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Benabdallah W, Loghmari A, Othmane MB, Ouahchi I, Hmida W, Jaidane M. Left paratesticular fibrous pseudotumor on the single testis and contribution of imaging in therapeutic management, a case report. Int J Surg Case Rep 2023; 105:108077. [PMID: 36996707 PMCID: PMC10070615 DOI: 10.1016/j.ijscr.2023.108077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Paratesticular fibrous pseudotumor is a rare benign tumor. Clinically, it can mimic testicular malignancy, but this lesion results from a reactive proliferation of inflammatory and fibrous tissue. CASE PRESENTATION A 62-year-old man presented with left scrotal swelling dating back years. A left paratesticular mass is palpated, firm and painless. Ultrasound showed a heterogeneous and hypoechoic lesion in a single left testicle; the right testicle was not found in the scrotum or at the inguinal level. CT scan showed a hypodense left scrotal mass. The scrotal MRI showed the presence of a paraliquid left intrascrotal formation pushing back the left testicle. We performed a scrotal exploration with excision of the paratesticular mass, sparing the left testicle. The definitive pathological diagnosis was reported as paratesticular fibrous pseudotumor. CLINICAL DISCUSSION Paratesticular Fibrous pseudotumors are a rare tumor with approximately 200 cases reported to date. These lesions constitute 6 % of all paratesticular lesions. Magnetic resonance imaging can give additional information when an ultrasound is inconclusive. The treatment of choice is a scrotal exploration of the mass and frozen section biopsy to avoid unnecessary orchiectomy. CONCLUSION The diagnosis of paratesticular Fibrous pseudotumor is challenging. The contribution of scrotal MRI and intra-operative frozen section is essential for therapeutic management.
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Chen Y, Li XN, Yi XL, Tang Y. Giant bilateral scrotal lipoma with abnormal somatic fat distribution: A case report. World J Clin Cases 2022; 10:10803-10810. [PMID: 36312474 PMCID: PMC9602210 DOI: 10.12998/wjcc.v10.i29.10803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/11/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Scrotal lipoma is exceedingly rare, so its origin is still unknown. Injury is suggested as a potential factor, but the cause remains unclear. It is difficult to determine the origin of these tumours. Previous studies have suggested that these tumours may be congenital or that they originate from small fatty particles around the cord. Other studies have suggested that these tumours originate from testicles or the tunica.
CASE SUMMARY A 66-years elderly male with giant scrotal mass. B-ultrasound, computed tomography and magnetic resonance imaging examinations are typical lipoma-like changes, which were confirmed by postoperative pathological analysis. Abnormal somatic fat distribution was confirmed by images. no recurrence after follow-up for 2 years. Previously published English-language literature was reviewed, and a history of inguinal or pelvic surgery was reported in 6 studies (total 21 cases). To our knowledge, this is the heaviest bilateral scrotal lipoma in the English-language literature, and it has the longest postoperative follow-up time. More importantly, the origin of these tumours is reviewed and discussed.
CONCLUSION Giant bilateral scrotal lipoma in elderly may as part of the symptoms of abnormal somatic fat distribution.
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Affiliation(s)
- Yu Chen
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning 530199, Guangxi Zhuang Autonomous Region, China
| | - Xiu-Ning Li
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning 530199, Guangxi Zhuang Autonomous Region, China
| | - Xian-Lin Yi
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning 530199, Guangxi Zhuang Autonomous Region, China
| | - Yong Tang
- Department of Urology, Wuming Hospital of Guangxi Medical University, Nanning 530199, Guangxi Zhuang Autonomous Region, China
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Tsili AC, Sofikitis N, Pappa O, Bougia CK, Argyropoulou MI. An Overview of the Role of Multiparametric MRI in the Investigation of Testicular Tumors. Cancers (Basel) 2022; 14:cancers14163912. [PMID: 36010905 PMCID: PMC9405843 DOI: 10.3390/cancers14163912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/07/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Simple Summary Although conventional ultrasonography remains the primary imaging modality for the assessment of testicular tumors, multiparametric MRI of the scrotum, which combines morphologic and functional data, serves as a powerful adjunct. Based on the recommendations issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology, scrotal MRI is strongly recommended after equivocal US findings. In cases of testicular masses, the main clinical indications are as follows: lesion characterization when sonographic findings are non-diagnostic, discrimination between germ-cell and non-germ-cell testicular tumors, local staging of testicular tumors in patients who are candidates for testis-sparing surgery, and preoperative histological characterization of testicular germ-cell tumors in selected cases. This article aims to provide an overview of the role of multiparametric MRI in the investigation of testicular tumors. Abstract Conventional ultrasonography represents the mainstay of testis imaging. In cases in which ultrasonography is inconclusive, scrotal MRI using a multiparametric protocol may be used as a useful problem-solving tool. MRI of the scrotum is primarily recommended for differentiating between benign and malignant testicular masses when sonographic findings are ambiguous. This technique is also accurate in the preoperative local staging of testicular tumors and, therefore, is recommended in patients scheduled for testis-sparing surgery. In addition, MRI may provide valuable information regarding the histological characterization of testicular germ-cell tumors, in selected cases. Scrotal MRI may also help in the differentiation between testicular germ-cell neoplasms and non-germ-cell neoplasms. Axial T1-weighted imaging, axial and coronal T2-weighted imaging, axial diffusion-weighted imaging, and coronal subtracted dynamic contrast-enhanced imaging are the minimum requirements for scrotal MRI. A variety of MRI techniques—including diffusion tensor imaging, magnetization transfer imaging, proton MR spectroscopy, volumetric apparent diffusion coefficient histogram analysis, and MRI-based radiomics—are being investigated for testicular mass characterization, providing valuable supplementary diagnostic information. In the present review, we aim to discuss clinical indications for scrotal MRI in cases of testicular tumors, along with MRI findings of common testicular malignancies.
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Affiliation(s)
- Athina C. Tsili
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
- Correspondence: or
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
| | - Ourania Pappa
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
| | - Christina K. Bougia
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
| | - Maria I. Argyropoulou
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 451 10 Ioannina, Greece
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Lewicki A, Freeman S, Jędrzejczyk M, Dobruch J, Dong Y, Bertolotto M, Dietrich CF. Incidental Findings and How to Manage Them: Testis- A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2787-2802. [PMID: 34303560 DOI: 10.1016/j.ultrasmedbio.2021.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 06/13/2023]
Abstract
Testicular incidentalomas are non-palpable, asymptomatic lesions, most frequently detected on ultrasound examinations. Each incidentaloma should undergo a standardized diagnostic workup to exclude malignancy and recognize other potentially significant non-malignant conditions that may first present with an incidental finding on scrotal ultrasound. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on management of testicular incidentalomas and describes efficient management strategies with particular reference to the role of ultrasound techniques.
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Affiliation(s)
- Andrzej Lewicki
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Simon Freeman
- Imaging Directorate, Derriford Hospital, University Hospitals Plymouth NHS Trust. Derriford Road, Plymouth, Devon, United Kingdom
| | - Maciej Jędrzejczyk
- Department of Diagnostic Imaging, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
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Tsili AC, Argyropoulou MI, Dolciami M, Ercolani G, Catalano C, Manganaro L. When to ask for an MRI of the scrotum. Andrology 2021; 9:1395-1409. [PMID: 33964115 PMCID: PMC8596813 DOI: 10.1111/andr.13032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/29/2022]
Abstract
Background Multiparametric MRI (mpMRI) of the scrotum has been established as a useful second‐line diagnostic tool for the investigation of scrotal diseases. Recently, recommendations on clinical indications for scrotal MRI were issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology. Objective To update current research on when to ask for an MRI of the scrotum. Methods PubMed database was searched for original articles and reviews published during 2010–2021. Results Eighty‐three articles fulfilled the search criteria. Scrotal MRI is mainly recommended after inconclusive US findings or inconsistent with the clinical examination and should be asked in the following cases: differentiation between intratesticular and paratesticular lesions (in rare cases of uncertain US findings), characterization of paratesticular and intratesticular lesions (when US findings are indeterminate), discrimination between germ cell and sex cord‐stromal testicular tumors, local staging of testicular malignancies (in patients planned for testis‐sparing surgery), differentiation between seminomas and non‐seminomatous tumors (when immediate chemotherapy is planned and orchiectomy is delayed), assessment of acute scrotum and scrotal trauma (rarely needed, in cases of non‐diagnostic US findings) and detection and localization of undescended testes (in cases of inconlusive US findings). Although preliminary data show promising results in the evaluation of male infertility, no established role for mpMRI still exists. Conclusion Multiparametric MRI of the scrotum, by assessing morphologic and functional data represents a valuable problem‐solving tool, helping to improve our understanding on the nature of scrotal pathology and the process of spermatogenesis. The technique may improve patient care and reduce the number of unnecessary surgical procedures.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Roma, Italy
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6
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Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement. Eur Radiol 2021; 31:4918-4928. [DOI: 10.1007/s00330-020-07631-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
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Revels JW, Wang SS, Gangadhar K, Ali A, Ali AA, Lee JH. Multimodality Radiological Pictorial Review of Testicular Carcinoma: From Initial Staging to Restaging. Res Rep Urol 2020; 12:599-613. [PMID: 33294422 PMCID: PMC7718994 DOI: 10.2147/rru.s257243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
With an overall 5-year survival rate >95%, patients with testicular cancer have a great prognosis. Although initial diagnosis is based on clinical examination, imaging does play a significant role in the diagnosis and prognosis of testicular cancer, which are dependent on tumor burden and staging. Successful treatment requires appropriate disease assessment throughout a patient’s treatment: evaluating treatment response, restaging, and monitoring for disease recurrence after treatment completion. Ultrasound is usually the initial screening modality for painless testicular masses, and computedtomography (CT) the most commonly used for staging and restaging. However, with regard to seminomas, positron-emission tomography (PET) combined with CT is slowly taking priority. With regard to nonseminomatous germ-cell tumors, PET-CT has not proven to be completely effective, due to a high number of false-negative results. The purpose of this paper is to provide radiologists with a pictorial review of testicular carcinoma from initial staging through posttreatment follow-up.
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Affiliation(s)
- Jonathan W Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake, UT, USA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Al-Amin Ali
- Department of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Jean H Lee
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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Thomas LJ, Brooks MA, Stephenson AJ. The Role of Imaging in the Diagnosis, Staging, Response to Treatment, and Surveillance of Patients with Germ Cell Tumors of the Testis. Urol Clin North Am 2019; 46:315-331. [DOI: 10.1016/j.ucl.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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9
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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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10
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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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Abstract
Testicular ultrasound is typically the first-line imaging examination in evaluating scrotal pathology. However, MR imaging can often provide valuable additional information, especially when ultrasound and/or clinical examinations are inconclusive. This is particularly evident when encountering testicular or paratesticular lesions, where accurate localization and characterization are paramount for management and prognosis. After reviewing normal scrotal anatomy as seen on MR imaging and offering a sample imaging protocol, the article describes specific indications for scrotal MR imaging and highlights imaging findings unique to various benign and malignant causes.
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Parenti GC, Feletti F, Carnevale A, Uccelli L, Giganti M. Imaging of the scrotum: beyond sonography. Insights Imaging 2018; 9:137-148. [PMID: 29450854 PMCID: PMC5893488 DOI: 10.1007/s13244-017-0592-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 01/31/2023] Open
Abstract
The aim of this article is to describe the role of second-level imaging techniques after an initial ultrasonography evaluation in the assessment of scrotal diseases. While ultrasonography remains central as the primary imaging modality for the evaluation of pathologic conditions of the scrotum, the role of magnetic resonance imaging continues to evolve: it can actually be valuable as a problem-solving tool when sonographic findings are equivocal or inconclusive. Magnetic resonance imaging of the scrotum may provide accurate detection and characterization of scrotal diseases, well depicting the precise location of scrotal masses (intratesticular or extratesticular) and reliably characterizing benign conditions simulating neoplastic processes, thus preventing unnecessary radical surgery. Advanced magnetic resonance techniques, most of all diffusion weighted imaging and magnetic resonance spectroscopy, play in the meanwhile a more significant role in evaluating scrotal diseases. TEACHING POINTS • Multiparametric ultrasonography usually represents the initial imaging modality for approaching scrotal diseases. • MRI is well established as a problem-solving tool for inconclusive sonographic findings. • Advanced MRI techniques can be successfully applied in scrotal pathology assessment. • MRI is valuable in differentiating benign conditions from neoplastic processes. • CT plays a role in trauma assessment and cancer staging alongside PET/CT.
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Affiliation(s)
- Gian Carlo Parenti
- Department of Diagnostic Imaging of Romagna, Section of Radiology, Ospedale Civile Santa Maria delle Croci, 48100, Ravenna, Italy
| | - Francesco Feletti
- Department of Diagnostic Imaging of Romagna, Section of Radiology, Ospedale Civile Santa Maria delle Croci, 48100, Ravenna, Italy
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy.
| | - Licia Uccelli
- Department of Morphology, Surgery and Experimental Medicine, Section of Nuclear Medicine, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
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Esen B, Yaman MÖ, Baltacı S. Should we rely on Doppler ultrasound for evaluation of testicular solid lesions? World J Urol 2018; 36:1263-1266. [PMID: 29572727 DOI: 10.1007/s00345-018-2273-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Colour Doppler ultrasound (CDUS) is the main radiologic tool to evaluate scrotal masses and intratesticular-vascularised solid lesions are mostly considered malign lesions. Objective of this trial is determine ratio of benign lesions in patients with hypervascularised solid intratesticular lesions. MATERIAL AND METHOD Patients who underwent radical orchiectomy due to hypervascularised intratesticular solid lesions detected in CDUS are evaluated retrospectively. Those with previous testicular cancer history and inguinal/scrotal surgeries were excluded from the study. All patients are evaluated for age, preoperative testicular atrophy, multicentricity, echotexture and size of solid lesions, preoperative tumor markers (AFP, bHCG and LDH), and postoperative pathology results. Two tailed p value test was used to evaluate numeric parameters and Fisher's exact test was used to evaluate non-numeric parameters. RESULTS A total of 117 patients with a mean age of 35.9 (5-86) were included to the study. Mean size of solid lesions was 4.39 cm. Seven patients had subcentimeter (subcm) lesions. 101 patients had hypoechoic, ten patients had isoechoic and six patients hyperechoic solid lesions. Preoperatively 60 patients (51.2%) had at least one tumor marker elevated. Postoperative pathology examination resulted to; 21 patients (17.9%) had benign lesions. Elevation of tumor markers, palpability, hypoechoic texture and larger size of the solid lesion were found to be parameters that predict malignancy. CONCLUSION Benign incidence of vascular testicular solid lesions detected with scrotal ultrasound with colour Doppler is greater than expected. In patients with smaller, non-palpable lesions without elevated tumor markers, treatment options other than radical orchiectomy such as testicular sparing surgery should be considered.
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Affiliation(s)
- Baris Esen
- Department of Urology, Medical Faculty, Ankara University, Ankara, Turkey.
| | | | - Sümer Baltacı
- Department of Urology, Medical Faculty, Ankara University, Ankara, Turkey
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14
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Valoración del volumen testicular mediante resonancia magnética. Rev Int Androl 2017. [DOI: 10.1016/j.androl.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Dharanya S, Vijayakumar C, Sudharsanan S, Jagdish S. A Rare Case Report of a Paratesticular Fibrous Pseudotumor Mimicking a Hydrocele. Cureus 2017; 9:e1565. [PMID: 29057177 PMCID: PMC5640385 DOI: 10.7759/cureus.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tumors arising in the spermatic cord are very rare. The common benign tumors of the spermatic cord include adenomatoid tumor, lipoma, neurofibroma, and leiomyoma. We report a rare case of fibrous pseudotumor of the spermatic cord presenting clinically as a hydrocele. A 28-year-old male presented with the complaint of swelling in the left scrotum, which gradually progressed in size over four years. Clinically, the swelling was soft and fluctuant. The left testis was not separately made out and a diagnosis of left hydrocele was made. On scrotal exploration, a large 12 x 7 cm fleshy mass was seen in the left hemiscrotum with the left testis adherent to the upper pole of the mass. The mass was dissected out from the testis, and the histology showed features of fibrous pseudotumor of the spermatic cord. Fibrous pseudotumor of the spermatic cord is a very rare entity and can pose a diagnostic challenge. Preoperative scrotal ultrasound and intraoperative frozen section assessment can prevent unnecessary orchiectomies in young patients with paratesticular fibrous pseudotumors.
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Affiliation(s)
- Srinivasan Dharanya
- Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sundaramurthi Sudharsanan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sadasivan Jagdish
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group. Eur Radiol 2017; 28:31-43. [DOI: 10.1007/s00330-017-4944-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 01/08/2023]
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17
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Mathur M, Mills I, Spektor M. Magnetic resonance imaging of the scrotum: pictorial review with ultrasound correlation. Abdom Radiol (NY) 2017; 42:1929-1955. [PMID: 28401283 DOI: 10.1007/s00261-017-1127-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The purpose of this review is to showcase the added value of scrotal magnetic resonance imaging (MRI) in the workup of neoplastic and non-neoplastic entities. While ultrasound (US) remains the first-line imaging modality for evaluating scrotal pathology, MRI may add valuable information, particularly when US findings are equivocal. The inherent soft tissue resolution characteristics of MRI, as well as the ability to detect subtle enhancement and provide wider field-of-view imaging, can prove useful in evaluating inconclusive US findings. The added value of MR in these instances is critical as it may have a significant impact on patient management.
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Affiliation(s)
- Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Ian Mills
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
| | - Michael Spektor
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
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Fernandez A, Krishnamoorthy S, Muralitharan S, Johnson T, Ramanan V. Bilateral Synchronous Paratesticular Leiomyoma - A Rare Entity. J Clin Diagn Res 2017; 11:PD05-PD06. [PMID: 28571207 DOI: 10.7860/jcdr/2017/25109.9518] [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] [Received: 10/28/2016] [Accepted: 12/11/2016] [Indexed: 01/17/2023]
Abstract
Paratesticular region is an obscure anatomical region that includes spermatic cord and its contents, tunica of the testes, epididymis and appendices of epididymis and testis. Paratesticular tumours may closely resemble and be clinically indistinguishable from testicular tumours, resulting in a diagnostic dilemma. Preoperative distinction between the benign and malignant paratesticular tumour is extremely difficult, resulting in difficulty in diagnosis and management. We hereby present a case of a 56-year-old male who reported with a painless bilateral scrotal mass and underwent surgical excision of the same. The final biopsy report was paratesticular leiomyoma. The main purpose of this manuscript is to emphasize on the fact that it is imperative for the treating urologists to be aware of such potentially benign rare entity. A high index of clinical suspicion is mandatory, as lack of knowledge about this condition would result in an unnecessary radical orchidectomy.
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Affiliation(s)
- Amrit Fernandez
- Registrar, Department of Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Sriram Krishnamoorthy
- Professor, Department of Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Susruthan Muralitharan
- Associate Professor, Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Thanka Johnson
- Professor, Department of Pathology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Venkat Ramanan
- Professor, Department of Urology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Dagur G, Gandhi J, Suh Y, Weissbart S, Sheynkin YR, Smith NL, Joshi G, Khan SA. Classifying Hydroceles of the Pelvis and Groin: An Overview of Etiology, Secondary Complications, Evaluation, and Management. Curr Urol 2017; 10:1-14. [PMID: 28559772 DOI: 10.1159/000447145] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/30/2016] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION A hydrocele is defined as the pathological buildup of serous fluid in the pelvis and groin due to various etiologies such as diseases or trauma. It has distinct clinical manifestations, particularly discomfort and psychosocial distress. Understanding the anatomy, embryology, and physiology associated with hydrocele formation is crucial to understand its onset and progression. MATERIALS AND METHODS A MEDLINE® search was conducted using keywords for the relevant classification of hydrocele and its etiology, complications, sexual barriers, evaluation, and management. RESULTS Appropriately classifying the hydrocele as primary, secondary communicating, secondary noncommunicating, microbe-induced, inflammatory, iatrogenic, trauma-induced, tumor-induced, canal of Nuck, congenital, and giant is important for identifying the underlying etiology. Often this process is overlooked when the classification or etiology is too rare. A focused evaluation is important for this, so that timely management can be provided. We comprehensively review the classifications, etiology, and secondary complications of hydrocele. Pitfalls of current diagnostic techniques are explored along with recommended methods for accurate diagnosis and current treatment options. CONCLUSION Due to the range of classifications and etiologies of hydrocele in the pelvis and groin, a deliberate differential diagnosis is essential to avoiding imminent life-threatening complications as well as providing the appropriate treatment.
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Affiliation(s)
- Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Yiji Suh
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Steven Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Women's Pelvic Health & Continence Center, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Yefim R Sheynkin
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | | | - Gargi Joshi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, N.Y., USA.,Department of Urology, Stony Brook University School of Medicine, Stony Brook, N.Y., USA
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20
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ACR Appropriateness Criteria Staging of Testicular Malignancy. J Am Coll Radiol 2016; 13:1203-1209. [DOI: 10.1016/j.jacr.2016.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 06/13/2016] [Accepted: 06/15/2016] [Indexed: 01/06/2023]
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21
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Liu FY, Yang SD, Huo LS, Wang T, Yang DL, Ding WY. Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy: A meta-analysis. Medicine (Baltimore) 2016; 95:e03588. [PMID: 27281067 PMCID: PMC4907645 DOI: 10.1097/md.0000000000003588] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/20/2016] [Accepted: 04/12/2016] [Indexed: 11/26/2022] Open
Abstract
This is a meta-analysis to compare the results between laminoplasty and laminectomy followed by fusion for the patients with multilevel cervical compressive myelopathy. An extensive search of literature was performed in MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), cervical lordosis (C2-7), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3 and STATA 12.0. A total of 23 studies comprising 774 and 743 patients treated with laminoplasty and laminectomy followed by fusion, respectively, were included in the final analysis. The pooled analysis showed that there was no significant difference in preoperative JOA scores [P = 0.89], postoperative JOA scores [P = 0.13], JOA scores improvement rate [P = 0.27], preoperative CCI [P = 0.15], postoperative CCI [P = 0.14], preoperative VAS [P = 0.41], postoperative VAS [P = 0.52], preoperative cervical lordosis (C2-7) [P = 0.46], postoperative cervical lordosis (C2-7) [P = 0.67], total complications [P = 0.07], axial pain [P = 0.94], and blood loss [P = 0.51]. However, there were significant difference in operation time (WMD = -19.57 [-32.11, -7.02], P = 0.002) and C5 palsy (OR = 0.26 [0.15, 0.44], P < 0.001). As compared with laminectomy followed by fusion, expansive laminoplasty showed no significant differences in JOA scores, CCI, ROM, VAS, cervical lordosis (C2-7), axial pain, total complications, and blood loss, but shorter operation time and fewer C5 palsy.
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Affiliation(s)
- Feng-Yu Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Li-Shuang Huo
- Department of Endocrinology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tao Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University
- Hebei Provincial Key Laboratory of Orthopedic Biomechanics
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Wongwaisayawan S, Kaewlai R, Dattwyler M, Abujudeh HH, Singh AK. Magnetic Resonance of Pelvic and Gastrointestinal Emergencies. Magn Reson Imaging Clin N Am 2016; 24:419-31. [DOI: 10.1016/j.mric.2015.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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[Emergencies of the external genital area]. Urologe A 2016; 55:444-53. [PMID: 27033375 DOI: 10.1007/s00120-016-0065-x] [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: 10/22/2022]
Abstract
BACKGROUND In addition to epididymitis and testicular torsion, emergencies of the external genital are rare. Rapid diagnosis and therapy are essential so that immediate therapy can be provided, which is important for survival (Fournier gangrene) of the patient or for the preservation of erectile function (priapism and penile fracture). A detailed patient history and clinical examination are generally sufficient for correct diagnosis. RESULTS Under certain circumstances, it might be useful to perform ultrasound, computed tomography scan or magnetic resonance imaging or retrograde urethrography. A urine analysis is obligatory. In case of penetrating injuries and genital trauma in females, additional imaging should be performed because these are often associated with concomitant injuries of the rectum, vagina, or bladder. Special cases are gunshot wounds, in which caliber and type of weapon play an important role for the degree of damage, and animal or human bites. For animal bites, the risk for rabies infection and in case of a human bite the risk for transmission of HIV and hepatitis should be taken into consideration and post-exposure prophylaxis should possibly be offered.
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Mykoniatis I, Metaxa L, Nikolaou V, Filintatzi C, Kikidakis D, Sountoulides P. Giant Scrotal Fibrolipoma. Rare Tumors 2015; 7:6001. [PMID: 26788275 PMCID: PMC4703921 DOI: 10.4081/rt.2015.6001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/16/2015] [Accepted: 07/18/2015] [Indexed: 11/30/2022] Open
Abstract
Fibrolipoma, an infrequent histological subtype of lipoma, is considered a benign mesenchymal neoplasm. Fibrolipoma of the scrotum is an even more rare entity. We report a case of a 55-year-old male complaining for a slow-growing, painless mass in his left hemis-crotum. Imaging with ultrasonography and magnetic resonance imaging was inconclusive regarding the nature of the tumor and the tumor was excised, sparing the testis. The surgical specimen was a well-defined, yellowish white, solid, and firm mass, measuring 19.5×7×5 cm. There was no cytological atypia or mitosis and no lipoblasts recognized. On immunohistochemistry, MDM2 and CDK4 were not expressed. The histopathology report was fibrolipoma of the scrotum. To the best of our knowledge, this is only the fourth case of fibrolipoma originating from the scrotal components, spermatic cord or testis that has been reported in the English literature.
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Affiliation(s)
| | - Linda Metaxa
- Radiology Department, AHEPA University Hospital , Thessaloniki, Greece
| | - Vasilios Nikolaou
- Urology Department, General Hospital of Veria , Thessaloniki, Greece
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Value of dynamic, contrast-enhanced MRI & intraoperative ultrasound for management of a nonpalpable, incidental, testicular Leydig-cell tumor. Radiol Case Rep 2015; 5:432. [PMID: 27307872 PMCID: PMC4898293 DOI: 10.2484/rcr.v5i3.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report a case of a small, intratesticular, incidentally identified, nonpalpable Leydig-cell tumor in which preoperative, dynamic, contrast-enhanced MRI was essential in characterizing the lesion as a neoplasm. Sonographic evaluation failed to demonstrate internal color Doppler flow, resulting in a differential diagnosis that included debris-filled cyst. At surgical resection, intraoperative ultrasound was essential to locate the mass and confirm complete removal. This case highlights the value of dynamic, contrast-enhanced MRI and intraoperative ultrasound for the management of incidental intratesticular lesions with indeterminate sonographic and Doppler characterization. Radiologists and urologists should be familiar with this approach to the incidental, sonographically indeterminate, nonpalpable intratesticular lesion identified on scrotal ultrasound.
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26
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Algebally AM, Tantawy HI, Yousef RRH, Szmigielski W, Darweesh A. Advantage of Adding Diffusion Weighted Imaging to Routine MRI Examinations in the Diagnostics of Scrotal Lesions. Pol J Radiol 2015; 80:442-9. [PMID: 26491491 PMCID: PMC4588671 DOI: 10.12659/pjr.894399] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 06/26/2015] [Indexed: 01/29/2023] Open
Abstract
Background The purpose of the study is to identify the diagnostic value of adding diffusion weighted images (DWI) to routine MRI examinations of the scrotum. Material/Methods The study included 100 testes of 50 patients with a unilateral testicular disease. Fifty normal contralateral testes were used as a control group. All patients underwent conventional MRI and DWI examinations of the scrotum. The results of MRI and DWI of the group of patients treated surgically were correlated with histopathological findings. The MRI and DWI results of non-surgical cases were correlated with the results of clinical, laboratory and other imaging studies. Comparison of the ADC value of normal and pathological tissues was carried out followed by a statistical analysis. Results There was a significant difference between ADC values of malignant testicular lesions and normal testicular tissues as well as benign testicular lesions (P=0.000). At a cut-off ADC value of ≤0.99, it had a sensitivity of 93.3%, specificity of 90%, positive predictive value of 87.5%, and negative predictive value of 94.7% in the characterization of intratesticular masses. Conclusions Inclusion of DWI to routine MRI has a substantial value in improving diagnosis in patients with scrotal lesions and consequently can reduce unnecessary radical surgical procedures in these patients.
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Affiliation(s)
| | | | | | - Wojciech Szmigielski
- Department of Clinical Imaging, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Adham Darweesh
- Department of Clinical Imaging, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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27
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Studniarek M, Skrobisz-Balandowska K, Modzelewska E. Scrotal imaging. J Ultrason 2015; 15:245-58. [PMID: 26674847 PMCID: PMC4657400 DOI: 10.15557/jou.2015.0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 11/28/2022] Open
Abstract
Pathological lesions within the scrotum are relatively rare in imaging except for ultrasonography. The diseases presented in the paper are usually found in men at the age of 15-45, i.e. men of reproductive age, and therefore they are worth attention. Scrotal ultrasound in infertile individuals should be conducted on a routine basis owing to the fact that pathological scrotal lesions are frequently detected in this population. Malignant testicular cancers are the most common neoplasms in men at the age of 20-40. Ultrasound imaging is the method of choice characterized by the sensitivity of nearly 100% in the differentiation between intratesticular and extratesticular lesions. In the case of doubtful lesions that are not classified for intra-operative verification, nuclear magnetic resonance is applied. Computed tomography, however, is performed to monitor the progression of a neoplastic disease, in pelvic trauma with scrotal injury as well as in rare cases of scrotal hernias involving the ureters or a fragment of the urinary bladder.
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Affiliation(s)
- Michał Studniarek
- Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland
- Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
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Baleato-González S, García-Figueiras R, Santiago-Pérez M, Requejo-Isidro I, Vilanova J. Usefulness of 1H magnetic resonance spectroscopy in human testes: preliminary study. Clin Radiol 2015; 70:1026-31. [DOI: 10.1016/j.crad.2015.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 04/04/2015] [Accepted: 05/28/2015] [Indexed: 01/18/2023]
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29
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Tsili AC, Sylakos A, Ntorkou A, Stavrou S, Astrakas LG, Sofikitis N, Argyropoulou MI. Apparent diffusion coefficient values and dynamic contrast enhancement patterns in differentiating seminomas from nonseminomatous testicular neoplasms. Eur J Radiol 2015; 84:1219-26. [DOI: 10.1016/j.ejrad.2015.04.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Revised: 02/25/2015] [Accepted: 04/08/2015] [Indexed: 02/01/2023]
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30
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Parker RA, Menias CO, Quazi R, Hara AK, Verma S, Shaaban A, Siegel CL, Radmanesh A, Sandrasegaran K. MR Imaging of the Penis and Scrotum. Radiographics 2015; 35:1033-50. [PMID: 26090569 DOI: 10.1148/rg.2015140161] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditionally, due to its low cost, ready availability, and proved diagnostic accuracy, ultrasonography (US) has been the primary imaging modality for the evaluation of scrotal and, to a lesser extent, penile disease. However, US is limited by its relatively small useful field of view, operator dependence, and inability to provide much information on tissue characterization. Magnetic resonance (MR) imaging, with its excellent soft-tissue contrast and good spatial resolution, is increasingly being used as both a problem-solving tool in patients who have already undergone US and as a primary modality for the evaluation of suspected disease. Specifically, MR imaging can aid in differentiating between benign and malignant lesions seen at US, help define the extent of inflammatory processes or traumatic injuries, and play a vital role in locoregional staging of tumors. Consequently, it is becoming more important for radiologists to be familiar with the wide range of penile and scrotal disease entities and their MR imaging appearances. The authors review the basic anatomy of the penis and scrotum as seen at MR imaging and provide a basic protocol for penile and scrotal imaging, with emphasis on the advantages of MR imaging. Pathologic processes are organized into traumatic (including penile fracture and contusion), infectious or inflammatory (including Fournier gangrene and scrotal abscess), and neoplastic (including both benign and malignant scrotal and penile tumors) processes.
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Affiliation(s)
- Rex A Parker
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Christine O Menias
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Robin Quazi
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Amy K Hara
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Sadhna Verma
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Akram Shaaban
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Cary L Siegel
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Alireza Radmanesh
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Kumar Sandrasegaran
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
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A prospective study on contrast-enhanced magnetic resonance imaging of testicular lesions: distinctive features of Leydig cell tumours. Eur Radiol 2015; 25:3586-95. [DOI: 10.1007/s00330-015-3766-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/01/2015] [Accepted: 04/02/2015] [Indexed: 01/08/2023]
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32
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Tsili AC, Ntorkou A, Baltogiannis D, Goussia A, Astrakas LG, Malamou-Mitsi V, Sofikitis N, Argyropoulou MI. The role of apparent diffusion coefficient values in detecting testicular intraepithelial neoplasia: Preliminary results. Eur J Radiol 2015; 84:828-33. [DOI: 10.1016/j.ejrad.2015.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/04/2015] [Accepted: 02/09/2015] [Indexed: 10/24/2022]
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Bin Y, Yong-Bao W, Zhuo Y, Jin-Rui Y. Minimal hydrocelectomy with the aid of scrotoscope: a ten-year experience. Int Braz J Urol 2015; 40:384-9. [PMID: 25010305 DOI: 10.1590/s1677-5538.ibju.2014.03.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/22/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since hydrocelectomy remains the choice of surgical treatment of hydrocele and standard surgical procedures may cause postoperative discomfort and complications, a new minimal surgery procedure is needed. The scrotoscope was used for the diagnosis and treatment of intrascrotal lesions. The aim of the study is to illustrate a new minimal hydrocelectomy with the aid of scrotoscope, in an effort to decrease complications. MATERIALS AND METHODS Between 2002 and 2012, 65 patients underwent hydrocelectomy with the aid of a scrotoscope. Before carrying out hydrocelectomy, the scrotoscopy was first used to examine the intrascrotal contents to exclude any pathological lesions. After determining the condition of testis, epididymis and spermatic cord and excluding any other secondary causes of hydrocele, a 2.0 cm scrotal incision was performed. The parietal tunica vaginalis was then grasped out of scrotum, and the mobilized tunica was excised. The scrotoscopy was then performed again to inspect the intrascrotal contents. RESULTS Mean operative time was 35.4 minutes. No major complications occurred during the post-operative follow-up period. Of these 65 patients, 61 underwent scrotoscopy and minimal hydrocelectomy, two patients underwent open hydrocelectomy because thickening of hydrocele wall was identified; two patients with acute inflammation only underwent scrotoscopy. Pathological changes were observed among eight patients. All patients were satisfied with the outcomes. CONCLUSIONS Minimal hydrocelectomy shows commendable results and fewer complications. The combination of minimal hydrocelectomy and scrotoscopy seems to be an encouraging technique. This novel surgical procedure proves to be a viable option for the diagnosis and treatment of hydrocele.
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Affiliation(s)
- Yan Bin
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Yong-Bao
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yin Zhuo
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Yang Jin-Rui
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
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Tsili AC, Giannakis D, Sylakos A, Ntorkou A, Sofikitis N, Argyropoulou MI. MR imaging of scrotum. Magn Reson Imaging Clin N Am 2015; 22:217-38, vi. [PMID: 24792679 DOI: 10.1016/j.mric.2014.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance (MR) imaging of the scrotum has been used as a valuable supplemental diagnostic modality in evaluating scrotal pathology, mostly recommended in cases of inconclusive sonographic findings. Because of the advantages of the technique, MR imaging of the scrotum may provide valuable information in the detection and characterization of various scrotal diseases. The technique may accurately differentiate intratesticular from extratesticular mass lesions and provide important information in the preoperative characterization of the histologic nature of scrotal masses. An accurate estimation of the local extent of testicular carcinomas in patients for whom testis-sparing surgery is planned is possible.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina 45110, Greece.
| | - Dimitrios Giannakis
- Department of Urology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Anastasios Sylakos
- Department of Urology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Alexandra Ntorkou
- Department of Clinical Radiology, University Hospital of Ioannina, Leoforos S. Niarchou, Ioannina 45500, Greece
| | - Nikolaos Sofikitis
- Department of Urology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina 45110, Greece
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Mitra A, Agarwal PN, Singh R, Verma S, Srivastava V, Chugh A, Jain V. Squamous cell carcinoma of the scrotum - still an occupational hazard. Indian J Occup Environ Med 2015; 18:150-2. [PMID: 25598622 PMCID: PMC4292202 DOI: 10.4103/0019-5278.146916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Squamous cell carcinoma (SCC) of the scrotum was one of the first occupational diseases to be described, and acquired its eponym from Sir Percivall Pott. The condition has now become rare owing to the establishment of industrial health norms. A 45-year-old male with a history of long-term exposure to petrochemicals presented to our institution with a scrotal lesion and underwent wide-local excision of the same. Histopathology revealed well-differentiated SCC involving the epididymis. Treatment options included excision with ilio-inguinal bloc dissection (in the event of lymphadenopathy) with subsequent chemotherapy and/or radiotherapy. Tumors following occupational exposure thus continue to contribute to the rapidly decreasing incidence of scrotal carcinoma.
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Affiliation(s)
- Aparajita Mitra
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - P N Agarwal
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Sushant Verma
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vaishali Srivastava
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Anmol Chugh
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Varun Jain
- Department of Surgery, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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Tsili AC, Giannakis D, Sylakos A, Ntorkou A, Astrakas LG, Sofikitis N, Argyropoulou MI. Apparent diffusion coefficient values of normal testis and variations with age. Asian J Androl 2014; 16:493-7. [PMID: 24556745 PMCID: PMC4023385 DOI: 10.4103/1008-682x.122865] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The usefulness of diffusion-weighted magnetic resonance imaging (DWI) in the evaluation of scrotal pathology has recently been reported. A standard reference of normal testicular apparent diffusion coefficient (ADC) values and their variations with age is necessary when interpreting normal testicular anatomy and pathology. We evaluated 147 normal testes using DWI, including 71 testes from 53 men aged 20-39 years (group 1), 67 testes from 42 men aged 40-69 years (group 2) and nine testes from six men older than 70 years (group 3). DWI was performed along the axial plane, using a single shot, multislice spin-echo planar diffusion pulse sequence and b-values of 0 and 900 s mm-2 . The mean and standard deviation of the ADC values of normal testicular parenchyma were calculated for each age group separately. Analysis of variance (ANOVA) followed by post hoc analysis (Dunnett T3) was used for statistical purposes. The ADC values (× 10-3 mm 2 s-1 ) of normal testicular tissue were different among age groups (group 1: 1.08 ± 0.13; group 2: 1.15 ± 0.15 and group 3: 1.31 ± 0.22). ANOVA revealed differences in mean ADC among age groups (F = 11.391, P < 0.001). Post hoc analysis showed differences between groups 1 and 2 (P = 0.008) and between groups 1 and 3 (P = 0.043), but not between groups 2 and 3 (P = 0.197). Our findings suggest that ADC values of normal testicular tissue increase with advancing age.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, University of Ioannina, Ioannina, Greece
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Algebally AM, Tantawy HI, Yousef RRH. Value of diffusion weighted magnetic resonance imaging in diagnosis and characterization of scrotal abnormalities. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Pees M, Ludewig E, Plenz B, Schmidt V. IMAGING DIAGNOSIS - SEMINOMA CAUSING LIVER COMPRESSION IN A SPUR-THIGHED TORTOISE (TESTUDO GRAECA). Vet Radiol Ultrasound 2014; 56:E21-4. [DOI: 10.1111/vru.12145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael Pees
- Clinic for Birds and Reptiles; University of Leipzig; Leipzig Germany
| | - Eberhard Ludewig
- Department of Small Animal Medicine; University of Leipzig; Leipzig Germany
| | - Bastian Plenz
- Clinic for Birds and Reptiles; University of Leipzig; Leipzig Germany
| | - Volker Schmidt
- Clinic for Birds and Reptiles; University of Leipzig; Leipzig Germany
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Dynamic contrast-enhanced subtraction MRI for characterizing intratesticular mass lesions. AJR Am J Roentgenol 2013; 200:578-85. [PMID: 23436847 DOI: 10.2214/ajr.12.9064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The objective of our study was to analyze the enhancement patterns of various intratesticular mass lesions at dynamic contrast-enhanced subtraction MRI and assess the value of the technique in distinguishing between benign and malignant lesions. MATERIALS AND METHODS We retrospectively evaluated the records and images of 44 consecutive men (11 benign and 16 malignant intratesticular lesions) who presented to the department of urology with a variety of clinical symptoms and were referred for imaging. Dynamic contrast-enhanced subtraction MRI was performed using a 3D fast-field echo sequence after the administration of paramagnetic contrast medium. Patients were divided into three groups according to the final diagnosis: benign intratesticular lesions, malignant intratesticular lesions, and normal testes. The patterns of contrast enhancement of both the normal testes and the intratesticular lesions were evaluated. Time-signal intensity plots were created and classified according to shape: Type I presented a linear increase of contrast enhancement throughout the examination, type II showed an initial upstroke followed by either a plateau or a gradual increase in the late contrast-enhanced phase, and type III presented an initial upstroke followed by gradual washout of the contrast medium. The relative percentages of peak height, maximum time, and mean slope were also calculated. RESULTS Normal testes enhanced homogeneously with a type I curve. Most benign intratesticular lesions showed inhomogeneous or homogeneous contrast enhancement and a type II curve. Testicular carcinomas showed heterogeneous contrast enhancement with a type III curve. The relative percentages of maximum time to peak proved the most important discriminating factor in differentiating malignant from benign intratesticular masses (p < 0.001). CONCLUSION Dynamic contrast-enhanced MRI may be used to distinguish between benign and malignant intratesticular mass lesions.
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Abstract
INTRODUCTION The aim of our study is to assess the incidence of the surgical approach in scrotal trauma. MATERIALS AND METHODS We retrospectively assessed both penetrating and blunt cases of scrotal trauma observed from 2002 to 2012. For each case we considered various parameters such as the age of the patient, whether the type of trauma was penetrating or blunt, whether or not a surgical approach was taken, whether or not there were polytrauma, whether or not an orchiectomy was performed, and how many days had elapsed since the first urological observation of the trauma. RESULTS 43 cases of scrotal trauma were assessed, of which 39 were blunt traumas (90%) and four penetrating traumas (10%). The median age of all patients was 29 years (range 4-88). Of these patients, eight underwent surgical procedures, of which three were cases of penetrating scrotal trauma and five were cases of blunt trauma, with an average age of 20. We only found it necessary to carry out an orchiectomy in two of these patients, of which one was after penetrating trauma and the other after blunt trauma. Most of the blunt traumas did not require surgery (8 versus 35, p<0.05). CONCLUSIONS In our case studies, in the majority of cases early exploratory intervention in scrotal trauma allows the testicle to be saved in its entirety or at least in part.
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MRI of Patients With Suspected Scrotal or Testicular Lesions: Diagnostic Value in Daily Practice. AJR Am J Roentgenol 2012; 199:609-15. [DOI: 10.2214/ajr.11.7349] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K. Primary diffuse large B-cell testicular lymphoma: magnetic resonance imaging findings. Andrologia 2012; 44:845-847. [DOI: 10.1111/j.1439-0272.2011.01236.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Tsili AC, Argyropoulou MI, Giannakis D, Tsampalas S, Sofikitis N, Tsampoulas K. Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results. Asian J Androl 2012; 14:649-54. [PMID: 22367182 DOI: 10.1038/aja.2011.172] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance (MR) imaging of the scrotum represents an important supplemental diagnostic tool in the evaluation of scrotal diseases. Diffusion-weighted (DW) MR imaging is a developing technique, proved to improve tissue characterization. We evaluated the feasibility and diagnostic performance of DW MR imaging in the detection and characterization of scrotal lesions. We retrospectively evaluated 31 scrotal lesions (23 intratesticular and 8 extratesticular) in 26 men. All MR examinations were performed on a 1.5-T unit, using a pelvic-phased array coil. DW sequences were obtained using a single shot, multislice spin echo planar diffusion pulse sequence and a b factor of 0 and 900 s mm(-2). The DW MR characteristics and the apparent diffusion coefficient (ADC) values of normal scrotal contents and scrotal diseases were evaluated. Comparison between the ADC values of normal scrotum, benign lesions and scrotal malignancies was performed. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scrotal lesions was calculated. The ADC values of testicular malignancies were different from those of normal testis and benign intratesticular lesions, and the ADC values of benign extratesticular lesions from those of normal epididymis (P<0.05). The overall accuracy of conventional imaging, DW imaging alone and DW MR combined with conventional sequences in the characterization of intratesticular lesions was 91%, 87% and 100%, respectively. Our findings suggest that DW MR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, University Hospital of Ioannina, Ioannina 45500, Greece.
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Abstract
The superior tissue contrast and flexible imaging planes afforded by magnetic resonance imaging (MRI) versus competing technologies permit optimal depiction of the pelvic viscera. Targeted protocols developed for specific pelvic visceral organs highlight important anatomic features that may not be imaged by other modalities. Therefore, a solid understanding of normal and variant pelvic anatomy is crucial for appropriate interpretation of pelvic MRI studies. This article discusses the protocol strategies and relevant anatomy with commonly encountered anatomical variants in a segmented/organ-specific manner, using gender as a broad split given the substantial variance in relevant organs.
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Affiliation(s)
- Ashish P Wasnik
- Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0030, USA
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Tsili AC, Argyropoulou MI, Giannakis D, Zioga E, Koukos S, Sofikitis N, Tsampoulas K. Isolated granulomatous orchitis: MR imaging findings. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ejrex.2011.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Valentino M, Bertolotto M, Derchi L, Bertaccini A, Pavlica P, Martorana G, Barozzi L. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol 2011; 21:1831-40. [PMID: 21633826 DOI: 10.1007/s00330-010-2039-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/21/2010] [Accepted: 10/28/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of contrast-enhanced ultrasound (CEUS) in patients with acute scrotal pain not defined at ultrasound (US) with colour Doppler . METHODS CEUS was carried out in 50 patients with acute scrotal pain or scrotal trauma showing testicular lesion of undefined nature at US. The accuracy of US and CEUS findings versus definitive diagnosis (surgery or follow-up) was calculated. RESULTS Twenty-three patients had a final diagnosis of testicular tumour, three abscess, eight focal infarction, seven trauma, three testicular torsion, one haematoma. Five patients were negative. Thirty-five patients were operated (23 testicular tumours, six trauma, three testicular torsion, one abscess, one focal infarction, and one haematoma) and 15 underwent medical treatment or were discharged. US provided a definitive diagnosis in 34/50 as compared to the 48/50 patients diagnosed at CEUS. Sensitivity and specificity were 76% and 45% for US and 96% and 100% for CEUS respectively. CONCLUSIONS CEUS was more accurate in the final diagnosis compared to US, potentially reducing the need for further imaging. In particular CEUS can be proposed in emergency in cases where US diagnosis remains inconclusive, namely in infarction, and trauma, when testicular torsion cannot be ruled out, and in identifying testicular mass.
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Affiliation(s)
- Massimo Valentino
- Department of Diagnostic Imaging-Emergency Radiology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
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Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K. Conventional and diffusion-weighted magnetic resonance imaging findings of benign fibromatous paratesticular tumor: a case report. J Med Case Rep 2011; 5:169. [PMID: 21539739 PMCID: PMC3113326 DOI: 10.1186/1752-1947-5-169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/03/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The vast majority of paratesticular masses are benign. Magnetic resonance imaging of the scrotum may provide valuable information in the pre-operative work-up of scrotal masses, by allowing the precise localization of the lesion and helping in characterizing its nature. Diffusion-weighted magnetic resonance imaging is an evolving technique that can be used to improve tissue characterization, when interpreted with the findings of conventional magnetic resonance sequences. We present the case of an adenomatoid tumor of the tunica albuginea, with abundant fibrosis evaluated by magnetic resonance imaging of the scrotum, including both conventional and diffusion-weighted sequences. To the best of our knowledge, there are very few reports in the English literature regarding the magnetic resonance imaging features of this rare benign paratesticular tumor and no report on the diffusion-weighted magnetic resonance findings. We discuss the value of magnetic resonance imaging in the pre-operative diagnosis of benign fibromatous paratesticular tumors and differential diagnosis. CASE PRESENTATION A 45-year-old Caucasian man was referred to us with a palpable left scrotal mass. Magnetic resonance imaging of his scrotum revealed the presence of a multilobular left paratesticular mass, mainly detected with very low signal intensity on T2-weighted images and restricted diffusion on apparent diffusion coefficient maps. These findings were suggestive of a fibrous component, and were confirmed on histology following lesion excision. CONCLUSION Magnetic resonance imaging of the scrotum, by using both conventional and diffusion-weighted sequences, could have a potential role in the evaluation of scrotal masses.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, University Hospital of Ioannina, Leoforos S Niarchou, 45500, Ioannina, Greece.
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Abstract
Scrotal and testicular problems range from the benign and painless to the malignant and debilitating. The primary care physician should be able to triage these problems and know when to give reassurance and when to initiate a targeted workup that may lead to specialist intervention. This article focuses on scrotal pain and palpable abnormalities. Scrotal pain includes well-defined acute causes such as torsion and infection and the less well-defined chronic orchialgia. Palpable abnormalities covered here include cryptorchidism, hydrocele, spermatocele, varicocele, and testicular cancer.
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Affiliation(s)
- Stephen M Wampler
- Department of Family Medicine, University of Michigan, Room L2003, Box 5239, Ann Arbor, MI 48109-5239, USA.
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Cassidy FH, Ishioka KM, McMahon CJ, Chu P, Sakamoto K, Lee KS, Aganovic L. MR imaging of scrotal tumors and pseudotumors. Radiographics 2010; 30:665-83. [PMID: 20462987 DOI: 10.1148/rg.303095049] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Magnetic resonance (MR) imaging is an important imaging technique in the evaluation of scrotal masses, providing a useful adjunct to ultrasonography (US). Although US is the modality of choice for initial evaluation of scrotal pathologic conditions because of its wide availability, low cost, and high sensitivity for detection of testicular and paratesticular disease processes, US findings may occasionally be inconclusive. MR imaging may provide additional information in these cases, often affecting patient management. This article reviews and illustrates the MR imaging features of solid extratesticular and intratesticular benign and malignant scrotal tumors, as well as nonneoplastic lesions that can mimic neoplasia. Normal scrotal MR anatomic features and optimal MR imaging technique are also presented.
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Affiliation(s)
- Fiona Hughes Cassidy
- Departments of Radiology, VA Medical Center/University of California, San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161, USA.
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