1
|
Karbasian N, Segaran N, Solomon N, Pellerito JS, Katz DS, Moshiri M, Revzin MV. Pathologic Conditions at Imaging of the Spermatic Cord. Radiographics 2022; 42:741-758. [PMID: 35394888 DOI: 10.1148/rg.210161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A wide range of benign and malignant processes can affect the spermatic cord (SC). Familiarity with and recognition of the characteristic imaging features of these entities are imperative for accurate diagnosis and optimal clinical care. While some SC diseases are self-limiting, others can result in infertility and potentially life-threatening infection or bleeding if they are left untreated. Therefore, correct diagnosis is important for life-saving treatment and preservation of fertility. Disorders including anomalies of the vas deferens and the processus vaginalis, arterial and venous diseases (torsion of the SC and varicoceles), infection, trauma, and neoplasms are the most pertinent entities with which radiologists should be familiar when assessing the SC. Knowing what to expect in a patient who has undergone SC interventions is imperative. US has a fundamental role in the initial examination of patients who present with symptoms that indicate abnormalities of the SC, such as suspected posttraumatic testicular retraction or SC torsion. Other imaging techniques including abdominal and pelvic MRI and CT have their own importance. For correct interpretation of the findings and to establish an accurate diagnosis, it is crucial to have a thorough knowledge of the anatomy, the utility and limitations of various imaging modalities, optimal imaging and scanning techniques, and the imaging features of various benign and malignant pathologic conditions that can involve the SC. Online supplemental material is available for this article. ©RSNA, 2022.
Collapse
Affiliation(s)
- Niloofar Karbasian
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nicole Segaran
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - John S Pellerito
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.K., N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Zucker School of Medicine at Hofstra/Northwell, Department of Radiology, Northwell Health System, Manhasset, NY (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle, Wash (M.M.)
| |
Collapse
|
2
|
Yang DM, Kim HC, Kim SW, Won KY. Groin abnormalities: ultrasonographic and clinical findings. Ultrasonography 2019; 39:166-177. [PMID: 31786905 PMCID: PMC7065985 DOI: 10.14366/usg.19041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/05/2019] [Indexed: 12/27/2022] Open
Abstract
Groin lesions can be classified as neoplastic or non-neoplastic. Neoplastic lesions include lipoma, epidermoid cyst, angiomyofibroblastoma-like tumor, liposarcoma, and synovial sarcoma, as well as metastases from lymphoma, neuroendocrine carcinoma, and carcinomas of the lung, breast, urinary bladder, ovary, vulva, and colon. Non-neoplastic lesions include hernias, round ligament varices, endometriosis, Kimura disease, Castleman disease, hematoma, and inflammation. Because the clinical implications and therapeutic strategies for groin lesions vary depending on the cause, the ability to noninvasively differentiate among etiologies is very important. Although there is substantial overlap in ultrasonographic findings across various groin lesions, some ultrasonographic features, along with clinical characteristics, may suggest a specific diagnosis. Familiarity with the ultrasonographic and clinical features of various groin lesions facilitates accurate diagnosis and treatment.
Collapse
Affiliation(s)
- Dal Mo Yang
- 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
| | - Kyu Yeoun Won
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| |
Collapse
|
4
|
Bertolotto M, Muça M, Currò F, Bucci S, Rocher L, Cova MA. Multiparametric US for scrotal diseases. Abdom Radiol (NY) 2018; 43:899-917. [PMID: 29460046 DOI: 10.1007/s00261-018-1510-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric US is increasingly recognized as a valuable problem-solving technique in scrotal pathologies. Compared to conventional Doppler modes, contrast-enhanced ultrasonography (CEUS) has higher sensitivity in assessing the presence or absence of flows, and to improve differentiation between poorly vascularized tumors and non-neoplastic, avascular lesions. Characterization of benign and malignant complex cysts is improved. In trauma patients, CEUS can help evaluating the viability of testicular parenchyma. In patients with severe epididymo-orchitis, it allows unequivocal assessment of post-inflammatory ischemic changes and abscess formation. CEUS does not add significantly to conventional Doppler modes in spermatic cord torsion. Attempt of differentiating benign and malignant tumors remains a research tool. In the clinical practice, elastography has a limited role for tumor characterization. The majority of malignant tumors are stiff at elastography, but they may display soft areas, or appear globally soft. A quantitative evaluation of testicular stiffness is feasible using shear-wave elastography. Potential clinical applications for elastographic modes could include work-up of infertile patients.
Collapse
Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Matilda Muça
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Laurence Rocher
- Department of Radiology, Hôpital de Bicêtre, 78 Avenue du General Lecters, 94270, Paris, France
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| |
Collapse
|
5
|
Secil M, Bertolotto M, Rocher L, Pekindil G, Stocca T, Richenberg J, Ramchandani P, Derchi LE. Imaging Features of Paratesticular Masses. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1487-1509. [PMID: 28370138 DOI: 10.7863/ultra.16.07015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/13/2016] [Indexed: 06/07/2023]
Abstract
In this pictorial essay, we review the sonographic and other imaging findings of paratesticular masses in correlation with the pathologic findings. The examples include benign and malignant tumors and also non-neoplastic mass lesions of the paratesticular structures. Diagnostic sonographic findings of these mass lesions as well as correlative findings of other imaging methods are presented.
Collapse
Affiliation(s)
- Mustafa Secil
- Department of Radiology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | | | - Gokhan Pekindil
- Department of Radiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tiziano Stocca
- Department of Radiology, San Giovanni di Dio Hospital, Gorizia, Italy
| | - Jonathan Richenberg
- Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, Brighton, Sussex, England
| | - Parvati Ramchandani
- Department of Genitourinary Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA
| | - Lorenzo E Derchi
- Department of Radiology, Dipartimento di Scienze Della Salute, University of Genoa, Genoa, Italy
| |
Collapse
|
6
|
Dagur G, Gandhi J, Kapadia K, Inam R, Smith NL, Joshi G, Khan SA. Neoplastic diseases of the spermatic cord: an overview of pathological features, evaluation, and management. Transl Androl Urol 2017; 6:101-110. [PMID: 28217455 PMCID: PMC5313312 DOI: 10.21037/tau.2017.01.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Extracellular tumors found with the spermatic cord, known as neoplasms, are usually identified to be benign. However, the accurate and timely diagnosis of spermatic cord masses is highly crucial, especially when most results are often overlooked or unclear. In this review, we discuss the anatomy and embryology of the spermatic cord. Upon rooting these fundamental concepts, we discuss an array of benign and malignant neoplastic tumors, including their origin, pathological features, clinical evaluation and management, as well as other case-specific characteristics of unique presentation. Many of these neoplasms are based on local neurological, vascular, muscular, bone, soft tissue, or lymphatic origin, while others have metastasized from particular areas of the body.
Collapse
Affiliation(s)
- Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Kailash Kapadia
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Rafid Inam
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA;; Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| |
Collapse
|
7
|
Monappa V, Kudva R, Ray S. Primary Paratesticular Lymphoma with Testicular Sparing: Account of an Unusual Scrotal Mass. J Clin Diagn Res 2016; 10:ED07-8. [PMID: 27134882 DOI: 10.7860/jcdr/2016/14421.7412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 01/08/2016] [Indexed: 11/24/2022]
Abstract
Tumours of the testicular adnexa include a heterogeous group of mesothelial, mesenchymal and germ cell tumours. Adenomatoid tumour, pseudosarcomatous myofibroblastic proliferations and rhabdomyosarcoma are the more frequently encountered neoplasms. Lymphoma/leukemic infiltration secondary to testicular involvement or primary tumour elsewhere is not unusual. However, Primary Para-Testicular Lymphoma (PPTL) involving spermatic cord and/or epididymis with sparing of the testicular parenchyma is extremely rare. Accurate staging and typing is crucial for effective management. We present a rare case of Diffuse Large B Cell Lymphoma (DLBCL) involving the left paratesticular tissue with testicular sparing in a young immunocompetant male patient.
Collapse
Affiliation(s)
- Vidya Monappa
- Associate Professor, Department of Pathology, KMC, Manipal University , Manipal, India
| | - Ranjini Kudva
- Professor, Department of Pathology, KMC, Manipal University , Manipal, India
| | - Satadru Ray
- Professor, Department of Surgical Oncology, KMC, Manipal University , Manipal, India
| |
Collapse
|