/10/2019] [Indexed: 11/18/2022] Open
Abstract
We report a rare case of paratesticular angiolipoma in a young male. The patient is a 21-year-old male who presented with a palpable firm right intrascrotal mass of 21 mm. Ultrasound findings demonstrated that it is a solid mass. Under the diagnosis of an intrascrotal solid mass, a right inguinal radical orchiectomy was performed. Histopathological examination concluded to a paratesticular angiolipoma. Angiolipoma is a rare benign form of paratesticular tumour and its diagnosis is based on histological findings of the surgical specimen with no recurrence risk. This mesenchymal tumour should be distinguished from liposarcoma, which has malignant or aggressive clinical course.
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78
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Rocher L, Criton A, Gennisson JL, Creze M, Albiges L, Ferlicot S, Bellin MF, Izard V, Correas JM. Characterization of Testicular Masses in Adults: Performance of Combined Quantitative Shear Wave Elastography and Conventional Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:720-731. [PMID: 30600129 DOI: 10.1016/j.ultrasmedbio.2018.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
We prospectively evaluated the performance of combined shear wave elastography (SWE) and conventional ultrasound (US) for the characterization of 89 testicular focal masses. Testes were evaluated with B-mode, color Doppler and SWE measurements, locating a region of interest on the normal and pathologic parenchyma. Thirty-seven malignant tumors (MTs), 12 burned out tumors (BOTs), 28 Leydig cell tumors (LCTs), 2 dermoid cysts and other benign lesions were included. MTs + BOTs exhibited more microliths and macrocalcifications compared with benign lesions (p < 10-4). LCTs manifested mostly a dominant peripheral vascularization pattern compared with other lesions. MTs + BOTs were stiffer compared with benign lesions (p < 2 × 10-4) but with a moderate area under the receiver operating characteristic curve (AUROC) of 80%. By focusing on LCTs versus MTs + BOTs, diagnostic performance led to an AUROC of 89% for the best stiffness parameter. For combined conventional US and SWE, the diagnostic performance to differentiate all benign lesions versus MTs + BOTs and LCTs versus MTs + BOTs increased to AUROCs of 93% and 98%, respectively.
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Affiliation(s)
- Laurence Rocher
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France.
| | - Aline Criton
- Supersonic Imagine, Aix en Provence Cedex, France
| | - Jean-Luc Gennisson
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Maud Creze
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Laurence Albiges
- Paris South Medical University, Le Kremlin Bicêtre, France; Département d'Oncologie, Institut Gustave Roussy, Villejuif, France
| | - Sophie Ferlicot
- Paris South Medical University, Le Kremlin Bicêtre, France; Department of Pathology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Marie-France Bellin
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Vincent Izard
- Department of Urology, Bicetre University Hospital, Le Kremlin Bicêtre, France
| | - Jean-Michel Correas
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France; Paris Descartes University, Paris, France
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79
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He Y, Liao H, Xiang X, Cai D, Qiu L. High-frequency ultrasonography and contrast-enhanced ultrasound for the evaluation of testicular capillary hemangioma: A case report. Medicine (Baltimore) 2019; 98:e14779. [PMID: 30882650 PMCID: PMC6426614 DOI: 10.1097/md.0000000000014779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Testicular capillary hemangioma (TCH) is a rare benign tumor of the testis. To the authors' knowledge, there is currently only a few literatures describing the use of contrast-enhanced ultrasound (CEUS) to diagnose TCH. Accurate preoperative diagnosis of benign tumors can avoid orchiectomy. A case of TCH evaluated using high-frequency ultrasound and CEUS is presented. PATIENT CONCERNS A 21-year-old male presented with a right testicular mass during a routine physical examination, and was admitted to the authors' hospital for definitive diagnosis and treatment. DIAGNOSES Combined gray-scale, color Doppler ultrasonography, and CEUS did not exclude the possibility that the right testicular lesion may be a benign tumor. Combined with morphological and immunohistochemical staining results, a pathological diagnosis of TCH was considered. INTERVENTIONS The patient underwent right orchiectomy under general anesthesia, which proceeded smoothly. OUTCOMES At the 12-month follow-up, the patient was completely asymptomatic and resumed all daily activities. LESSONS TCH is a rare benign tumor and lacks extensive previous data in imaging findings. If TCH can be diagnosed accurately before surgery, excessive or inappropriate treatment of benign lesions can be minimized, which will be beneficial to the physical and psychological health of patients.
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80
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Abstract
Although testicular carcinoma represents approximately only 1% of solid neoplasms in men, it is the most common malignancy between young men. The two main histologic categories are testicular germ cell tumors (TGCTs), including seminomas and nonseminomas, accounting for 90-95% of testicular neoplasms and sex cord-stromal tumors. Scrotal MRI, including a multiparametric protocol, has been proposed as a valuable supplemental imaging technique in the investigation of testicular pathology. Recently, the Scrotal and Penile Imaging Working Group appointed by the board of the European Society of Urogenital Radiology has produced recommendations on when to perform scrotal MRI. Regarding intratesticular masses, MRI of the scrotum may be used for their characterization, when US findings are indeterminate and for local staging of TGCTs, when organ-sparing surgery is planned. Differentiation between seminomas and nonseminomas is possible based on MRI features, when clinically needed. Scrotal MRI may also help in differentiating between TGCTs and nongerm cell tumors. Functional information based on diffusion-weighted imaging and dynamic contrast-enhanced MRI data improve testicular mass lesion characterization. Preliminary observations on diffusion tensor imaging, magnetization transfer imaging, and proton MR spectroscopy bring about new data in the understanding of testicular microstructure and pathophysiology.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece.
| | - Nikolaos Sofikitis
- Department of Urology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Efrosyni Stiliara
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, 45110, Ioannina, Greece
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81
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Abstract
Ultrasound is the imaging modality of choice to evaluate the scrotum because of its high resolution, Doppler capabilities, availability, and lack of ionizing radiation. Acute urologic emergencies diagnosed with ultrasound include testicular torsion, testicular rupture, and Fournier gangrene. The radiologist's knowledge of sonographic features of vascular, infectious, traumatic, and benign and malignant processes that occur in the scrotum coupled with the patient's presenting symptoms, age, and physical examination allows for the correct diagnosis of a wide spectrum of scrotal pathology.
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Affiliation(s)
- Kristin Rebik
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA.
| | - Jason M Wagner
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
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82
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Reesink DJ, Huisman PM, Wiltink J, Boeken Kruger AE, Lock TMTW. Sneeze and pop: a ruptured varicocele; analysis of literature, guided by a well-documented case-report. BMC Urol 2019; 19:14. [PMID: 30704438 PMCID: PMC6357415 DOI: 10.1186/s12894-019-0442-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background An acute scrotal hematoma, secondary to a spontaneous rupture of a varicocele is still a rare presentation in daily practice. However, multiple case reports have been reported. Sudden increase in abdominal pressure, resulting to an increased venous pressure can lead to a rupture of the varicocele. Literature search shows that due to uncertainty of the diagnosis, explorative surgery is often performed, sometimes resulting in unnecessary orchiectomies. The objective of this study was to determine classical clinical presentation of patients with a spontaneous rupture of a varicocele, determine the diagnostic procedure, and give an insight in the follow-up. Case presentation We present a case of a 24-year old male with acute scrotal swelling after sneezing. Subsequently, we carried out a systematic literature search to identify all eligible studies to determine classic clinical presentation of spontaneous ruptures of a varicocele. Conclusion The literature search shows that clinical presentation of idiopathic spontaneous scrotal hematomas is similar to testicular torsion, epididymo-orchitis, malignancy, or (incarcerated) inguinal hernia making differential diagnosis difficult. Especially when there has been increased abdominal pressure or strenuous activity preceding the symptoms, and the swelling is left sided, it should be included in the differential diagnosis for patient with acute inguinoscrotal swelling. Colour Doppler-Ultrasonography is recommended to distinguish between other causes of acute scrotum. The hematoma is usual self-limiting, justifying conservative treatment. Early surgical intervention is indicated with signs of ischaemia due to obstruction, infection of the hematoma, or uncertain diagnosis (i.e. malignancy). However, physicians should be cautious with direct exploration, as it led to unnecessary orchiectomy in 25% of patients. The hematoma can increase in size up to 3 months post-event, and it can take up to 15 months to completely resolve.
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Affiliation(s)
- Daan J Reesink
- Department of Urology, Tergooi Hospital Hilversum, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands.
| | - Peter M Huisman
- Department of Radiology, Tergooi Hospital, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Judith Wiltink
- Department of Urology, Tergooi Hospital Hilversum, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Arto E Boeken Kruger
- Department of Urology, Tergooi Hospital Hilversum, Rijksstraatweg 1, 1261 AN, Blaricum, The Netherlands
| | - Tycho M T W Lock
- Department of Urology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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83
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Ghazle H, Apeland T. Epidermoid Cyst of the Testis: Sonographic Characteristic Appearance. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318805451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intratesticular epidermoid cysts are rare, benign, well-defined, and solitary keratinized intratesticular lesions. They usually present as a painless, discrete, and firm swollen area before being diagnosed. Preoperative diagnosis of epidermoid cysts is often difficult. Sonography is a useful imaging modality in the preoperative assessment of testicular lesions. Although it is difficult to distinguish epidermoid cysts from germ cell tumors, certain sonographic characteristics such as the classical “onion-peel” appearance, the negative tumor markers, and the underlying symptoms should raise the suspicion of epidermoid cysts.
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Affiliation(s)
- Hamad Ghazle
- Rochester Institute of Technology, College of Health Sciences and Technology, Rochester, NY, USA
| | - Tracy Apeland
- University of Rochester Medical Center, Imaging Sciences/Ultrasound, Rochester, NY, USA
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84
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Testicular Rupture or Testicular Fracture? A Case Report and Literature Review. Case Rep Urol 2018; 2018:1323780. [PMID: 30538883 PMCID: PMC6261066 DOI: 10.1155/2018/1323780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/13/2018] [Accepted: 11/01/2018] [Indexed: 12/20/2022] Open
Abstract
Testicular trauma is relatively uncommon. However, severe injuries can result in many complications and should be carefully diagnosed and managed. We present a case of testicular fracture diagnosis made by ultrasonography. The surgical exploration revealed the fracture as well as complete rupture of the tunica albuginea. Testicular rupture is the disruption of the tunica albuginea, while testicular fracture is a “break” in the testicular parenchyma. Management could be conservative in mild fracture cases without rupture while suspected or confirmed fracture should be treated by surgical exploration.
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85
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Tsili AC, Bertolotto M, Rocher L, Turgut AT, Dogra V, Seçil M, Freeman S, Belfield J, Studniarek M, Ntorkou A, Derchi LE, Oyen R, Ramchandani P, Ramanathan S, Richenberg J. Sonographically indeterminate scrotal masses: how MRI helps in characterization. ACTA ACUST UNITED AC 2018; 24:225-236. [PMID: 30091713 DOI: 10.5152/dir.2018.17400] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, Ioannina, Greece
| | | | - Laurence Rocher
- Hôpitaux Universitaires Paris Sud, APHP, site Bicêtre, Ecole doctorale Biosigne, Le Kremlin Bicêtre, France
| | - Ahmet Tuncay Turgut
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mustafa Seçil
- Department of Radiology, Dokuz Eylul University Faculty of Medicine, İzmir, Turkey
| | | | | | | | - Alexandra Ntorkou
- Department of Clinical Radiology, Medical School, University of Ioannina, University Campus, Ioannina, Greece
| | | | | | - Parvati Ramchandani
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, USA
| | - Subramaniyan Ramanathan
- Consultant Clinical Imaging, Hamad medical corporation, Doha-Qatar, Weill Cornell Medicine-New York (Qatar campus)
| | - Jonathan Richenberg
- Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, UK
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86
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Pedersen MR, Bartlett EC, Brown C, Rafaelsen SR, Sellars ME, Sidhu PS. Is Testicular Macrocalcification a Risk for Malignancy?: Tumor Development on Ultrasonographic Follow-up of Preexisting Intratesticular Macrocalcification. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2949-2953. [PMID: 29665033 DOI: 10.1002/jum.14657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
Testicular macrocalcification is an uncommon finding when imaging the scrotum with ultrasonography (US). It is not normally a recognized risk factor for development of testicular malignancy, and patients are not usually offered follow-up US examinations or counseled for self-examination. This aspect is in distinction to patients with testicular microlithiasis (usually with an additional risk factor), who are offered follow-up on the assumption that microlithiasis is associated with malignancy. We report a series of 6 patients with predetermined testicular macrocalcification, with development of a malignancy on follow-up US. We encourage US follow-up examinations for patients with macrocalcification, potentially in a similar manner as for those with testicular microlithiasis.
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Affiliation(s)
- Malene R Pedersen
- University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark
- Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Emily C Bartlett
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Christian Brown
- Department of Urology, King's College Hospital, King's College London, London, England
| | - Søren R Rafaelsen
- University of Southern Denmark, Institute of Regional Health Research, Odense, Denmark
- Department of Radiology, Vejle Hospital, Vejle, Denmark
| | - Maria E Sellars
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, England
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87
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Lesions Without Borders: Scrotal Lesions That Involve Both the Intratesticular and Extratesticular Regions. AJR Am J Roentgenol 2018; 210:W70-W79. [PMID: 29355401 DOI: 10.2214/ajr.17.18369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Differentiation of scrotal lesions is often dictated by whether they are intraor extratesticular. However, these regions are not entirely isolated, and disease processes can span both spaces. We review a variety of lesions that can involve both regions, describe the relevant anatomy, and illustrate their imaging appearances. CONCLUSION Identification of involvement of both intra- and extratesticular regions by a single process can narrow the differential considerations and help arrive at the correct diagnosis.
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Bourgon S, Diel de Amorim M, Chenier T, Sargolzaei M, Miller S, Martell J, Montanholi Y. Relationships of nutritional plane and feed efficiency with sexual development and fertility related measures in young beef bulls. Anim Reprod Sci 2018; 198:99-111. [DOI: 10.1016/j.anireprosci.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/07/2018] [Accepted: 09/06/2018] [Indexed: 02/04/2023]
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Abstract
OBJECTIVE The purpose of this review is to evaluate the current role of percutaneous testicular biopsy in the diagnosis of focal testicular lesions. CONCLUSION Percutaneous testicular biopsy can be either fine needle aspiration biopsy or trucut core needle biopsy. It is a well-tolerated and effective procedure useful in small testicular lesions, multifocal lesions, hematological malignancies, and focal lesions in single testis.
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Affiliation(s)
- Subramaniyan Ramanathan
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box 82228, Doha, Qatar.
- Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - Vikram Dogra
- Department of Imaging Science, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Huang H, Ling W, Qiu T, Luo Y. Ultrasonographic features of testicular metastasis from renal clear cell carcinoma that mimics a seminoma: A case report. Medicine (Baltimore) 2018; 97:e12728. [PMID: 30290683 PMCID: PMC6200504 DOI: 10.1097/md.0000000000012728] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Testicular metastases from renal cell carcinoma (RCC) are extremely rare. To the best of our knowledge, only 35 cases have been described in the literatures. PATIENT CONCERNS A 64-year-old male presented to our urology clinic for a palpable painless mass on his right side of the scrotum by self-examination 1 week ago, with a general abdominal ultrasonographic report showing a mass in his right kidney. DIAGNOSES AND INTERVENTIONS Scrotal B-mode ultrasound revealed a 15 × 13 × 15 mm well-defined round homogenously hypoechoic nodule with a halo at the upper pole of the right testis. Color Doppler and spectral Doppler ultrasound detected abundant intranodular and perinodular blood flow signals including both arteries and veins. Malignancy was suspected. Abdominal contrast-enhanced computed tomography identified an irregular tumor in the posterior side of the right kidney, highly suspicious for renal carcinoma. The patient received right radical nephrectomy and right partial orchiectomy. Histologically, the right renal mass was diagnosed as RCC, clear cell type, grade 2. As to the right testicular mass, a metastasis from renal clear cell carcinoma was confirmed. OUTCOMES The patient has lived with no recurrence for at least 17 months without adjuvant therapy. LESSONS In the case, we focus on the ultrasonographic features of the testicular metastasis from RCC. Ultrasound could provide initial and helpful information for diagnosis. When finding a mass in the testicle on the ultrasound, although most of them are primary, it is important to know whether the patient has tumor history from other parts of the body. A halo may be a special feature for metastases. Contrast-enhanced ultrasound (CEUS) and ultrasonic elastography could provide more information for differential diagnoses.
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Song QD. Ultrasound Appearances of Pediatric Testicular Yolk Sac Tumors: Twenty-one Cases in a Single Institution. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2457-2463. [PMID: 29637573 DOI: 10.1002/jum.14597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/18/2018] [Accepted: 01/18/2018] [Indexed: 06/08/2023]
Abstract
Testicular yolk sac tumors are rare, and analyses of relevant ultrasound (US) findings are limited. We retrospectively reviewed the US features of 21 pathologically verified cases (patients aged 10-64 months). Neoplasms were unilateral and solitary, occupying part (focal) or all (diffuse) of the testis. Focal lesions (14 cases) were usually solid and ovoid, with a homogeneous echo texture or multiple random anechoic spaces, and hypervascular. Diffuse neoplasms had heterogeneous echo textures; most were hypervascular. On spectral Doppler US imaging, 11 cases had a mean peak systolic velocity of 12.9 cm/s and a mean resistive index of 0.54. Ultrasound is a useful tool for imaging pediatric testes when a yolk sac tumor is suspected.
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Affiliation(s)
- Qing-Da Song
- Department of Ultrasound, Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
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92
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Bibi M, Sellami A, Taktak T, Kassar AZ, Chehida MAB, Chaker K, Abid K, Rhouma SB, Nouira Y. Idiopathic chronic hematocele mimicking a mesothelioma of the tunica vaginalis testis. Urol Case Rep 2018; 20:104-105. [PMID: 30116715 PMCID: PMC6083900 DOI: 10.1016/j.eucr.2018.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mokhtar Bibi
- Department of Urology, La Rabta Hospital Tunisia, Tunisia
| | - Ahmed Sellami
- Department of Urology, La Rabta Hospital Tunisia, Tunisia
| | - Tarek Taktak
- Department of Urology, La Rabta Hospital Tunisia, Tunisia
| | | | | | - Kays Chaker
- Department of Urology, La Rabta Hospital Tunisia, Tunisia
| | - Karem Abid
- Department of Urology, La Rabta Hospital Tunisia, Tunisia
| | | | - Yassine Nouira
- Department of Urology, La Rabta Hospital Tunisia, Tunisia
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93
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Lymphatic Endothelial Cell in Endemic Bancroftian Filariasis: A Focus on the Lymphatics of the Tunica Vaginalis Testis. J Trop Med 2018; 2018:5134670. [PMID: 29861747 PMCID: PMC5976995 DOI: 10.1155/2018/5134670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/03/2018] [Indexed: 11/23/2022] Open
Abstract
Background In endemic areas, lymphangiectasia is the fundamental alteration to live Wuchereria bancrofti adult worms which, in adult males, are usually found in the lymphatic vessels of the spermatic cord; accordingly, hydrocele/filaricele is the most common clinical manifestation of bancroftian filariasis. The pathogenic role of the lymphatic endothelial cells (LECs) and the status of mesothelial cells (MCs) samples of the parietal layer (PL) of the tunica vaginalis testis were examined. Methods The PL of thirty-two patients, excised for different reasons, was examined by histology and immunohistochemistry using the D2-40 monoclonal antibody for identification of LECs and CK-7 antibody for recognition of mesothelial cells (MCs). Results The most important findings were (a) marked lymphangiectasia, especially in hydroceles with minor evolution time; (b) the first report of lymphatic stomata and submesothelial lacunae in filarial acute hydrocele; (c) the likely participation of LECs in filarial granuloma; (d) the potential phenotypic transition of LECs into myofibroblasts in severe chylocele; and (e) mesothelial reactive hyperplasia, a hallmark of filaricele, varying in intensity from mild to severe, sometimes mimicking a mesothelial neoplasia. Conclusion The data suggest that LECs have an active role in the pathogenesis of bancroftian hydrocele and, possibly, in other clinical forms of lymphatic filariasis.
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Fonseca EKUN, Peixoto MR, Cavalcante Júnior FDA, Rahal Júnior A, Francisco Neto MJ, Funari MBDG. Ultrasound evaluation of inguinoscrotal pain: an imaging-based review for the ultrasonographer. Radiol Bras 2018; 51:193-199. [PMID: 29991842 PMCID: PMC6034721 DOI: 10.1590/0100-3984.2016.0175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Emergencies involving the inguinal region and scrotum are common and can be
caused by a plethora of different causes. In most cases, such conditions have
nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have
high complication rates. Early and accurate diagnosis is therefore imperative.
Ultrasound is the method of choice for the initial evaluation of this vast range
of conditions, because it is a rapid, ionizing radiation-free, low-cost method.
Despite the practicality and accuracy of the method, which make it ideal for use
in emergency care, the examiner should be experienced and should be familiarized
with the ultrasound findings of the most common inguinoscrotal diseases. On the
basis of that knowledge, the examiner should also be able to make an accurate,
direct, precise report, helping the emergency room physician make decisions
regarding the proper (clinical or surgical) management of each case. Here, we
review most of the inguinoscrotal conditions, focusing on the imaging findings
and discussing the critical points for the appropriate characterization of each
condition.
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Affiliation(s)
| | - Milena Rocha Peixoto
- MD, Resident in the Imaging Department of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | | | - Antonio Rahal Júnior
- MD, Radiologist in the Imaging Department of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Miguel José Francisco Neto
- MD, PhD, Radiologist and Coordinator of the Ultrasound Group in the Imaging Department of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Akınsal EC, Baydilli N, Demirtaş A, Ekmekçioğlu O. Do positional variations of epididymis affect infertility? Turk J Urol 2018; 44:198-201. [PMID: 29733792 DOI: 10.5152/tud.2018.60486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the ratio of epididymal position variations and whether this had any effect on seminal parameters. MATERIAL AND METHODS Scrotal examination results and epididymal positions were retrospectively assessed in subjects presenting to our clinic for infertility, varicocele, and sexual developmental delay. Scrotal examination consisted of epididymal position, testicular volumes, and vas deferens and varicocele presence. The subjects were categorized according to sperm counts per mL. Data were assessed whether there was a significant difference in terms of epididymal positions among the groups. RESULTS A total of 5812 epididymides were examined. There was no significant difference with respect to one or two epididymides being in an anterior position between the groups allocated with respect to a sperm count above 15 million per mL, between 5 and 15 million per mL, and below 5 million per mL (p=0.542). Sperm counts and motility did not differ according to the position of the epididymis in analyzes performed separately within each group. CONCLUSION Positional variations of epididymis can be seen at a considerable rate. Nevertheless, there was no clear relationship between these variations and infertility. In terms of avoiding possible misdiagnoses and treatment complications possible epididymal position variations should be kept in mind during clinical practice.
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Affiliation(s)
- Emre Can Akınsal
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Numan Baydilli
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdullah Demirtaş
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Oğuz Ekmekçioğlu
- Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey
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96
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Mittal PK, Abdalla AS, Chatterjee A, Baumgarten DA, Harri PA, Patel J, Moreno CC, Gabriel H, Miller FH. Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging. Radiographics 2018; 38:806-830. [DOI: 10.1148/rg.2018170150] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Ahmed S. Abdalla
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Argha Chatterjee
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Deborah A. Baumgarten
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Jay Patel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Helena Gabriel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
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98
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McAdams CR, Del Gaizo AJ. The utility of scrotal ultrasonography in the emergent setting: beyond epididymitis versus torsion. Emerg Radiol 2018; 25:341-348. [PMID: 29679169 DOI: 10.1007/s10140-018-1606-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/10/2018] [Indexed: 11/24/2022]
Abstract
Scrotal pain is a common acute presentation for medical care. Testicular torsion and epididymo-orchitis are two diagnoses for which early detection is critical and their sonographic imaging features have been thoroughly described in the radiologic literature. Other important conditions for which radiologists must be aware have received less attention. This article will highlight key traumatic and non-traumatic causes of acute scrotal pain other than testicular torsion and epididymo-orchitis that may present in the emergency department setting.
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Affiliation(s)
- Christopher R McAdams
- Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC, 27157, USA.,Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Andrew J Del Gaizo
- Department of Radiologic Sciences, Wake Forest University Baptist Medical Center, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Abstract
There were an estimated 8720 new cases of testicular cancer (TC) in the United States in 2016. The cause of the disease is complex, with several environmental and genetic risk factors. Although rare, the incidence has been steadily increasing. Fortunately, substantial advances in treatment have occurred over the last few decades, making TC one of the most curable malignancies. However, because TC typically occurs in younger men, considerations of the treatment impact on fertility, quality of life, and long-term toxicity are paramount; an individualized approach must be taken with patients based on their clinical and pathologic findings.
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Affiliation(s)
- Zachary L Smith
- Section of Urology, Department of Surgery, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA.
| | - Ryan P Werntz
- Section of Urology, Department of Surgery, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
| | - Scott E Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 6038, Chicago, IL 60637, USA
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Patnana M, Korivi BR, Devine CE, Faria S, Prieto V, Ross MI, Ng CS. Metastatic melanoma to the testis. BJR Case Rep 2018; 4:20170104. [PMID: 31489212 PMCID: PMC6711278 DOI: 10.1259/bjrcr.20170104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 11/23/2022] Open
Abstract
This case report presents the ultrasound and positron emission
tomography-computed tomography (PET-CT) imaging findings related to a patient
with metastatic melanoma to the testis. We review this very rare entity and
discuss the role of imaging.
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Affiliation(s)
- Madhavi Patnana
- Department of Diagnostic Radiology, Anatomical, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Brinda Rao Korivi
- Department of Diagnostic Radiology, Anatomical, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Catherine E Devine
- Department of Diagnostic Radiology, Anatomical, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Silvana Faria
- Department of Diagnostic Radiology, Anatomical, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Victor Prieto
- Department of Pathology, Anatomical, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Merrick I Ross
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chaan S Ng
- Department of Diagnostic Radiology, Anatomical, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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