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Edo H, Yagi F, Mizuno M, Okada M, Hyoe E, Ozaki I, Akita H, Jinzaki M, Shinmoto H. Extratesticular masses focusing on MRI findings. Jpn J Radiol 2024:10.1007/s11604-024-01605-4. [PMID: 38836965 DOI: 10.1007/s11604-024-01605-4] [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: 04/01/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
Scrotal masses, whether cystic or solid lesions, are routinely evaluated using ultrasonography. Magnetic resonance imaging (MRI) may be used for further investigation in cases with atypical findings, difficult diagnoses, large masses, and/or unclear relationships with the surrounding tissues. Scrotal solid masses are divided into intra- and extra-testicular masses. A staggering 90% of the intratesticular masses are malignant, whereas 75% of extratesticular masses are benign. Extratesticular masses are less common than intratesticular masses; however, some extratesticular masses present characteristic MRI findings. Familiarity with these specific MRI features of extratesticular masses is beneficial to radiologists, as appropriate diagnoses can help avoid unnecessary invasive treatments such as orchiectomy. In this review, we describe fibrous pseudotumors, polyorchidism, adenomatoid tumors, and scrotal leiomyoma as benign paratesticular masses, focusing on their characteristic imaging features on MRI. Although these tumors are extremely rare, their MRI findings are distinctive, and accurate diagnoses can prevent unnecessary orchiectomy. In addition, to demonstrate the pitfalls of diagnosing extratesticular masses, we present a case of seminoma misidentified as extratesticular masses due to large extensions outside the testis. Spermatic cord sarcoma, including rhabdomyosarcoma, leiomyosarcoma, and liposarcoma, and metastasis to the spermatic cord are described as malignant extratesticular masses. This review focused on extratesticular masses and elaborates the imaging findings that can aid in the accurate diagnosis using MRI.
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Affiliation(s)
- Hiromi Edo
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan.
| | - Fumiko Yagi
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mariko Mizuno
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchikami-Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchikami-Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Eiko Hyoe
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Ippei Ozaki
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
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Dias ERM, Amaral PHF, Covas DG, Macret JZ, Carvalho JPV, Pivetta LGA, Roll S. Cord lipoma in minimally invasive surgical repairs of inguinal hernias: a prospective study. Hernia 2024:10.1007/s10029-024-03080-2. [PMID: 38837073 DOI: 10.1007/s10029-024-03080-2] [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: 03/27/2024] [Accepted: 05/26/2024] [Indexed: 06/06/2024]
Abstract
Cord lipomas are frequent findings in laparoscopic inguinal hernia surgeries in male patients. The symptoms of lipoma and the potential benefits of removing them are often overlooked because the focus is on the primary pathology of the hernia itself. Current recommendations are to reduce this fatty content, when present. When inguinal cord lipomas are left untreated in inguinal hernia surgery they can potentially cause symptoms and be detected in follow-up imaging exams. The objective of this study was to study incidence of cord lipomas in a cohort operated on by a single group specializing in abdominal wall surgery, as well as to analyze the possible relationship of this finding with the patient's symptoms, the characteristics of the operated hernia and postoperative outcome. This is a prospective study of male patients operated on for inguinal hernia laparoscopically or robotically in a single reference center. Of the total of 141 hernias, the distribution according to European Hernia Society classification showed that 45.4% were lateral, 19.1% medial and 35.5% mixed, highlighting a variety in the presentation of hernias. Analysis of the size of the hernias revealed that the majority (35.5%) were ≤ 1.5 cm. Inguinal cord lipoma was present in 64.5% of the samples, with no statistically significant association between the presence of the lipoma and an indirect hernia sac or obesity. The incidence of surgical site occurrences (SSO) was 9,2%, with seroma and hematoma. No recurrences were observed during follow-up, indicating a successful approach. There were no statistically significant relationships between SSO, the presence of lipoma and indirect hernial sac.
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Affiliation(s)
- E R M Dias
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil.
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil.
| | - P H F Amaral
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - D G Covas
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - J Z Macret
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - J P V Carvalho
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - L G A Pivetta
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - S Roll
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
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Huayanay Espinoza JL, Espinoza Figueroa JVJ, Velezmoro Díaz VE, Huanca Amesquita LS, Cruz Baca RC, Rioja Vega MA, Guelfguat M. Soft-Tissue Sarcomas of the Genitourinary Tract with Radiologic-Pathologic Correlation. Radiographics 2024; 44:e230138. [PMID: 38236750 DOI: 10.1148/rg.230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Genitourinary tract soft-tissue sarcomas are rare neoplasms with varied pathologic and clinical features. While some of these tumors may be aggressive high-grade malignancies, others are low grade with a relatively better prognosis. Given that the grade and extent of the disease are important prognostic factors in these tumors, timely diagnosis is crucial. Unfortunately, most imaging features of these malignancies are not pathognomonic, and various histologic subtypes do not manifest with typical classic imaging features. Therefore, reliable differentiation of the various histologic tumor types is not always possible based solely on the radiologic manifestations. Imaging findings need to be considered in the context of clinical history in corroboration with radiologic-pathologic correlation. The authors discuss the specific imaging and pathologic characteristics of various genitourinary tract soft-tissue sarcomas, emphasizing diagnostic difficulties and differential diagnoses. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Jorge L Huayanay Espinoza
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Jossue V J Espinoza Figueroa
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Vanessa E Velezmoro Díaz
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Lourdes S Huanca Amesquita
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Renier C Cruz Baca
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Marco A Rioja Vega
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
| | - Mark Guelfguat
- From the Departments of Radiology (J.L.H.E., J.V.J.E.F., V.E.V.D.) and Pathology (L.S.H.A., R.C.C.B., M.A.R.V.), Instituto Nacional de Enfermedades Neoplásicas, Av Angamos 2520 Surquillo, 15038 Lima, Peru; and Department of Radiology, Jacobi Medical Center, Bronx, NY (M.G.)
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Ponsiglione A, Campo I, Sachs C, Sofia C, Álvarez-Hornia Pérez E, Ciabattoni R, Sharaf DE, Causa-Andrieu P, Stanzione A, Cuocolo R, Zawaideh J, Brembilla G. Extraprostatic incidental findings on prostate mpMRI: A pictorial review from the ESUR junior network. Eur J Radiol 2023; 166:110984. [PMID: 37480649 DOI: 10.1016/j.ejrad.2023.110984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
The role of multiparametric MRI (mpMRI) in prostate cancer setting is increasingly consolidated and, as a result, its usage in clinical practice is in exponential growth. However, beyond the prostate gland, several key structures are included in the field of view of mpMRI scans. Consequently, various extra-prostatic incidental findings (IFs) belonging to different anatomical systems can be accidentally recognized. Therefore, it is mandatory for a radiologist to be familiar with the wide range of pathologies potentially encountered, to guide management and avoid patient anxiety and costs due to additional work-up prompted by clinically insignificant extra-prostatic findings. With this pictorial review, we aim to illustrate a wide range of IFs that can be detected when performing mpMRI of the prostate, focusing on their imaging characteristics, differential diagnosis, and clinical relevance. Additionally, we propose the CheckDEEP, the Checklist for DEtection of ExtraProstatic findings, to be used for a thorough evaluation of target areas within each anatomical system.
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Affiliation(s)
- Andrea Ponsiglione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
| | - Irene Campo
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Camilla Sachs
- Department of Radiology, Ospedale Ca' Foncello, 31100, Treviso, Italy
| | - Carmelo Sofia
- Department of Biomedical Sciences and Morphologic and Functional Imaging, Policlinico Universitario G. Martino, University of Messina, Messina, Italy
| | | | - Riccardo Ciabattoni
- Department of Radiology, Ospedale San Salvatore di Pesaro, Azienda Sanitaria Territoriale Pesaro Urbino, Pesaro, Italy
| | - Doaa E Sharaf
- Department of Radiology, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt
| | | | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Jeries Zawaideh
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgio Brembilla
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Gabriel H, Hammond NA, Marquez RA, Lopes Vendrami C, Horowitz JM, Casalino DD, Nikolaidis P, Miller FH, Bhatt S. Gamut of Extratesticular Scrotal Masses: Anatomic Approach to Sonographic Differential Diagnosis. Radiographics 2023; 43:e220113. [PMID: 36893051 DOI: 10.1148/rg.220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
The commonly taught tenet that intratesticular lesions are always malignant and extratesticular scrotal lesions are always benign is a simplistic statement that erroneously minimizes the significance of extratesticular scrotal masses and their diagnosis. Yet, disease in the extratesticular space is commonly encountered by clinicians and radiologists and is often a source of uncertainty in diagnosis and management. Given the embryologically rooted complex anatomy of this region, a wide range of pathologic conditions is possible. Radiologists may not be familiar with some of these conditions; further, many of these lesions can have a specific sonographic appearance, allowing accurate diagnosis that can minimize surgical intervention. Lastly, malignancies can occur in the extratesticular space-although this is less common than in the testicles-and proper recognition of findings that warrant additional imaging or surgery is critical in optimizing outcomes. The authors present a compartmental anatomic framework for differential diagnosis of extratesticular scrotal masses and provide a comprehensive illustrative display of many of the pathologic conditions that can be encountered to familiarize radiologists with the sonographic appearances of these lesions. They also review management of these lesions and scenarios where US may not be definitive in diagnosis and selective use of scrotal MRI can be helpful. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Helena Gabriel
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Nancy A Hammond
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Rocio A Marquez
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - David D Casalino
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Paul Nikolaidis
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Frank H Miller
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Shweta Bhatt
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
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Liu Y, Zhang Z, Wang J, Wang S. Effects of radiotherapy on the survival of patients with malignant spermatic cord tumors: A retrospective cohort study. Cancer Med 2023; 12:5580-5589. [PMID: 36354142 PMCID: PMC10028065 DOI: 10.1002/cam4.5402] [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: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Malignant spermatic cord tumors (SCT) are rare and currently, there is no consensus regarding the role of radiotherapy in their treatment. This study evaluated the effect of radiotherapy on the overall survival (OS) of patients with malignant SCT based on the large-sample advantage of the Surveillance, Epidemiology, and End Results (SEER) database. METHODS Patients with malignant SCT recorded in the SEER database from 1975 to 2016 were included. All patients were divided into non-radiation and radiation groups, and propensity score matching (PSM) (1:1) was performed for baseline covariates between the two groups. The overall survival rate between the two groups of patients was analyzed using the Kaplan-Meier curve. The effects of radiotherapy on patient prognosis were analyzed using univariate and multivariate COX regression analyses. RESULTS In total, 389 patients with malignant SCT were included. There were 285 (73.26%) and 104 (26.74%) patients who either did or did not receive radiotherapy, respectively. Kaplan-Meier curves before and after PSM showed no significant differences in OS between the two groups. Similarly, multivariate COX regression models before and after PSM showed that radiotherapy was not an independent risk factor for OS in patients with malignant SCT. CONCLUSIONS Radiotherapy has no obvious advantage in improving the survival time of patients with malignant SCT.
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Affiliation(s)
- Yifu Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zhicheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jinxiang Wang
- Department of Cell Biology, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Siyuan Wang
- Department of Urology, Sichuan Cancer Hospital, Chengdu, China
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Bonde A, Singh R, Prasad SR, Kamireddy D, Aggarwal A, Ramani N, Saboo S, Shanbhogue K, Dasyam AK, Katabathina VS. Mesotheliomas and Benign Mesothelial Tumors: Update on Pathologic and Imaging Findings. Radiographics 2023; 43:e220128. [PMID: 36757881 DOI: 10.1148/rg.220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
A diverse spectrum of benign entities and malignant neoplasms originate from the monotonous mesothelium that lines the serosal membranes of the pleural, pericardial, and peritoneal cavities. The mesothelium of myriad sites shows a common origin from the lateral plate mesoderm; primary mesothelial tumors thus demonstrate similar pathogenesis, imaging findings, and treatment options. Significant changes have been made in the 2021 World Health Organization (WHO) classification schemata of the pleural and pericardial tumors on the basis of recent advances in pathology and genetics. While malignant mesotheliomas are biologically aggressive malignancies that occur primarily in patients exposed to asbestos with attendant poor survival rates, well-differentiated papillary mesothelial tumors and adenomatoid tumors charter a benign clinical course with an excellent prognosis. Mesothelioma in situ is a newly characterized entity represented by recurrent unexplained pleural effusions without any identifiable mass at imaging or thoracoscopy. Immunohistochemical markers based on BAP1, MTAP, CDKN2A, and TRAF7 gene mutations help differentiate diffuse mesotheliomas from benign mesothelial proliferations and localized mesotheliomas. Cross-sectional imaging modalities, including US, CT, MRI, and fluorine 18-fluorodeoxyglucose (FDG) PET/CT, permit diagnosis and play a major role in staging and assessing surgical resectability. Imaging studies are invaluable in providing noninvasive and quantitative assessment of tumor response in patients with unresectable disease. Owing to significant overlap in patient characteristics and pathomorphology, accurate diagnosis based on advanced histopathology techniques and genetic abnormalities is imperative for optimal management and prognostication. While patients with nonepithelioid pleural mesotheliomas benefit from immunotherapy, novel targeted therapies for CDKN2A-, NF2-, and BAP1-altered mesotheliomas are under consideration. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Apurva Bonde
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Ramandeep Singh
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Dhiraj Kamireddy
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Aarushi Aggarwal
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Nisha Ramani
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Sachin Saboo
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Krishna Shanbhogue
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Anil K Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
| | - Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (A.B., D.K., A.A., S.S., V.S.K.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (R.S.); Departments of Radiology (S.R.P.) and Pathology (N.R.), University of Texas M. D. Anderson Cancer Center, Houston, Tex; Department of Radiology, NYU Medical Center, New York, NY (K.S.); and Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (A.K.D.)
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Caviglia A, Beverini M, Pacchetti A, Branger N, Pignot G, Bertucci F, Walz J. A Giant Paratesticular Liposarcoma: Case Report and Literature Review. Case Rep Oncol 2023; 16:162-166. [PMID: 36970715 PMCID: PMC10035545 DOI: 10.1159/000528221] [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: 08/22/2022] [Accepted: 11/02/2022] [Indexed: 03/25/2023] Open
Abstract
Liposarcoma of the spermatic cord (LSC) is a very rare disease. In literature, are reported less than 350 cases. Genitourinary sarcomas account for <5% of all soft-tissue sarcomas and <2% of malignant urologic tumours. An inguinal mass is the clinical presentation, which can mimic a hernia or hydrocele. Since it is such a rare disease, there are insufficient data on chemotherapy and radiotherapy, and in any case, the data come from low-level scientific evidence. Here, we report the case of a patient who came to the observation for a giant inguinal mass, in which a definitive diagnosis was obtained with the histological examination.
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Affiliation(s)
- Alberto Caviglia
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Martina Beverini
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, UMC+, Maastricht, The Netherlands
| | | | - Nicolas Branger
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | - Geraldine Pignot
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
| | | | - Jochen Walz
- Department of Urology, Institut Paoli-Calmettes, Marseille, France
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9
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Hua R, Zhao L, Xu L, Sun J, Huang J, Hua Q. Recurrent paratesticular giant liposarcoma: A case report and literature review. Front Surg 2023; 10:1171952. [PMID: 37181598 PMCID: PMC10172677 DOI: 10.3389/fsurg.2023.1171952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Background Primary paratesticular liposarcoma is rarely diagnosed among urinary tumors. In this study, through the retrospective analysis of clinical data and literature review, a case of recurrent paratesticular liposarcoma with lymph node metastasis after radical resection has been reported to explore novel strategies for the diagnosis, treatment and prognosis of this rare disease. Case summary The present case involved a patient who was misdiagnosed as a left inguinal hernia for the first time two years ago, but was later diagnosed as mixed liposarcoma by using postoperative pathology. Currently, he is readmitted to the hospital with a recurrence of the left scrotal mass for more than 1 year. Combined with the patient's past medical history, we performed radical resection of the left inguinal and scrotal tumors and lymphadenectomy of left femoral vein. The postoperative pathology indicated that well-differentiated liposarcoma was accompanied by mucinous liposarcoma (about 20%), and lymph node metastasis of left femoral vein both of which occurred at the same time. After the operation, we recommended the patient to receive further radiation therapy, but the patient and his family refused, hence we followed up the patient closely for a long time. During the recent follow-up, the patient reported no complaints of discomfort, and no recurrence of mass in the left scrotum and groin area. Conclusion After conducting extensive review of literature, we conclude that radical resection remains the key to treat primary paratesticular liposarcoma, while the significance of the lymph node metastasis is still unclear. The potential effects of postoperative adjuvant therapy depends on the pathological type, and hence close follow-up observation is essential.
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Affiliation(s)
- Runmiao Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Liwei Zhao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Li Xu
- Department of Urology, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Ji Sun
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Qiyan Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
- Correspondence: Qiyan Hua
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10
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Cheng CQ, Sun J, Yin JY, Wang TT, He XM. Ultrasonography of a giant adenomatoid tumor of the tunica vaginalis: A case report and review of the literature. Radiol Case Rep 2022; 17:4302-4307. [PMID: 36132067 PMCID: PMC9483582 DOI: 10.1016/j.radcr.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/07/2022] [Accepted: 08/10/2022] [Indexed: 10/31/2022] Open
Abstract
Adenomatoid tumor is a kind of benign tumor, accounts for a low percentage of scrotal tumors. It usually locates in epididymis, less commonly, arises from the tunica albuginea, spermatic cord or tunica vaginalis of male's urogenital tract system. Here, we report a case of a 32-year-old male, which presented as a 6-month history of left scrotal swelling pain with a scrotal mass, and it had progressively enlarged over the last 1 month. The ultrasonography (US) described a giant well-defined hypoechoic mass in the left scrotum, a thick pedicle connected the mass and the left scrotal wall, and the pedicle had large blood vessels in it. Enhanced CT showed an irregular solid mass in the left scrotum, the left testicular artery was thickened to supply blood for the mass, and the radiologist mentioned it could not be excluded as a malignant lesion. The patient underwent left radical orchiectomy, the mass was diagnosed as an adenomatoid tumor of the tunica vaginalis by pathology. We review literature regarding adenomatoid tumors originating in the tunica vaginalis, summarize the ultrasonographic presentations, provide the idea of diagnosis and differential diagnosis to improve diagnostic accuracy and avoid unnecessary orchiectomy.
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11
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Kizilgoz V, Kantarci M, Tonkaz G, Levent A, Ogul H. Incidental findings on prostate MRI: a close look at the field of view in this anatomical region. Acta Radiol 2022; 64:1676-1693. [PMID: 36226365 DOI: 10.1177/02841851221131243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Magnetic resonance imaging (MRI) has been widely used as an advanced imaging modality to detect prostate cancer and indicate suspicious areas to guide biopsy procedures. The increasing number of prostate examinations with MRI has provided an opportunity to detect incidental lesions, and some might be very significant to elucidate patient symptoms or occult neoplastic process in the early stages. These incidental lesions might be located in the prostate gland, adjacent tissues, or organs around the prostate gland or out of the genitourinary system. The field of view of prostate MRI includes not only the prostate gland but also other critical pelvic organs in this specific anatomical region. Some of these incidental lesions might cause the same symptoms as prostate cancer and might explain the symptoms of the patient, and some might indicate early cancer stages located outside the prostate. Reporting these lesions might be life-saving by initiating early disease treatment. Awareness of the predicted locations of congenital anomalies would also be beneficial for the radiologists to mention these incidental findings.
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Affiliation(s)
- Volkan Kizilgoz
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Mecit Kantarci
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey.,Faculty of Medicine, Department of Radiology, 37503Atatürk University, Erzurum, Turkey
| | - Gokhan Tonkaz
- Erzurum Regional Education and Research Hospital, Erzurum, Turkey
| | - Akin Levent
- Faculty of Medicine, Department of Radiology, 162315Erzincan Binali Yıldırım University, Erzincan, Turkey.,Faculty of Medicine, Department of Radiology, 37503Atatürk University, Erzurum, Turkey
| | - Hayri Ogul
- Faculty of Medicine, Department of Radiology, Düzce University, Düzce, Turkey
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12
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Kerr DM, Middleton WD. Ultrasound of the Normal and Abnormal Vas Deferens. Ultrasound Q 2022; 38:224-236. [PMID: 35129151 DOI: 10.1097/ruq.0000000000000588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The extrapelvic portion of the vas deferens is readily visible with ultrasound but often overlooked. Several publications have described the scanning technique and the normal anatomy of the vas deferens. Sonographic evaluation of the vas deferens provides critical information in the workup of male infertility. Obstruction, inflammatory conditions, and neoplasms of the vas deferens can also be diagnosed with ultrasound. Knowledge of the normal and abnormal appearance of the vas deferens improves scans of the scrotum and expands the conditions that can be recognized and accurately diagnosed with ultrasound.
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13
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Pikramenos K, Katsimperis S, Zachou M, Giannakakou M, Mitsogianni M, Mitsogiannis I. Liposarcoma of the Spermatic Cord Mimicking an Inguinal Hernia: A Case Report and Literature Review. Cureus 2022; 14:e28269. [PMID: 36158429 PMCID: PMC9491821 DOI: 10.7759/cureus.28269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
Liposarcomas of the spermatic cord are extremely rare, with less than 200 cases in the literature. We present a case of sclerosing mixed with myxoid liposarcoma of the left spermatic cord in a 55-year-old male patient, mimicking an inguinal hernia on pre-operative ultrasound. The patient underwent orchidectomy and is currently on follow-up surveillance with no signs of recurrence.
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14
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Kefalas C, Karlafti E, Zatagias A, Karakatsanis A, Tsakiris G, Michalopoulos A, Paramythiotis D. Transabdominal Preperitoneal inguinal hernia repair leading to orchiectomy: A case report. Ann Med Surg (Lond) 2022; 80:104288. [PMID: 36045854 PMCID: PMC9422286 DOI: 10.1016/j.amsu.2022.104288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Charalampos Kefalas
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
- Corresponding author.
| | - Eleni Karlafti
- Emergency Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Apostolos Zatagias
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Anestis Karakatsanis
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Georgios Tsakiris
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Antonios Michalopoulos
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Propaedeutic Surgery Department, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
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15
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Jo JI, Yang DM, Kim HC, Kim SW. Various Intratesticular Hypoechoic Lesions on Scrotal Sonography. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:861-875. [PMID: 36238913 PMCID: PMC9514578 DOI: 10.3348/jksr.2021.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/04/2021] [Accepted: 09/27/2021] [Indexed: 06/16/2023]
Abstract
Sonography with a high-frequency transducer is the modality of choice for imaging the scrotum. Most intratesticular lesions are hypoechoic. Differentiation of intratesticular hypoechoic lesions as either malignant or benign is important because the treatment of these lesions vary. In this paper, we review the sonographic features of different types of intratesticular hypoechoic lesions, such as testicular cysts, testicular tumors, testicular inflammatory lesions, segmental testicular infarction, and testicular trauma.
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16
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Lee J, Kim Y, Jou S, Park C. [Inguinal and Scrotal Diseases in Children and Adolescents]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:792-807. [PMID: 36238923 PMCID: PMC9514593 DOI: 10.3348/jksr.2021.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022]
Abstract
In children and adolescents, inguinal and scrotal diseases are relatively common, and imaging is very useful for the diagnosis and differential diagnosis of these diseases. Therefore, it is important to understand the imaging findings of these diseases. In this article, we classify these diseases into small testes, cryptorchidism, patent processus vaginalis, acute scrotum pain, trauma, testicular tumors, and others and describe their characteristic findings.
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17
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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.
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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.)
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18
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Tsili AC, Bougia CK, Pappa O, Argyropoulou MI. Ultrasonography of the scrotum: Revisiting a classic technique. Eur J Radiol 2021; 145:110000. [PMID: 34741987 DOI: 10.1016/j.ejrad.2021.110000] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 01/16/2023]
Abstract
Conventional US is the primary imaging modality for the evaluation of the scrotum, due to its high resolution, availability, cost-effectiveness and absence of ionizing radiation. Grayscale and color Doppler US provide a comprehensive assessment of scrotal diseases. The technique represents the mainstay for imaging of acute scrotum. US is highly accurate in the detection, localization and characterization of scrotal masses. Multiparametric US, including conventional US, contrast-enhanced US and tissue elastography has improved the diagnostic performance of the technique in the assessment of testicular diseases. MRI represents a valuable supplemental imaging tool for the investigation of scrotal pathology, mainly recommended in cases of indeterminate US findings. Recommendations recently issued by the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) refer to the use of scrotal sonography for the evaluation of pathologic entities, including testicular microlithiasis, small, non-palpable incidentally detected testicular masses, varicocele and scrotal trauma. In this review, the technical specifications for scrotal US and the normal sonographic findings are presented. Grayscale and color Doppler US findings of common acute scrotal diseases and scrotal masses are discussed. The complimentary role of multiparametric US and scrotal MRI is addressed. ESUR-SPIWG's guidelines are also reviewed.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece.
| | - Christina K Bougia
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Ourania Pappa
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45110 Ioannina, Greece
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19
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Houser M, Khati NJ. The Rare, the Odd, and the Atypical: A Pictorial Essay of Testicular and Paratesticular Diseases. Ultrasound Q 2021; 37:207-218. [PMID: 34478418 DOI: 10.1097/ruq.0000000000000570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Understanding a variety of scrotal diseases is essential to developing an accurate differential diagnosis and is critical in providing optimal patient care. Ultrasound is the imaging modality of choice when evaluating for scrotal pathology, with the major purpose of locating such pathology to either the testis, or epididymis, or other intrascrotal structures, as well as characterizing lesions as solid or cystic. It is generally assumed that most solid intratesticular masses are more likely malignant, whereas most extratesticular ones are benign, although some exceptions to that rule exist. This pictorial essay will focus on rare and less commonly encountered benign and malignant testicular and paratesticular pathologies, which may pose a diagnostic dilemma for interpreting radiologists and treating physicians. Knowledge of their imaging characteristics will help narrow the differential diagnosis and assist in proper patient management and care.
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Affiliation(s)
| | - Nadia J Khati
- Abdominal Imaging Section, The George Washington University Hospital, Washington, DC
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20
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Kumar P, Sengar M, Mohta A. Atypical scrotal masses: Surgical surprise. Trop Doct 2021; 52:116-119. [PMID: 34369826 DOI: 10.1177/00494755211036588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present three unusual cases of atypical scrotal lesions in children. The first was a firm left scrotal mass with the testis indistinguishable. The second with apparently a large hydrocoele, which was a cyst, and the third with multiple nodular lesions, pushing the left testis into the right hemiscrotum. These turned out to be a pigmented neuroectodermal tumour, a lymphatic malformation and neurofibromas respectively. Paediatric surgeons should be aware of such surgical surprises.
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Affiliation(s)
- Parveen Kumar
- Assistant Professor, Department of Paediatric Surgery, Chacha Nehru Bal Chikitsalya, New Delhi 110031, India
| | - Mamta Sengar
- Professor, Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalya, New Delhi 110031, India
| | - Anup Mohta
- Director Professor, Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalya, New Delhi 110031, India
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21
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Lotti F, Bertolotto M, Maggi M. Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal. Andrology 2021; 9:1331-1355. [PMID: 34089245 DOI: 10.1111/andr.13062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ultrasonography is the gold standard imaging method for scrotal investigation. Colour Doppler ultrasonography, contrast-enhanced ultrasonography and sonoelastography allow sonographers to assess size, echotexture, vascular features and stiffness of the scrotal organs and abnormalities. Scrotal ultrasonography has been used to investigate male reproductive health, scrotal pain, masses and trauma. However, ultrasonography thresholds/classifications used to distinguish normal and pathologic features of the scrotal organs have changed over time, and have not yet been fully standardized. OBJECTIVES To evaluate historical trends for the standards in scrotal ultrasonography: what was, what is and what will be normal. METHODS An extensive Medline search was performed identifying the most relevant studies in the English language from inception to date. RESULTS We provide here (i) a brief overview of the history of ultrasonography, (ii) current indications for scrotal ultrasonography and (iii) previous and current normal values, cut-offs and classifications of the main colour-Doppler ultrasonography parameters/characteristics of the scrotal organs, as derived from recent guidelines and evidence-based studies. In addition, we report recommendations and the clinical utility of contrast-enhanced ultrasonography and sonoelastography. Finally, we discuss critical issues needing further evidence and future directions to fill in the current gaps. DISCUSSION Several studies on scrotal ultrasonography are available. However, guidelines/recommendations dealing with specific ultrasonography applications have been published only in recent years. More recently, the European Academy of Andrology published evidence-based scrotal colour-Doppler ultrasonography reference ranges/normative parameters derived from a cohort of healthy, fertile men. In addition, a standardization of the methodology to evaluate qualitative and quantitative colour-Doppler ultrasonography parameters was reported. Other international societies reported indications, methodological standards, clinical utility and limitations of contrast-enhanced ultrasonography and sonoelastography. CONCLUSIONS To date, colour-Doppler ultrasonography normative values for the scrotal organs are available. However, a wide international consensus on assessment and classification of several ultrasonography parameters is still lacking. An alignment of the world societies on these issues is advocated.
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Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Michele Bertolotto
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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22
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AlGhamdi M, AlYami M, Faqeeh S, AlKubeyyer B, AlShabyli N, AlAyed A. Beyond germ cell tumors, unusual testicular and extra-testicular masses and mass-like lesions: MRI and US pictorial review. Clin Imaging 2021; 74:106-122. [DOI: 10.1016/j.clinimag.2020.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 11/23/2020] [Accepted: 12/28/2020] [Indexed: 01/08/2023]
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23
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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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Rafailidis V, Huang DY, Sidhu PS. Paratesticular lesions: Aetiology and appearances on ultrasound. Andrology 2021; 9:1383-1394. [PMID: 33864338 DOI: 10.1111/andr.13021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ultrasound (US) is the primary modality for the investigation of scrotal pathology, including both intra- and paratesticular abnormalities. OBJECTIVE To describe the abnormalities of the paratesticular space. MATERIALS/METHODS The paratesticular space contains the epididymis, spermatic cord and the tunica vaginalis cavity and is affected by a variety of inflammatory or tumoral entities. Differential diagnosis based on US criteria is frequently problematic, as the findings are non-specific. RESULTS Some general rules apply: (i) unlike testicular lesions, extra-testicular entities are usually benign in the adult, (ii) the first steps to accurate diagnosis include careful localization of the lesion and assessment of its consistency (solid or cystic) and (iii) magnetic resonance imaging can be useful for further tissue characterization of lesions suspected to contain fat, but surgical biopsy will often provide the definite diagnosis. Contrast-enhanced ultrasound (CEUS) has been applied with limited experience indicating a narrow role, primarily for the differential diagnosis of echogenic cystic entities and the delineation of a necrotic abscess from a solid neoplasm. DISCUSSION The various abnormalities are discussed and illustrated. CONCLUSION This manuscript summarizes the literature on paratesticular lesions and the value of US in diagnosis.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, King's College London, King's College Hospital, London, UK
| | - Dean Y Huang
- Department of Radiology, King's College London, King's College Hospital, London, UK
| | - Paul S Sidhu
- Department of Radiology, King's College London, King's College Hospital, London, UK
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Demirel HC, Tokuç E, Eryilmaz OT, Aykanli E, Yavuzsan AH, Ozagari AA, Kirecci SL, Horasanli K. The fate of paratesticular masses: 13 years' experience in a tertiary referral centre. Aktuelle Urol 2021. [PMID: 33853159 DOI: 10.1055/a-1345-6808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Paratesticular neoplasms exhibit different behaviours, depending on the embryological tissue of origin. Treatment modalities can depend on the differential diagnosis. The aim of this study is to present the clinical, morphological and histopathological features of patients with paratesticular masses and their follow-ups and is intended to increase awareness of the issues. METHODOLOGY We included 31 excisions of paratesticular masses, after radiological diagnosis as paratesticular mass in our hospital between 2007-2020. Information on treatment modalities, tumour recurrence, metastasis, and survival rates were obtained from hospital archives. All patients were evaluated by taking patients' history, physical examination, scrotal ultrasound, chest radiography, and serum tumour markers. Treatment modality was selected according to intraoperative findings. Haematoxylin-eosin sections were examined, and immunohistochemical analyses were performed for smooth muscle actin, desmin, Ki67, CD34, S100, and myogenin. Ten high-power fields were counted to document Ki67 and p53 nuclear positivity rates. RESULTS A total of 31 operations were performed with recurrence in three patients. Histomorphological and immunohistochemical examination revealed eleven malignant masses; eight rhabdomyosarcomas, a leiomyosarcoma, a liposarcoma and a large B cell lymphoma. Other excised masses were benign and infective lesions. CONCLUSION Paratesticular masses are heterogeneous tumours that follow different clinical courses. Clinicians must be aware of this histological diversity in order to plan a treatment pathway. This study is one of the largest published series, with a long follow-up period. It shows that the most critical features in determining prognosis are histopathological subtype and tumour grade.
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Affiliation(s)
| | - Emre Tokuç
- Istanbul Sultanbeyli State Hospital, Urology, Istanbul, Turkey
| | - Ozlem Ton Eryilmaz
- Şişli Hamidiye Etfal Training and Research Hospital, Pathology, Şişli, Turkey
| | - Emre Aykanli
- Şişli Hamidiye Etfal Training and Research Hospital, Urology, Şişli, Turkey
| | | | - Ayse Aysim Ozagari
- Şişli Hamidiye Etfal Training and Research Hospital, Pathology, Şişli, Turkey
| | | | - Kaya Horasanli
- Şişli Hamidiye Etfal Training and Research Hospital, Urology, Şişli, Turkey
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Incidental findings in and around the prostate on prostate MRI: a pictorial review. Insights Imaging 2021; 12:37. [PMID: 33738590 PMCID: PMC7973355 DOI: 10.1186/s13244-021-00979-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/19/2021] [Indexed: 02/07/2023] Open
Abstract
Prostate MRI has seen rapid growth in use in recent years as an advanced diagnostic modality to detect focal areas of clinically significant prostate cancer, to identify an area for targeted biopsy and to guide management and surveillance. The increase in use has also led to increased diagnosis of incidental lesions arising from structures around the prostate. These incidental findings may be related to the genitourinary system or non- genitourinary system and may have a benign aetiology which needs no additional follow-up, or it may require surveillance and management. The field of view in a multiparametric prostate MRI includes other pelvic organs, neurovascular bundles, bowel, lymph nodes and bones. Being familiar with standard MRI characteristics and a sound knowledge of anatomy of the prostate and surrounding structures can help in distinguishing normal anatomy from pathology. Given that patients undertaking a prostate MRI are usually a cohort with increased anxiety from their known or suspicion of prostate cancer, it is important that radiologists are familiar with these common incidental findings to minimise anxiety to the patient, have a well-informed discussion with the referring clinician and reduce costs associated with unnecessary further testing and follow-up of benign incidental findings. Additionally, being able to diagnose more serious incidental pathologies early can be life-saving and potentially significantly alter patient management.
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Ebey BN, Naouar S, Faidi B, Lahouar R, Ben Khalifa B, El Kamel R. Pleomorphic spermatic cord liposarcoma: A case report and review of management. Int J Surg Case Rep 2021; 81:105725. [PMID: 33740530 PMCID: PMC7995474 DOI: 10.1016/j.ijscr.2021.105725] [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: 01/25/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 11/17/2022] Open
Abstract
Liposarcoma of the spermatic cord is very rare, representing about 7% of para testicular sarcomas. It is considered to be one of the highest malignancy grades. We present a case of a liposarcoma of the spermatic cord in a 45-year-old male complaining of a progressive painless swelling in the right inguinoscrotal region. Ultrasonography and computed tomography findings were compatible with liposarcoma of the spermatic cord. We performed a right radical orchiectomy with a wide resection of the mass. Histological examination confirmed the diagnosis and showed a pleomorphic subtype. The mainstay of management of spermatic cord liposarcoma is wide excision with radical orchiectomy. The most important factors for prognosis are the histologic subtype and surgical margin status. Adjuvant radiotherapy should be considered in cases at high risk for local recurrence. Long-term surveillance is mandatory. Liposarcoma of the spermatic cord is an uncommon para testicular tumor which should be part of the differential diagnosis of inguinoscrotal mass. A radical inguinal orchiectomy with wide resection of the soft tissue mass and the spermatic cord are the key to longest local and systemic disease-free survival.
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Affiliation(s)
- Babe Nejib Ebey
- Urology Department, Les Aghlabides Surgical Division, Ibn Jazzar Teaching Hospital, Rue Hassan Ibn Nouaman, 3100, Kairouan, Tunisia.
| | - Sahbi Naouar
- Urology Department, Les Aghlabides Surgical Division, Ibn Jazzar Teaching Hospital, Rue Hassan Ibn Nouaman, 3100, Kairouan, Tunisia.
| | - Bilel Faidi
- Surgery Department, Les Aghlabides Surgical Division, Ibn Jazzar Teaching Hospital, Rue Hassan Ibn Nouaman, 3100, Kairouan, Tunisia.
| | - Rayen Lahouar
- Urology Department, Les Aghlabides Surgical Division, Ibn Jazzar Teaching Hospital, Rue Hassan Ibn Nouaman, 3100, Kairouan, Tunisia.
| | - Badreddine Ben Khalifa
- Urology Department, Les Aghlabides Surgical Division, Ibn Jazzar Teaching Hospital, Rue Hassan Ibn Nouaman, 3100, Kairouan, Tunisia.
| | - Rafik El Kamel
- Urology Department, Les Aghlabides Surgical Division, Ibn Jazzar Teaching Hospital, Rue Hassan Ibn Nouaman, 3100, Kairouan, Tunisia.
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Testicular, Spermatic Cord, and Scrotal Soft Tissue Sarcomas: Treatment Outcomes and Patterns of Failure. Sarcoma 2021; 2021:8824301. [PMID: 33746565 PMCID: PMC7954631 DOI: 10.1155/2021/8824301] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Paratesticular sarcomas are defined as tumors that arise within the scrotum and include the subsites of epididymis, spermatic cord, and tunica vaginalis and represent the most common type of GU sarcoma. The mainstay of treatment is often surgical resection, combined with histology specific chemotherapy and radiotherapy. Due to the rare nature of the disease, there are limited data to guide management. We present our single-institution retrospective experience regarding the management and treatment of paratesticular sarcomas. Materials and Methods We queried our oncology registry database for patients treated for testicular, spermatic cord, and scrotal soft tissue sarcomas between 1971 and 2017. Patients in this series had pathological confirmation of a sarcoma diagnosis by a sarcoma-specialized pathologist. Only patients with localized disease were included in this analysis with the exception of patients with a diagnosis of rhabdomyosarcoma where patients with both localized and metastatic disease were included on this study. Results A total of 34 patients were included in this retrospective analysis. The median was 24 (range, 5–78), and the median tumor size was 6.25 cm. Twenty-six patients had localized disease (76.6%) at the time of diagnosis. A predominance of patients had tumors involving the spermatic cord (45.5%), and the most common histology was rhabdomyosarcoma (35.3%), leiomyosarcoma (26.5%), and well-differentiated liposarcoma (23.5%). The median follow-up was 71.0 months (range, 2.5–534.4 months). A total of 7 patients experienced an isolated local failure (20.6%), four patients developed distant metastatic disease (11.8%), and one patient (2.9%) with synovial sarcoma of the spermatic cord experienced a regional recurrence. The median progression-free survival (PFS) was 99.6 months, 95% CI (45.8–534.3 months), with a three-year PFS rate of 71%, 95% CI (53%–83%), and a 5-year PFS rate of 64% (range, 46%–78%). We did not find any statistically significant associations based on surgery type (p=0.15), the use of chemotherapy, (p=0.36), or final margin status (p=0.21). Two patients who were treated with preoperative radiotherapy had significant wound healing complication with chronic sinus tracts, though these patients did not experience a local recurrence. Conclusions We provide a characterization of the natural history and treatment patterns of paratesticular sarcomas. While effective at reducing a local recurrence, preoperative radiotherapy was associated with significant toxicity. As a result, we prefer the use of postoperative radiotherapy in patients as clinically indicated. We did not find any specific treatment patterns associated with an improvement in clinical outcomes.
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Zeng J, Pollock G, Addams J, Bracamonte E, Chipollini J. Leiomyosarcoma of the scrotum: a case report and literature review. Transl Androl Urol 2021; 10:1342-1346. [PMID: 33850768 PMCID: PMC8039593 DOI: 10.21037/tau-20-1184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Leiomyosarcoma (LMS) is one of the most common forms of soft tissue sarcoma with approximately 2,500 cases per year in the United States. The symptoms LMS vary depending upon the location, size, and spread of the tumor. In early stages, it may not be associated with any obvious symptoms so diagnosis and treatment may be delayed. In some cases, it can grow quickly and behave aggressively. Most types of LMS occur in the abdomen or in the uterus; although, scrotal LMS can be a very rare presentation of the disease. Here we present our case of a large, ulcerated scrotal LMS originating from subcutaneous tissue but not invading spermatic cord or tunica. Radical orchiectomy with high ligation of spermatic cord was performed, and patient had an uneventful postoperative course. This disease entity remains rare in the literature, and warrants larger studies in order to better understand treatment and oncologic outcomes. When LMS is identified early and is removed by surgical excision, prognosis can be good and full recovery quite likely. When LMS is already large or has spread to other parts of the body, treatment is relatively more complex and the prognosis poor. Hence, prompt diagnosis and treatment of genitourinary LMS require prompt attention, referral to tertiary, referral center should be strongly considered.
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Affiliation(s)
- Jiping Zeng
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Grant Pollock
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joel Addams
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Erika Bracamonte
- Department of Pathology, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Juan Chipollini
- Department of Urology, University of Arizona College of Medicine, Tucson, AZ, USA
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Jeremić D, Maletin M, Vojinov S, Levakov I, Grbić D, Lakić T, Trivunić Dajko S. LIPOSARCOMA OF THE SPERMATIC CORD - DIAGNOSTIC AND THERAPEUTIC ISSUE. Acta Clin Croat 2021; 60:50-54. [PMID: 34588721 PMCID: PMC8305359 DOI: 10.20471/acc.2021.60.01.07] [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: 09/16/2020] [Accepted: 12/24/2020] [Indexed: 01/09/2023] Open
Abstract
Liposarcoma of the spermatic cord is a malignant tumor so rare that there are less than 200 cases reported in the literature worldwide. Liposarcoma is a malignancy which originates from fat tissue. Although only 3%-7% of all paratesticular sarcomas primarily arise from structures of the spermatic cord, clinical significance of these tumors must not be neglected because they are often preoperatively misdiagnosed. A 66-year-old male presented with a painless swelling on the left side of the scrotum. Local examination revealed a solid, smooth, limited mass of approximately 4x3 cm in the left side of the scrotum. Tumor markers were within the reference range. Ultrasound examination showed a solid, clearly limited non-homogeneous mass of 40x20 mm localized in the left spermatic cord. Magnetic resonance imaging showed an expansive mass measuring 60x85x60 mm in the left inguinoscrotal region without propagation into the abdominal cavity. Both testicles and epididymides appeared normal on magnetic resonance examination and no locoregional enlarged lymph nodes were seen. The patient was treated operatively with radical inguinal orchiectomy. In conclusion, liposarcomas of the spermatic cord are extremely rare neoplasms that clinically present as slow-growing, painless, palpable inguinal or scrotal masses. Radical orchiectomy with high ligation of the spermatic cord and wide excision of the surrounding soft tissues within the inguinal canal remains the gold standard treatment option. Recurrence of the disease is frequent even several years after primary therapy, therefore long-term follow-up is mandatory.
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Affiliation(s)
| | - Miloš Maletin
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Saša Vojinov
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Ivan Levakov
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Dragan Grbić
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Tanja Lakić
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
| | - Sandra Trivunić Dajko
- 1Clinical Center of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
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Lee S, Oh YT, Jung DC. Imaging of Scrotal Tumors. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:1053-1065. [PMID: 36238386 PMCID: PMC9432360 DOI: 10.3348/jksr.2021.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022]
Abstract
음낭 종양은 고환, 부고환, 정삭, 고환막 등에서 발생하며 악성 가능성을 평가하는데 가장 중요한 요소는 병변의 위치이다. 추가적인 영상 소견과 임상 정보를 종합하여 효과적으로 진단 할 수 있다. 초음파검사는 표재성 기관인 음낭을 관찰하기 용이하며, 우수한 영상 품질을 바탕으로 병변의 유무뿐만 아니라 위치와 성상까지 확인 가능하다. 초음파검사로 감별이 어려울 경우에는 자기공명영상을 이용하여 지방, 출혈, 섬유화, 조영증강 등 추가적인 종양의 특징을 확인하는 것이 진단에 도움이 된다. 전산화단층촬영은 고환암의 병기결정이나 복강 내 미하강고환의 위치를 탐색하는데 유용하다. 본 종설에서는 고환 내외에서 발생하는 음낭 종양의 영상 소견을 살펴보고자 한다.
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Affiliation(s)
- Seungsoo Lee
- Department of Radiology, Research Institute of Radiological Science, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Young Taik Oh
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Chul Jung
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Qadeer A, Quincey C, Gill K, Paddock M. Splenogonadal fusion: a radiologic-pathologic correlation and review of the literature. Radiol Case Rep 2020; 15:1817-1822. [PMID: 32793323 PMCID: PMC7413983 DOI: 10.1016/j.radcr.2020.07.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022] Open
Abstract
We present the case of a 29-year-old male who presented to his General Practitioner with a left testicular lump. Scrotal ultrasound examination revealed 4 well-defined, homogenous, mildly hypoechoic extratesticular mass lesions. He was referred for an urgent urological opinion and underwent local excision. Histologic analysis revealed splenic tissue resulting in the diagnosis of splenogonadal fusion.
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Affiliation(s)
- Amir Qadeer
- Department of Paediatrics, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
| | - Caroline Quincey
- Department of Pathology, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
| | - Kanwar Gill
- Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom
| | - Michael Paddock
- Medical Imaging Department, Barnsley Hospital NHS Foundation Trust, Barnsley, South Yorkshire, United Kingdom.,Academic Unit of Child Health, Department of Oncology and Metabolism, University of Sheffield, Damer Street Building, Sheffield Children's NHS Foundation Trust, Sheffield, South Yorkshire, United Kingdom
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Tension hydrocele as an additional cause of acute scrotum: case series and literature review. Abdom Radiol (NY) 2020; 45:2082-2086. [PMID: 30929051 DOI: 10.1007/s00261-019-01991-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the correlation between acute scrotum pain and tension hydrocele, focusing on US and Doppler features. METHODS AND MATERIALS We evaluated retrospectively a series of five patients with a long history of hydrocele who were referred to our institutions for increasing acute scrotal pain. Patients were approached with gray scale US of both testes, as well as with color-Doppler and spectral analysis, comparing the results with those after aspiration and symptoms relief. RESULTS All patients had a "simple" hydrocele with no internal septa; the involved testicles had a "flattened" appearance and parenchymal Doppler signals showed increased intratesticular vascular resistance. One patient had a low diastolic flow, compared to the contralateral testis, with an increased RI value, one had no diastolic flow, two patients had retrograde diastolic flow, and the remaining one had no intratesticular flow visible. After decompression, there were disappearance of pain and improved flow with normalization of testicular vascularity; post-ischemic hyperemia was appreciated in the two patients examined immediately after fluid aspiration, while normal flow was seen in three studies carried out the day after. CONCLUSION To conclude, tension hydrocele is a rare condition that produces alterations of form and circulation of testicles, increase of intraparenchymal vascular resistances and strong and continuous pain, mimicking a testicular torsion. The increase in pressure produces an effect similar to that observed in a compartment syndrome. US findings, together with clinical assessment, indicate when emergency decompression may be appropriate to relieve testicular ischemia.
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Thinking beyond hernia: a review of non-hernia groin lumps. Abdom Radiol (NY) 2020; 45:1929-1949. [PMID: 31786622 DOI: 10.1007/s00261-019-02351-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
With increasing reliance on imaging, a large number of patients presenting with a groin lump are being referred to radiology to confirm the diagnosis of hernia, usually with an ultrasound in the first instance (occasionally MRI or CT). However, when imaging of the groin was performed, we have encountered many different kinds of non-hernia lesions in our practice. Such lesions can be categorized based on their tissue of origin and pathology. A specific diagnosis can often be reached using ultrasonography, MRI or a combination of imaging modalities. This review article will help general, musculoskeletal and abdominal radiologists to understand the anatomy of the groin, diagnose and characterise soft tissue lesions that may present as a groin lump, provide guidance for further imaging and insight into imaging features which may need specific investigations like core biopsy, tertiary referral and review at multidisciplinary meetings.
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Mondal K, Mandal R, Saha A, Shahabuddin MD, Sarkar R. Fine needle aspiration cytology of epididymal nodules and its corroboration with ultrasonographic‐histological findings. Diagn Cytopathol 2019; 48:118-127. [PMID: 31697443 DOI: 10.1002/dc.24336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 09/04/2019] [Accepted: 10/23/2019] [Indexed: 11/10/2022]
Affiliation(s)
| | - Rupali Mandal
- Department of PathologySonoscan Healthcare Malda West Bengal India
| | - Amitava Saha
- Department of PathologySonoscan Healthcare Malda West Bengal India
| | - MD Shahabuddin
- Department of PathologySonoscan Healthcare Malda West Bengal India
| | - Ranjan Sarkar
- Department of PathologySonoscan Healthcare Malda West Bengal India
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Low LS, Nair SM, Davies AJW, Akapita T, Holmes MA. Aspiration and sclerotherapy of hydroceles and spermatoceles/epididymal cysts with 100% alcohol. ANZ J Surg 2019; 90:57-61. [PMID: 31628703 DOI: 10.1111/ans.15467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/14/2019] [Accepted: 08/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of aspiration and sclerotherapy with 100% alcohol for the primary treatment of benign scrotal cysts. METHODS From March 2014 to March 2018, 114 patients were identified who underwent their first aspiration and sclerotherapy procedure (80 hydroceles and 34 spermatoceles/epididymal cysts). The procedure was carried out in the outpatient clinic with local anaesthesia. A 16-gauge IV catheter is used to puncture the sac under aseptic conditions. The volume of alcohol instilled was 10% of the aspirated volume (maximum of 50 mL). Patients were then observed in the waiting room and completed a questionnaire. Urology clinic follow up was scheduled at 6 weeks. RESULTS At follow up, 54 patients (67.5%) with hydroceles and 25 patients (73.5%) with spermatoceles/epididymal cysts had resolution after a single procedure. A second procedure was offered if fluid collection persisted, of which 71% of patients with hydroceles and 100% of patients with spermatoceles/epididymal cysts had a successful outcome. At a median of 31 months post-initial procedure, the overall success rate, after at most two procedures, was 80% for hydroceles and 85% for spermatoceles/epididymal cysts. The complication rate was low (6%). Almost all patients were happy to undergo the procedure again, if needed. Persistence following aspiration and sclerotherapy were more likely to occur in younger patients (45.4 versus 61.2 years, P = 0.001). Persistence was not related to the volume of fluid aspirated. CONCLUSION Aspiration and sclerotherapy with alcohol is a reliable, safe and effective technique for treatment of benign scrotal cysts.
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Affiliation(s)
- Li Sian Low
- Urology Department, Waikato District Health Board, Hamilton, New Zealand
| | - Shiva M Nair
- Urology Department, Waikato District Health Board, Hamilton, New Zealand
| | - Adam J W Davies
- Urology Department, Waikato District Health Board, Hamilton, New Zealand
| | - Teresa Akapita
- Urology Department, Waikato District Health Board, Hamilton, New Zealand
| | - Michael A Holmes
- Urology Department, Waikato District Health Board, Hamilton, New Zealand
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Smereczyński A, Kołaczyk K. Differential diagnosis of fat-containing lesions in the inguinal canal using ultrasound. J Ultrason 2019; 19:222-227. [PMID: 31807328 PMCID: PMC6856773 DOI: 10.15557/jou.2019.0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 07/19/2019] [Indexed: 12/05/2022] Open
Abstract
Abdominal hernias are usually located in the inguinal canals. Differential diagnosis of hernias should consider other pathologies, which typically occur at this site. The aim of this review paper is to present fat-containing lesions located in the inguinal canal based on both our own experience and literature. The first part of the paper describes the embryogenesis and differences in the structure and content of male and female inguinal canal. The canal is clearly wider in men, which results from the presence of the spermatic cord and its components. The female canal contains only the narrow round ligament of the uterus. The second part of the paper discusses the incorrect use of the term “lipoma” for retroperitoneal fat, which penetrated into the lumen of the patent processus vaginalis – the authors using this term acknowledge its incorrectness. These lesions often coexist with oblique inguinal hernia and should be excised during a surgery as they may cause inguinal pain. As for other fat-containing inguinal pathologies, we discussed lipomatosis of the spermatic cord, liposarcoma and the greater omentum. Differential diagnosis of these lesions considers their echogenicity, echostructure and vascularity. Furthermore, attention was paid to the adipose tissue surrounding the lower epigastric vessels, which may be incorrectly localized in the inguinal canal. Finally, the importance of proper diagnostic methodology and knowledge of the inguinal anatomy for the correct ultrasonographic diagnosis was emphasized.
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Affiliation(s)
- Andrzej Smereczyński
- Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Self-Education Ultrasound Study Group, Department of Genetics and Pathomorphology of the Pomeranian Medical University in Szczecin, Szczecin, Poland
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Sonographic Evaluation of Genitourinary Inflammatory Pseudotumors and Its Mimics. Ultrasound Q 2019; 37:298-307. [PMID: 31478985 DOI: 10.1097/ruq.0000000000000468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Inflammatory pseudotumor is a relatively rare, nonneoplastic lesion composed of inflammatory cells and myofibroblastic spindle cells that can be identified on sonographic evaluation of the genitourinary system. These lesions are thought to be an inflammatory response to insults such as surgery, trauma, infection, or malignancy. Such lesions need to be distinguished from true neoplasms and other benign lesions, including inflammatory responses and infectious processes. Identification of inflammatory pseudotumors and its mimics is important for radiologists to guide patient treatment and follow-up. This pictorial essay presents sonographic features of inflammatory pseudotumors of the genitourinary tract and its mimics with cross-sectional imaging and histopathology, where available.
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Payne JA, Adler BH, Mangray S, Alpert SA. Free-floating Paratesticular Calcifying Fibrous Pseudotumors in a Pediatric Patient. Urology 2019; 128:84-86. [DOI: 10.1016/j.urology.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/01/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
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40
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Zawaideh JP, Bertolotto M, Olivero A, Trambaiolo Antonelli C, Derchi LE. The added value of simultaneous palpation during scrotal ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:220-221. [PMID: 30719745 DOI: 10.1002/jcu.22701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Jeries P Zawaideh
- Department of Health Sciences (DISSAL), Radiology Section, University of Genoa, Genoa, Italy
| | | | - Alberto Olivero
- Department of Surgical Sciences (DISC), Urology section, University of Genoa, Italy
| | | | - Lorenzo E Derchi
- Department of Health Sciences (DISSAL), University of Genoa; Emergency Radiology, Policlinico San Martino IST, Genoa, Italy
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O'Kelly F, McAlpine K, Abdeen N, Keays MA, Guerra LA, Leonard MP. The futility of continued surveillance of epididymal cysts - A study of the prevalence and clinico-demographics in pre- vs. post-pubertal boys. Can Urol Assoc J 2019; 13:E398-E403. [PMID: 31039113 DOI: 10.5489/cuaj.5667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The first description of epididymal cysts in children appears from a 1976 case study. Since then, there have been a total of 24 indexed publications relating to pediatric epididymal cysts. Risk factors that may exist for children presenting with epididymal cyst remain unknown, as has the best method of management. And there have not been any studies looking at the cost implications of this diagnosis. The aim of this study was to assess the incidence, clinico-demographics, outcomes, and costs of epididymal cysts in pre-pubertal boys compared with a post-pubertal epididymal cyst cohort, and to assess whether this cohort requires continued surveillance METHODS:: Our institutional ultrasound (US) database was searched for all scrotal US. From these, a filtered, institution review board-approved search was performed for any reports containing the word "cyst." These were then cross-referenced with a retrospective chart review (October 2006 to September 2017). Clinico-demographics, cyst characteristics, and outcomes were analysed for both pre- and post-pubertal boys using descriptive and non- parametric statistical methods RESULTS:: Of 4508 boys undergoing scrotal US during the study period, 191 were indicated to contain cysts. This was manually reduced to 109 scans (2.4%) that met inclusion criteria (85 pre-pubertal; 24 post-pubertal). Thirty-one scans were ordered by urology, including all those with abnormal testicular echotexture (n=5). The average age of the post-pubertal cohort was 15.8 years, compared with 3.8 years in the pre-pubertal cohort. Most (70.5%) epididymal cysts were incidental. There was no difference between the pre- and post-pubertal cohorts in terms of presence of hydrocoeles (p=0.9), symptoms (p=0.9), ordering service (p=0.61), rate of resolution (4.2% vs. 8.2%; p=0.68), or length of followup (4 vs. 4.5 years; p=0.44). Pre- pubertal cysts were significantly smaller in size (3.35 vs. 14.52 mm; p=0.025) and more likely to trigger repeat scanning (67 vs. 10; p=0.008). There were no operative interventions and no subsequent clinical deterioration occurred with observation. At a cost of $71.10 CAD per US, $15 002.10 CAD was expended on epididymal cyst surveillance in direct cost to the healthcare system. CONCLUSIONS Epididymal cysts are comparable in both pre- and post-pubertal boys and can be safely managed non-operatively without the use of continued US surveillance or urological referral. The higher than expected rate of detection may be a result of the improved ultra-resolution of modern scanners. These children should not require continued followup with repeat surveillance imaging solely for epididymal cysts and could be managed in the primary care setting as part of routine clinical examination.
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Affiliation(s)
- Fardod O'Kelly
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Kristen McAlpine
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Nishard Abdeen
- University of Ottawa, Ottawa, ON, Canada.,Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Melise A Keays
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Luis A Guerra
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
| | - Michael P Leonard
- Division of Pediatric Urology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,University of Ottawa, Ottawa, ON, Canada
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Moussa M, Abou Chakra M. Leiomyosarcoma of the spermatic cord: A case report and literature review. Int J Surg Case Rep 2019; 57:175-178. [PMID: 30981071 PMCID: PMC6461569 DOI: 10.1016/j.ijscr.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/25/2019] [Accepted: 04/03/2019] [Indexed: 11/28/2022] Open
Abstract
Leiomyosarcoma of the spermatic cord is a rare entity. The diagnosis of spermatic cord leiomyosarcoma is difficult based on imagery alone. The standard treatment is radical orchidectomy with high ligation of the spermatic cord.
Background Leiomyosarcoma of the spermatic cord is a rare entity. It presents as a firm and painless intrascrotal mass. For diagnosis radiological methods such as ultrasound, CT or MRI are necessary. Radical orchiectomy is the gold standard of treatment. Case description We reported a one case of a 66-year-old man that he has suffered from a painless hard mass in the right hemiscrotum since three years. Ultrasound revealed a paratesticular mass. Further workup revealed no distant metastasis before surgery. Right radical orchiectomy was performed, the final pathologic examination showed a leiomyosarcoma of the spermatic cord. The patient remained disease-free twelve-month during follow up after surgery. Discussion Leiomyosarcoma of the spermatic cord is a rare condition, it arises from mesenchymal cells of the spermatic cord and occurs mainly in elderly patients. The diagnosis of spermatic cord leiomyosarcoma is difficult if based only on imaging procedures, it is revealed by histological examination post surgery. No treatment protocol has yet been established for paratesticular leiomyosarcoma due to the rarity of the disease. Standard treatment is radical orchidectomy with high ligation of the spermatic cord. The benefit of adjuvant chemotherapy, radiotherapy, and retroperitoneal lymphadenectomy are not well understood and may differ according to the surgeon's preferences. Conclusion The lack of such cases results in the challenging nature of the diagnosis and treatment of leiomyosarcoma of the spermatic cord. Additional studies are needed to better define optimal management strategies.
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Affiliation(s)
- Mohamad Moussa
- Head of Urology Department, Zahra University Hospital, Beirut, Lebanon.
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Dell'Aversana S, Stanzione A, Romeo V, Caggiano M, Gisonni P, Insabato L, Maurea S. MR imaging of paratesticular bilateral leiomyoma: A case report. Radiol Case Rep 2019; 14:591-594. [PMID: 30891109 PMCID: PMC6407094 DOI: 10.1016/j.radcr.2019.02.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/20/2019] [Accepted: 02/23/2019] [Indexed: 12/02/2022] Open
Abstract
Paratesticular leiomyoma is a rare benign neoplasm that may arise from smooth muscle cells contained in either the epididymis, the spermatic cord, or the tunica albuginea. Usually patients present a palpable, asymptomatic mass, with a higher prevalence among the fourth and fifth decade of life. In this case report we describe a 57-year-old man with bilateral scrotal palpable masses evaluated with ultrasound and magnetic resonance imaging that were suggestive for leiomyoma. The lesions were surgically removed and pathology revealed no signs of malignancy confirming the diagnostic hypothesis of leiomyoma. Ultrasound is considered the imaging modality of choice for the initial evaluation of testicular masses since it allows an accurate localization (ie testicular vs paratesticular) and can identify signs of malignancy. Magnetic resonance imaging is less frequently performed but can considerably improve lesion characterization.
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Affiliation(s)
- Serena Dell'Aversana
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Marcello Caggiano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Pietro Gisonni
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Italy
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Abstract
Ultrasound is the imaging modality of choice to evaluate the scrotum because of its high resolution, Doppler capabilities, availability, and lack of ionizing radiation. Acute urologic emergencies diagnosed with ultrasound include testicular torsion, testicular rupture, and Fournier gangrene. The radiologist's knowledge of sonographic features of vascular, infectious, traumatic, and benign and malignant processes that occur in the scrotum coupled with the patient's presenting symptoms, age, and physical examination allows for the correct diagnosis of a wide spectrum of scrotal pathology.
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Affiliation(s)
- Kristin Rebik
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA.
| | - Jason M Wagner
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73104, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA
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Nishio H, Iwatsuki S, Takada H, Kobayashi T, Mizuno K, Okada A, Umemoto Y, Yasui T. Scrotal abscess mimicking as intrascrotal liposarcoma. Urol Case Rep 2019; 23:62-64. [PMID: 30619715 PMCID: PMC6312828 DOI: 10.1016/j.eucr.2018.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hidenori Nishio
- Department of Urology, Nagoya City West Medical Center, Nagoya, Japan
| | | | - Hideki Takada
- Department of Urology, Nagoya City West Medical Center, Nagoya, Japan
| | | | - Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Atsushi Okada
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yukihiro Umemoto
- Department of Education and Research Center for Advanced Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Keenan RA, Nic An Riogh AU, Stroiescu A, Fuentes A, Heneghan J, Cullen IM, Daly PJ. Paratesticular sarcomas: a case series and literature review. Ther Adv Urol 2019; 11:1756287218818029. [PMID: 30671140 PMCID: PMC6329018 DOI: 10.1177/1756287218818029] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 01/08/2023] Open
Abstract
Paratesticular soft tissue tumours are remarkably rare entities, with malignant subtypes accounting for approximately 30%. Due to the paucity of cases, a consensus on the best treatment has not yet been reached, presenting a diagnostic and therapeutic challenge for clinicians. Although rare, three such cases presented to the care of our institution serving a population of approximately 400,000 in the space of 13 months. These were three gentlemen, aged 54, 82 and 86 years old, presenting with left sided testicular swellings. Ultrasound in each case confirmed an extratesticular mass. Only the second gentleman complained of associated pain, however he had experienced scrotal trauma in the preceding weeks. Only one patient had suspicions of metastatic disease, with a 9 mm pulmonary nodule on computed tomography. All patients underwent a radical inguinal orchidectomy with high ligation of the spermatic cord, in keeping with best accepted guidelines. Histology confirmed a well-differentiated liposarcoma, a dedifferentiated liposarcoma and a leiomyosarcoma respectively, all high grade. One gentleman returned to theatre for re-excision of margins. Our case series emphasises the need for full multidisciplinary team specialist sarcoma input, as well as radical resection with judicious margins in order to reduce the risk of local recurrence, in the treatment of these rare tumours.
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Affiliation(s)
| | | | - Andrea Stroiescu
- Department of Radiology, University Hospital Waterford, Waterford, Ireland
| | - Adrian Fuentes
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Joan Heneghan
- Department of Radiology, University Hospital Waterford, Waterford, Ireland
| | - Ivor M Cullen
- Department of Urology, University Hospital Waterford, Waterford, Ireland
| | - Padraig J Daly
- Department of Urology, University Hospital Waterford, Waterford, Ireland
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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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Fibrous Pseudotumor of Tunica Albuginea Testis Mimicking Testicular Neoplasm in a Young Man. Case Rep Surg 2018; 2018:9315864. [PMID: 30026998 PMCID: PMC6031155 DOI: 10.1155/2018/9315864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/17/2018] [Indexed: 12/30/2022] Open
Abstract
Intrascrotal lesions are common findings with a majority occurring in paratesticular tissue. Fibrous pseudotumors are rare, benign lesions of the testicular tunics and present with mass lesion(s) in the scrotum. Preoperative clinical and radiological diagnosis is challenging. We report a case of a 34-year-old man who presented with a 3-year history of left testicular swelling and was advised left radical orchidectomy by another surgeon. Physical examination revealed a firm, nontender mass attached to the lower pole of the testis. Testicular tumor markers were all negative, and ultrasound scan showed a relatively hypoechoic lesion closely associated with the left testis and suspicious for neoplastic process. The patient underwent a testicular sparing surgery. An intraoperative frozen section biopsy confirmed the lesion to be benign and this was reported on permanent section to be fibrous pseudotumor of the tunica albuginea. We also present the clinical, sonographic, and histopathological findings of this condition along with the literature review.
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Mittal PK, Abdalla AS, Chatterjee A, Baumgarten DA, Harri PA, Patel J, Moreno CC, Gabriel H, Miller FH. Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging. Radiographics 2018; 38:806-830. [DOI: 10.1148/rg.2018170150] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Ahmed S. Abdalla
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Argha Chatterjee
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Deborah A. Baumgarten
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Jay Patel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Helena Gabriel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
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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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