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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; 42:1087-1099. [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] [MESH Headings] [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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2
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Al-Obudi Y, Khurram R, Bhogal P, Nawab H, Bell J. Paratesticular metastasis from primary midgut neuroendocrine tumor: A rare initial presentation. Radiol Case Rep 2024; 19:4554-4560. [PMID: 39206336 PMCID: PMC11357829 DOI: 10.1016/j.radcr.2024.07.032] [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: 05/14/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
Neuroendocrine tumors are malignant neoplasms arising from neuroendocrine cells. These are increasingly recognized with rising incidence and encompass a diverse range of phenotypes. The large majority of these originate in the gastrointestinal tract however primary neuroendocrine tumors have also been reported to arise in a variety of organs such as lung, breast, prostate, and skin. Primary malignant paratesticular masses are often sarcomatous in origin and metastatic spread to the paratesticular region or scrotum is exceedingly rare. We report a fascinating case of a 56-year-old male who had an unusual initial presentation of paratesticular lesions on a background of an undescended testicle and an incidental umbilical nodule. After a combination of radiological and histopathological investigations, he was diagnosed with metastatic midgut neuroendocrine tumor.
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Affiliation(s)
- Yasser Al-Obudi
- Department of Radiology, The Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
| | - Ruhaid Khurram
- Department of Radiology, The Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
| | - Palveer Bhogal
- Department of Radiology, The Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
| | - Hasan Nawab
- Department of Radiology, The Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
| | - James Bell
- Department of Radiology, The Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
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3
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Sevinç D, Tiryaki S, Yardım S, Erikçi VS. Paratesticular Mass in Childhood a 13-Year-Old Boy: A Case Report and Literature Review. Clin Pediatr (Phila) 2024; 63:1156-1159. [PMID: 37905514 DOI: 10.1177/00099228231208291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- Dilnur Sevinç
- Tepecik Training and Research Hospital Clinics, Konak, Turkey
| | | | - Serdarl Yardım
- Tepecik Training and Research Hospital Clinics, Konak, Turkey
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4
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Huang X, Xu K, Zhao Y, Chen M, Li Z. Paratesticular metastasis from colorectal adenocarcinoma presenting as hydrocele: a rare case report and literature review. Front Oncol 2024; 14:1373760. [PMID: 38646436 PMCID: PMC11026633 DOI: 10.3389/fonc.2024.1373760] [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: 01/25/2024] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Colorectal cancer, with the liver being the most common site of distant metastasis, followed by the lungs and bones. Although reports of metastasis to the testis exist, paratesticular metastasis is extremely rare. A 37-year-old male presented with scrotal swelling. Ultrasound revealed hydrocele of the tunica vaginalis. The patient underwent routine surgical treatment, and postoperative pathology of the tunica vaginalis indicated adenocarcinoma of gastrointestinal origin. Colonoscopic biopsy confirmed adenocarcinoma of the sigmoid colon. After six months of systemic therapy, tumor reduction surgery was performed in conjunction with tunica vaginalis excision. Postoperative pathology suggested histological similarity in both sites, with immunohistochemistry results supporting the diagnosis of sigmoid colon adenocarcinoma metastasizing to the tunica vaginalis. We conducted a literature review, summarizing and discussing clinical presentations, metastatic pathways, and diagnostic approaches.
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Affiliation(s)
- XiaoJun Huang
- Department of Urology, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - KeLi Xu
- The Second school of Clinical Medicine, Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yin Zhao
- The Second school of Clinical Medicine, Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - MinHui Chen
- The Second school of Clinical Medicine, Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - ZheYang Li
- The Second school of Clinical Medicine, Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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5
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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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6
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Schoot RA, van Ewijk R, von Witzleben AA, Kao SC, Merks JHMH, Morosi C, Pace E, Shulkin BL, Ferrari A, von Kalle T, van Rijn RR, Weiss AR, Sparber-Sauer M, Ter Horst SAJ, McCarville MB. INternational Soft Tissue saRcoma ConsorTium (INSTRuCT) consensus statement: Imaging recommendations for the management of rhabdomyosarcoma. Eur J Radiol 2023; 166:111012. [PMID: 37541182 DOI: 10.1016/j.ejrad.2023.111012] [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: 05/19/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023]
Abstract
Rhabdomyosarcoma is the most common soft-tissue neoplasm in the pediatric population. The survival of children with rhabdomyosarcoma has only marginally improved over the past 25 years and remains poor for those with metastatic disease. A significant challenge to advances in treatment of rhabdomyosarcoma is the relative rarity of this disease, necessitating years to complete clinical trials. Progress can be accelerated by international cooperation and sharing national experiences. This necessitates agreement on a common language to describe patient cohorts and consensus standards to guide diagnosis, treatment, and response assessment. These goals formed the premise for creating the INternational Soft Tissue saRcoma ConsorTium (INSTRuCT) in 2017. Multidisciplinary members of this consortium have since developed international consensus statements on the diagnosis, treatment, and management of pediatric soft-tissue sarcomas. Herein, members of the INSTRuCT Diagnostic Imaging Working Group present international consensus recommendations for imaging of patients with rhabdomyosarcoma at diagnosis, at staging, and during and after completion of therapy. The intent is to promote a standardized imaging approach to pediatric patients with this malignancy to create more-reliable comparisons of results of clinical trials internationally, thereby accelerating progress in managing rhabdomyosarcoma and improving survival.
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Affiliation(s)
- Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Roelof van Ewijk
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Anna-Anais von Witzleben
- Institute of Radiology Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany.
| | - Simon C Kao
- Department of Radiology, The University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - J H M Hans Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Carlo Morosi
- Department of Radiology, Istituto Nazionale Tumori, Milan, Italy.
| | - Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, England, United Kingdom.
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - Andrea Ferrari
- Pediatric Oncology Unit, Medical Oncology and Hematology Department, Istituto Nazionale Tumori, Milan, Italy.
| | - Thekla von Kalle
- Institute of Radiology Olgahospital, Zentrum für Kinder-, Jugend- und Frauenmedizin, Klinikum Stuttgart, Stuttgart, Germany.
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| | - Aaron R Weiss
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Maine Medical Center, Portland, ME, USA.
| | - Monika Sparber-Sauer
- Klinikum der Landeshauptstadt Stuttgart gKAöR, Olgahospital, Stuttgart Cancer Center, Zentrum für Kinder-, Jugend- und Frauenmedizin, Pädiatrie 5 (Pädiatrische Onkologie, Hämatologie, Immunologie), Stuttgart, Germany; University of Medicine Tübingen, Tübingen, Germany.
| | - Simone A J Ter Horst
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands; Department of Radiology and Nuclear Medicine, Wilhelmina Children's Hospital/University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - M Beth McCarville
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Koshevarova V, Kim A, Wilhelm AB, Eyzaguirre EJ, Bhargava P. Paratesticular Ewing's sarcoma. Radiol Case Rep 2023; 18:3260-3263. [PMID: 37456614 PMCID: PMC10339124 DOI: 10.1016/j.radcr.2023.06.059] [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: 05/03/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
This case report follows a 23-year-old man who presented with a painful right scrotal mass which was found to be a paratesticular vascular solid mass on ultrasound, and after uncomplicated orchiectomy, was revealed to be a high-grade extraskeletal Ewing's sarcoma. Diagnosis leading up to the orchiectomy was primarily clinical with only ultrasound used in identification and characterization of the paratesticular mass. Paratesticular masses are more commonly benign, and ultrasound is the first modality, with computed tomography and magnetic resonance imaging providing more definitive findings. We discuss imaging findings and histopathology of this rare tumor with an uncommon presentation.
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8
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Saidian A, Bagrodia A. Imaging Techniques to Differentiate Benign Testicular Masses from Germ Cell Tumors. Curr Urol Rep 2023; 24:451-454. [PMID: 37368095 PMCID: PMC10449965 DOI: 10.1007/s11934-023-01172-7] [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] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE OF REVIEW To discuss role of different diagnostic imaging modalities in differentiation of benign testicular masses from seminomatous germ cell tumors (SGCTs) and non-seminomatous GCTs (NSGCTs). RECENT FINDINGS New modalities of ultrasonography, including contrast enhancement and shear wave elastography, may help differentiate between benign and malignant intratesticular lesions. Ultrasonography remains the recommended imaging modality for initial evaluation of testicular masses. However, MRI can be used to better define equivocal testicular lesions on US.
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Affiliation(s)
- Ava Saidian
- Department of Urology, University of California San Diego Health, 9400 Campus Point Drive #7897, 92093-7897, La Jolla, CA, USA.
| | - Aditya Bagrodia
- Department of Urology, University of California San Diego Health, 9400 Campus Point Drive #7897, 92093-7897, La Jolla, CA, USA
- Moores Cancer Center, San Diego, CA, USA
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9
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Corvino A, Catalano O, Faggian G, Delli Pizzi A, Tafuri D, Corvino F, Borzelli A, Picchi SG, Lassandro G, Boccatonda A, Schips L, Cocco G. Multiparametric Ultrasound Diagnostic Approach to Malignancy-Mimicking Adenomatoid Tumors of the Scrotum: Is Strain Elastography Enough? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1261. [PMID: 37512071 PMCID: PMC10384894 DOI: 10.3390/medicina59071261] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
Background: Paratesticular tumors (PTs) are very uncommon, accounting for almost 5% of intrascrotal tumors. Of these, adenomatoid tumors (ATs) represent about 30% and most frequently arise in the tail of the epididymis. Ultrasound (US) examination is the first-choice imaging method employed for the evaluation of the scrotum. Unfortunately, there are no specific US-imaging features useful for distinguishing an AT from a malignant lesion. To increase diagnostic accuracy and confidence, new sonographic techniques have incorporated real-time tissue elastography (RTE) under the assumption that malignant lesions are "harder" than benign lesions. Case report: In our paper, we describe a very rare case of a 60-year-old patient with a giant paratesticular mass mimicking malignancy when examined using RTE, i.e., it was stiffer than the surrounding tissue (a hard pattern), which, upon histologic examination, was identified as an AT. Discussion: Our case underscores that there is also a significant overlap between different types of scrotal lesions when RTE is used for examination. Thus, if a PT is found, the imaging approach should always be supplemented with more definitive diagnostic methods, such as FNAC or FNAB, which are the only diagnostic methods capable of leading to a certain diagnosis. Conclusions: Alongside underlining the importance of pre-operative imaging for making correct diagnoses and selecting the correct therapy, we wish to draw our readers' attention to this report in order to demonstrate the clinical implications of a giant AT presenting as stiff lesions when examined using SE.
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Affiliation(s)
- Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples "Parthenope", Via Medina 40, I-80133 Naples, Italy
| | - Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, I-80126 Naples, Italy
| | - Guido Faggian
- Advanced Biomedical Sciences Department, University Federico II of Naples, I-80131 Naples, Italy
| | - Andrea Delli Pizzi
- Department of Innovative Technologies in Medicine and Dentistry, University "G. D'Annunzio", I-6610 Chieti, Italy
| | - Domenico Tafuri
- Movement Sciences and Wellbeing Department, University of Naples "Parthenope", Via Medina 40, I-80133 Naples, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, I-80131 Naples, Italy
| | - Antonio Borzelli
- Vascular and Interventional Radiology Department, Cardarelli Hospital, I-80131 Naples, Italy
| | | | - Giulia Lassandro
- Radiology Department, Ospedale del Mare, ASL NA1 Centro, I-80147 Naples, Italy
| | - Andrea Boccatonda
- Internal Medicine, Bentivoglio Hospital, AUSL Bologna, I-40010 Bologna, Italy
| | - Luigi Schips
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Urology Unit, SS Annunziata Hospital, I-6610 Chieti, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, I-6610 Chieti, Italy
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Science of Aging, "G. D'Annunzio" University, I-6610 Chieti, Italy
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10
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Bapir R, Kakamad FH, Aghaways I, Abdullah AM, Hassan MN, Abid AAM, Hasan SJ, Salih KM, Hamasalih HM. Para‑testicular arteriovenous malformation: A case report and mini‑review of the literature. MEDICINE INTERNATIONAL 2023; 3:28. [PMID: 37323126 PMCID: PMC10265326 DOI: 10.3892/mi.2023.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
Arteriovenous malformations from para-testicular structures are very rare, with only a limited number of cases reported in the literature. The present study reports a rare case of para-testicular arteriovenous malformation. A 6-year-old boy presented with painless swelling in the scrotum for 6 months. Upon examination, a non-tender and non-pulsatile cystic swelling was observed in the right hemi-scrotum below the testis. A scrotal ultrasound revealed a separate cystic lesion with a normal texture and the vascularity of both testes. Under general anesthesia, via a small scrotal incision, a cystic, blood-filled mass was excised. The results of a histopathological examination were suggestive of vascular malformation. The case described in the present study aims to shed light on vascular malformations. A number of vascular malformations are incorrectly referred to as hemangiomas, and numerous patients undergo inappropriate therapy due to this misclassification. Although para-testicular arteriovenous malformation is a very rare condition, it should be included in the differential diagnosis of para-testicular lesions.
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Affiliation(s)
- Rawa Bapir
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46000, Iraq
- Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Fahmi H. Kakamad
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Ismaeel Aghaways
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Ari M. Abdullah
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
- Department of Pathology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Marwan N. Hassan
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
- Kscien Organization for Scientific Research, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Ayoob Asaad Mohammed Abid
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
- College of Medicine, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Sabah Jalal Hasan
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Karzan M. Salih
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
| | - Hussein M. Hamasalih
- Department of Scientific Affairs, Smart Health Tower, University of Sulaimani, Sulaymaniyah, Kurdistan 46000, Iraq
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11
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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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12
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Phatak SV, Manoj M, Bhansali PJ, Ghanta P. Adenomatoid Tumor of Epididymis Associated with Tubular Ectasia of Rete Testis: Sonographic Evaluation. J Med Ultrasound 2023; 31:157-159. [PMID: 37576421 PMCID: PMC10413400 DOI: 10.4103/jmu.jmu_10_22] [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: 01/21/2022] [Revised: 02/13/2022] [Accepted: 03/30/2022] [Indexed: 08/15/2023] Open
Abstract
Paratesticular tumors are a relatively rare group of mesenchymal tumors, accounting for 7%-10% of all intrascrotal tumors. Adenomatoid tumor of the epididymis is the most common epididymal tumor. It is difficult to distinguish intra- versus paratesticular tumors and to know the nature of the lesion (benign versus malignant) on clinical examination since they may have similar presentation; therefore, ultrasound examination of these lesions is required to demonstrate its extratesticular location and also to suggest its benign nature. Elastography can further help in characterizing the lesion by evaluating the stiffness of the tumor. Here, we present a case of adenomatoid tumor of the left epididymis with tubular ectasia of the rete testis.
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Affiliation(s)
- Suresh Vasant Phatak
- Department of Radio-Diagnosis, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Megha Manoj
- Department of Radio-Diagnosis, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | | | - Prasanthi Ghanta
- Department of Radio-Diagnosis, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
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13
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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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14
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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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15
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Song R, Xi J, Shi H, Xue Z, Li H, Yu X. Ultrasonographic manifestations and the effective diagnosis of epididymal leiomyosarcoma: Case report and systematic literature review. Front Oncol 2023; 13:1101801. [PMID: 36845710 PMCID: PMC9950396 DOI: 10.3389/fonc.2023.1101801] [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: 11/28/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
Background Epididymal leiomyosarcoma is an extremely rare tumor. In this study, we describe the sonographic features of this uncommon tumor. Methods A case of epididymal leiomyosarcoma diagnosed at our institute was retrospectively analyzed. Ultrasonic images, noted clinical manifestations, treatment procedures, and pathology results were collected for this patient. The same information was collected from a systematic literature search on epididymal leiomyosarcoma, including the PUBMED, Web of Science and Google Scholar databases. Results The literature search resulted in 12 articles; we were able to extract data from 13 cases of epididymal leiomyosarcomatosis. The median patient age was 66 (35-78) years, and the average tumor diameter was 2-7 cm. All patients had unilateral epididymal involvement. The lesions were all solid, irregular-shaped in almost half of the cases, featured clear borders in six cases, and had unclear borders in four cases. The internal echogenicity was heterogeneous in the majority of lesions: six cases were hypoechoic (7/11) and three cases moderately echoic (3/10). Information on blood flow within the mass was provided in four cases, but all were noted with significant vascularity. Surrounding tissue invasion was discussed in 11 cases, with 4 featuring peripheral invasion or metastasis. Conclusion Epididymal Leiomyosarcoma demonstrates sonographic characteristics common to many malignant tumors, such as increased density, irregular shape, heterogeneous internal echogenicity, and hypervascular. Ultrasonography is helpful to differentiate benign epididymal lesions, and can provide some reference for clinical diagnosis and treatment. However, compared with other malignant tumors of the epididymis, it has no characteristic sonographic features,and pathological confirmation is required.
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Affiliation(s)
- Ruixiao Song
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China,Science and Education Section, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Jing Xi
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Honglei Shi
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Zhixin Xue
- Department of Pathology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Huifang Li
- Department of Urology, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China
| | - Xiaolong Yu
- Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China,Science and Education Section, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China,*Correspondence: Xiaolong Yu,
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16
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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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Irsayanto D, Azmi YA, Rahman IA, Soebadi DM. Paratesticular leiomyoma mimicking an inguinal hernia: A rare case report and literature review. Int J Surg Case Rep 2022; 98:107580. [PMCID: PMC9468378 DOI: 10.1016/j.ijscr.2022.107580] [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: 08/03/2022] [Revised: 08/27/2022] [Accepted: 08/28/2022] [Indexed: 11/18/2022] Open
Abstract
Leiomyomas are considered as a rare, benign, slow-growing, and smooth muscle tumours which may present in all regions in the body. The presentation of leiomyoma in genitourinary tract specifically in paratesticular region is extremely rare. The patients may present with palpable, and painful mass in the inguinal region hence mimicking the nature of inguinal hernia. Herewith, we report our experience of 36-year-old male which had been referred for the suspicion of incarcerated inguinal hernia manifesting with painful mass in the right inguinal and testicular region. During testicular exploration surgery, a benign tumour was incidentally discovered. The lesions were then surgically removed by performing radical orchiectomy with the pathology result confirmed the presence of paratesticular leiomyoma. The post-operative course was uneventful and the patient was discharged on first post-operative day. The patient remained free from metastases or local recurrence after 12 months of regular follow up. This case report demonstrated a rare presentation of paratesticular leiomyoma with misleading manifestation of inguinal hernia. Careful and tailored investigation should be performed to avoid misled diagnosis of this case. Paratesticular leiomyoma is a rare benign tumour that may present similarly with ingunal hernia. Thorough clinical examination, imaging modalities, histopathology and immunohistochemistry may aid in the diagnosis. Surgical exploration is the mainstay treatment of paratesticular leiomyomas. Radical orchidectomy may be considered if malignancy is suspected.
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Hakimi T, Rezavi F, Farook MI, Jawed MA. Polyorchidism presenting as cryptorchidism. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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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Feiertag J, Clark JY. Urology Clinical Challenge: Intra-Scrotal Mass. Urology 2022; 165:e4-e6. [DOI: 10.1016/j.urology.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022]
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21
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Castro AA, Utrilla VS, Antón BR, Carmona LER, Ruiz LP. MULTIPLE LESIONS IN SCROTAL TUNICA VAGINALIS. Urology 2022; 166:e12-e14. [DOI: 10.1016/j.urology.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/03/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
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22
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Dighe SP, Shinde RK, Shinde SJ, Raghuwanshi PS. The Dilemma in the Diagnosis of Paratesticular Lesions. Cureus 2022; 14:e22783. [PMID: 35382182 PMCID: PMC8976154 DOI: 10.7759/cureus.22783] [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: 03/02/2022] [Indexed: 11/05/2022] Open
Abstract
Intra-scrotal swellings are commonly encountered all over the globe. Common causes include hydroceles, hernias, lipoma, cysts, etc. Rarely manifested as scrotal swelling is paratesticular swelling arising outside the testis. Clinically, they may mimic a tumour arising from testis either benign or malignant with grave consequences. Diagnosis hence is of paramount importance. It has to be ruled out as a diagnosis of exclusion. Knowledge of such swelling those other than the ones originating from the testis is thus crucial in order to have a better patient outcome in the absence of any mandated published guideline.
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Ojaghzadeh D, Naji P, Ensannezhad A, Mahmoudpour M, Jalili J, Hakimzadeh Z. Pentaorchidism diagnosed on ultrasound examination: A case report and literature review. Andrologia 2022; 54:e14389. [PMID: 35122296 DOI: 10.1111/and.14389] [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: 09/18/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/27/2022] Open
Abstract
Polyorchidism is a congenital malformation of the urogenital system that is usually found incidentally in adolescent age groups. Ultrasound and MRI are effective non-invasive diagnostic modalities which can differentiate this condition from other intrascrotal pathologies. Ultrasonography is mostly used in initial steps of diagnostic approach; however, MRI is considered as a modality to confirm diagnosis and evaluate possible malignancy. We report an extremely rare case of pentaorchidism (five testicles), presented with a left hemiscrotum mass. Diagnosis was made based on physical examination, laboratory analysis (testicular germ cell tumour markers and semen analysis) and imaging. Finally, close surveillance with ultrasound and physical examination was recommended for follow-up of this uncomplicated patient.
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Affiliation(s)
| | - Pourya Naji
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Javad Jalili
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Hakimzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Abstract
A 23-year-old male presented with complaints of gradually increasing swelling of the left hemiscrotum. Preliminary ultrasound scan revealed a heterogeneous, predominantly solid lesion showing raised internal vascularity with few cystic areas in the paratesticular region, towards the midline with both testes seen separately from the lesion. To rule out presence of locoregional or distant metastases, a CT scan was done which revealed a well-defined, intrascotal, extratesticular, heterogeneous, moderately enhancing mass lesion with cystic areas in the scrotal sac with no significant lymphadenopathy or obvious distant metastasis. Subsequent MRI done for surgical planning revealed a heterogeneous signal intensity lesion with cystic areas and areas of haemorrhage with focal loss of fat planes with the left corpora cavernosa at the root of the penis. The patient underwent an inguinoscrotal exploration with excision of the left paratesticular mass. Final histopathology suggested an undifferentiated high grade pleomorphic sarcoma. Paratesticular tumours while rare are an important cause of scrotal swelling. Exact histological identification of tumour subtype is not possible based on imaging but preoperative multi-modality imaging has an important role in identifying tissue of origin, differentiating benign from malignant lesions, surgical planning and assessing the need for adjuvant CT/RT.
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Rousslang LK, Burr CR, Wood JR. Scrotal Lipoblastoma with Radiological and Histological Correlation. Indian J Radiol Imaging 2021; 31:710-713. [PMID: 34790320 PMCID: PMC8590560 DOI: 10.1055/s-0041-1736395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Lipoblastomas are rare benign mesenchymal tumors comprised primarily mature adipocytes, which are most commonly found in infants and children younger than 3 years. They are usually found in the extremities, trunk, head, neck, and retroperitoneum, although cases occurring in the scrotum have been reported. Due to its rarity, there is a relative paucity of literature describing its imaging and management. We present a rare case of a scrotal lipoblastoma, and discuss the current imaging strategies to differentiate this adipocytic tumor from other more common paratesticular masses, including aggressive neoplasms such as rhabdomyosarcomas. Knowledge of the radiological appearance of lipoblastoma can provide the correct diagnosis and prevent unnecessary orchiectomy.
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Affiliation(s)
- Lee K Rousslang
- Department of Radiology, Tripler Army Medical Center, Hawaii, United States
| | - Cole R Burr
- Department of Radiology, Tripler Army Medical Center, Hawaii, United States
| | - Jonathan R Wood
- Department of Radiology, Tripler Army Medical Center, Hawaii, United States
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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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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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Onder O, Karaosmanoglu AD, Kraeft J, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Hahn PF. Identifying the deceiver: the non-neoplastic mimickers of genital system neoplasms. Insights Imaging 2021; 12:95. [PMID: 34232414 PMCID: PMC8263845 DOI: 10.1186/s13244-021-01046-x] [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: 05/17/2021] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Tumors of the genital system are common and imaging is of crucial importance for their detection and diagnosis. Several non-neoplastic diseases may mimic these tumors and differential diagnosis may be difficult in certain cases. Misdiagnosing non-neoplastic diseases as tumor may prompt unnecessary medical treatment or surgical interventions. In this article, we aimed to present the imaging characteristics of non-neoplastic diseases of the male and female genital systems that may mimic neoplastic processes. Increasing awareness of the imaging specialists to these entities may have a severe positive impact on the management of these patients.
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Affiliation(s)
- Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | | | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, 06010, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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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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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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Zhu Y, Zhu Z, Xiao Y, Zhu Z. Case Report: Paratesticular Rhabdomyosarcoma. Front Oncol 2021; 11:629878. [PMID: 33816267 PMCID: PMC8010692 DOI: 10.3389/fonc.2021.629878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/01/2021] [Indexed: 11/19/2022] Open
Abstract
Paratesticular rhabdomyosarcoma (RMS) accounts for only 7% of all the RMS cases. Due to the limited available data, there is no consensus on the diagnosis and management of the paratesticular tumors. Here, we interrogated two paratesticular RMS cases in 25 and 27-year-old men presenting with painless and rapidly growing mass in the scrotum. Whereas the data showed no upregulation of tumor markers such as β-human chorionic gonadotropin (β-HCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH), scrotal ultrasonography and magnetic resonance imaging indicated the existence of paratesticular and inguinal lesions respectively. There was local recurrence in one patient who underwent radical orchiectomy for the sarcoma one year ago. In addition, the CT scans showed no occurrence of distant metastasis. The two patients underwent radical inguinal orchiectomy or resection of the recurrent tumors with nerve-sparing retroperitoneal lymph node dissection. Histologic examination revealed embryonal RMS (eRMS) without lymph node metastasis. We highlight the importance of multi-disciplinary participation for paratesticular RMS detection and preoperative ultrasound-guided needle biopsy (UNB) for rapid confirmatory diagnosis. Complete surgical resection coupled with chemotherapy and radiotherapy is the main treatment option for the paratesticular RMS. In addition, sperm cryopreservation treatment and endocrine follow-up could increase the overall survival and quality of life of the patients.
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Affiliation(s)
- Yiyi Zhu
- Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziwei Zhu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
| | - Yunyuan Xiao
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
| | - Zaisheng Zhu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
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Lee A, Ruiz-Cordero R, Meng M, Chi T, Yang H. Extramedullary multiple myeloma in the spermatic cord: A case report. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2020.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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34
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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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Dunev VR, Genov PP, Georgiev MI, Stoykov BA, Kolev NH. A rare case of liposarcoma of the spermatic cord. Urol Case Rep 2020; 33:101336. [PMID: 33102038 PMCID: PMC7573950 DOI: 10.1016/j.eucr.2020.101336] [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: 06/04/2020] [Accepted: 07/03/2020] [Indexed: 12/04/2022] Open
Abstract
We present a 42 year old man, who was admitted in the Urology Department with symptoms of unilateral, painless, hard and firm slow-growing mass of the left scrotum for 4 months. Pelvic computed tomography (CT) scan showed a 8 cm3 mass lesion in the left hemiscrotum. Left radical orchiectomy and wide excision were performed and a yellowish soft tissue mass measuring closely attached to the spermatic cord was resected during surgery. Histopathologic evaluation revealed a tumor mass composed of well-differentiated liposarcoma.
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Affiliation(s)
- V R Dunev
- University of Ruse "Angel Kanchev" Ruse, 8 "Studentska" Str.7000, Bulgaria
| | - P P Genov
- Medical University Pleven, 8A "Georgi Kochev" Str. 5800, Bulgaria
| | - M I Georgiev
- Medical University Sofia, 1 "Georgi Sofiiski" Str. 1431, Bulgaria
| | - B A Stoykov
- University of Ruse "Angel Kanchev" Ruse, 8 "Studentska" Str.7000, Bulgaria
| | - N H Kolev
- University of Ruse "Angel Kanchev" Ruse, 8 "Studentska" Str.7000, Bulgaria
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Abstract
PURPOSE OF REVIEW The presence of vascular solid tumors within the testicle is considered to be malignant until proven otherwise. However, it is prudent for clinicians to be aware of rare benign and malignant intratesticular lesions as management can differ from the established treatment algorithms for germ-cell tumors. RECENT FINDINGS Utilizing certain histopathologic findings can assist with the diagnosis of rare testis tumors. Often times the tumor subtypes are an important consideration in the grading and classification of the disease, which drives management. The multidisciplinary management of rare malignant testis tumors at an experienced center seems to provide optimal patient outcomes. Regardless of the primary treatment, prolonged follow-up for sex cord stromal tumors and other rare testis malignancies is advocated due to the delayed metastatic potential. SUMMARY The clinical presentation of rare benign and malignant testis tumors is often similar to that of germ-cell tumors. Likewise, imaging characteristics are also often indistinguishable. However, the management of these rare tumors is often different from the well established treatment algorithms of germ-cell tumors. To that end, it is important for the practicing urologist to be familiar with the current principles of these tumor characteristics and the management.
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Ojaghzadeh D, Mahmoudpour M, Ezzati N, Akhavi Milani A. Polyorchidism in ultrasound examination: A case report. Andrologia 2020; 53:e13832. [PMID: 32897591 DOI: 10.1111/and.13832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022] Open
Abstract
Polyorchidism is usually diagnosed incidentally when the patient undergoes imaging or surgery for some other reason. Although we are facing lack of evidence in different steps of diagnostic and therapeutic workup of these patients, this disorder is usually considered benign, not requiring any intervention. We report the case of a man complaining of a palpable mass in his scrotum. We evaluated the patient using ultrasound, MRI and serum tumour marker level measurement. The patient was finally diagnosed with polyorchidism (three testes). For the management, we recommended annual physical examination, US examination and serum tumour marker level measurement.
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Affiliation(s)
| | | | | | - Ali Akhavi Milani
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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Rogers TN, De Corti F, Burrieza GG, Guérin F, Terwisscha van Scheltinga S, Smeulders N, Craigie R, Jenney M, Kelsey A, Zanetti I, Coppadoro B, De Salvo GL, Bisogno G, Martelli H. Paratesticular rhabdomyosarcoma-Impact of locoregional approach on patient outcome: A report from the European paediatric Soft tissue sarcoma Study Group (EpSSG). Pediatr Blood Cancer 2020; 67:e28479. [PMID: 32573979 DOI: 10.1002/pbc.28479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Paratesticular rhabdomyosarcoma (PT RMS) is rare compared to benign scrotal pathology. Inappropriate first surgery (InFS) required supplementary treatment to maintain excellent outcomes. Initial staging of regional lymph nodes is important. The aim of this study was to determine to what extent the quality of locoregional approach impacted on patient morbidity and survival. DESIGN/METHODS Analysis was performed on all nonmetastatic PT RMS patients enrolled in the European paediatric Soft tissue sarcoma Study Group (EpSSG) RMS 2005 protocol. Aspects assessed were adherence to surgical guidelines and impact of protocol violations, relapse analysis, and survival outcomes. RESULTS Analysis was performed on 237 patients, with median follow up of 67.1 months. Median age was 9.0 years. InFS occurred in 75 of 237 (32%) patients. InFS required intensified chemotherapy (10) and local therapy. After InFS, 61 required primary reexcision and five delayed surgery. Of 26 recurrences, the risk of relapse was higher in patients ≥10 years (21/26) and was mainly locoregional in 16 of 26 recurrences (± metastatic). Sixteen of 26 died with 14 of 16 patients ≥10 years. Nodal relapse neither occurred when N1 nodes were identified at diagnosis, nor after surgical staging. Five-year overall survival (OS) at age <10 years versus ≥10 years was 98.1 and 86.7%, respectively (P = .0013). Event-free survival (EFS) at age <10 years versus ≥10 years was 95.8 and 79.6%, respectively (P = .0004). OS and EFS did not highlight a significant difference in patients undergoing appropriate versus InFS (P = .8479, P = .2780, respectively). CONCLUSIONS InFS required intensified therapy to maintain excellent OS and EFS, so better anticipation of malignancy is required. Surgical staging of the retroperitoneal lymph nodes should be performed in patients ≥10 years old.
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Affiliation(s)
- Timothy N Rogers
- Department of Paediatric Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Federica De Corti
- Pediatric Surgery Unit, Department of Woman's and Child's Health, University Hospital of Padova, Padova, Italy
| | | | - Florent Guérin
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | | | - Naima Smeulders
- Department of Urology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Ross Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Meriel Jenney
- Department of Pediatric Oncology, Children's Hospital for Wales Heath Park, Cardiff, UK
| | - Anna Kelsey
- Department of Pediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ilaria Zanetti
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Beatrice Coppadoro
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Gian Luca De Salvo
- Clinical Trials and Biostatistics Unit, IRCCS Istituto Oncologico Veneto, Padova, Italy
| | - Gianni Bisogno
- Hematology Oncology Division, Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Hélène Martelli
- Department of Paediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicetre, France
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39
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Mohan VK, Ethiraj D, Indiran V, Pandiaraj IJ, Murugan A, Maduraimuthu P. Radiologic Pathologic Correlation of Primary Paratesticular Rhabdomyosarcoma. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0040-1715776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractRhabdomyosarcoma is the most common soft tissue sarcoma in childhood and adolescence, arising from the mesenchymal tissue. It is an intrascrotal tumor localized in the paratesticular structures such as the epididymis or spermatic cord. The majority of this tumor occurs in the first two decades of life. Ultrasound is considered the imaging modality of choice for evaluating an intra-scrotal abnormality. We present a case of a 4-year-old boy with a 2-weeks history of rapidly increasing left scrotal swelling which was clinically diagnosed as hydrocoele. We present the ultrasound, elastography and MRI features of a case of paratesticular embryonal rhabdomyosarcoma with pathologic correlation and also emphasize need to consider sarcoma as a differential diagnosis for rapidly growing scrotal swelling.
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Affiliation(s)
- Vignesh Kumar Mohan
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil nadu, India
| | - Dillibabu Ethiraj
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil nadu, India
| | - Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil nadu, India
| | - Immanuel Judah Pandiaraj
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil nadu, India
| | - Adarsh Murugan
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil nadu, India
| | - Prabakaran Maduraimuthu
- Department of Radiology, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
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41
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Abstract
Testicular cancer is responsible for approximately 0.1% of all cancer deaths in the USA, and seminoma is the most common type of testicular tumor. Ultrasonography is the primary imaging modality for accessing testicular and extratesticular lesions, while magnetic resonance imaging can be used for problem solving in lesion characterization in certain cases. CT imaging is usually performed for retroperitoneal staging of testicular cancer metastasis and follow-up after treatment. Extratesticular masses are common, yet rarely malignant. Imaging plays an important role in primary diagnosis of testicular cancer and differentiating it from common non-neoplastic findings. The purpose of this article is to review various imaging findings in testicular and extratesticular masses.
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42
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Stein R, Dürken M, Zahn K, Younsi N. [Testicular tumors in prepubertal boys-organ preservation possible more often than expected]. Urologe A 2020; 59:278-283. [PMID: 32020239 DOI: 10.1007/s00120-020-01120-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In prepubertal boys, testicular tumors are rare with an incidence between 2 and 5/million. In contrast to testicular tumors in adolescents and adults, more than 2/3 of these tumors are benign. Unfortunately, in Germany in most cases, only malignant tumors (usually yolk sac tumors) are reported to the study center (MAKEI IV and now V). Therefore, the incidence in Germany is unknown. Since the introduction of polychemotherapy in the 1970s, the prognosis of malignant testicular tumors has improved enormously and has become a curable disease, even in the case of recurrence. Today the orchiectomy, which was usually carried out in the past, appears to be no longer justified in most prepubertal boys due to the high incidence of benign tumors. It has been shown in various studies that organ-sparing surgery in germ cell tumors (epidermoid cysts, teratoma); gonadal stoma tumors (Sertoli, Leydig and granulosa cell tumors) and cystic lesions (intratesticular cysts and tubular ectasia of the rete testis) is reliable and safe. In cases with preoperative significantly increased AFP (caution: norm values not valid in the first year of life) and a clear testicular tumor in the ultrasound (yolk sac tumor) or if no testicular parenchyma is sonographically detectable, orchiectomy can still be carried out. Today orchiectomies in prepubertal boys should be an exception and the reasons for an orchiectomy must be well documented.
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Affiliation(s)
- R Stein
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - M Dürken
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Mannheim, Deutschland
| | - K Zahn
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - Nina Younsi
- Zentrum für Kinder‑, Jugend- und rekonstruktive Urologie, Medizinische Fakultät Mannheim, der Universität Heidelberg, Universitätsklinikum Mannheim GmbH, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
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43
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Yang F, Wu J, Lu X, Guo Z, Qing L, He C. Primary rhabdomyosarcoma of tunica vaginalis misdiagnosing as hydrocele: A case report and literature review. Andrologia 2020; 52:e13517. [PMID: 31965584 DOI: 10.1111/and.13517] [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: 01/22/2019] [Revised: 10/05/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022] Open
Abstract
Primary rhabdomyosarcoma of tunica vaginalis is very rare. We report a case of a 15-year-old man presenting as hydrocele. Pre-operatively, no masses were detected by ultrasonography. Hydrocelectomy was performed. At surgery, a 0.8 cm polypoid nodule and diffusely thickened tunica were found. Pathologic examination finally revealed rhabdomyosarcoma. A PET-CT was then performed and indicated scrotal implantation metastasis. The patient underwent radical inguinal orchiectomy and was treated with chemotherapy and radiotherapy after surgery. At 12 months of follow-up, he remained disease-free.
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Affiliation(s)
- Fan Yang
- Department of Urology, Shanghai Minhang Hospital, Fudan University, Shanghai, China
| | - Jiawen Wu
- Department of Urology, Shanghai Minhang Hospital, Fudan University, Shanghai, China
| | - Xuwei Lu
- Department of Urology, Shanghai Minhang Hospital, Fudan University, Shanghai, China
| | - Zhuifeng Guo
- Department of Urology, Shanghai Minhang Hospital, Fudan University, Shanghai, China
| | - Liang Qing
- Department of Urology, Shanghai Minhang Hospital, Fudan University, Shanghai, China
| | - Chang He
- Department of Urology, Shanghai Minhang Hospital, Fudan University, Shanghai, China
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Aydemir H, Budak S, Kahyaoglu Z, Kumsar S. Inflammatory myofibroblastic tumor of the spermatic cord: two cases and review of the literature. Ann Saudi Med 2020; 40:66-71. [PMID: 32027518 PMCID: PMC7012034 DOI: 10.5144/0256-4947.2020.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a neoplasm of intermediate biological potential. Few cases of spermatic cord IMT have been reported in the literature. Inflammatory myofibroblastic tumor is a consequence of the proliferation of fibroblasts and inflammatory cells. Despite its benign nature, the tumor often clinically mimics intrascrotal malignancy and usually remains undiagnosed preoperatively. The diagnosis of spermatic IMT is difficult preoperatively due to the non-specific findings. Therefore, if testicular tumors cannot be precisely excluded, radical orchiectomy should be performed for the diagnosis and treatment. However, it mainly occurs in children and young adults; spermatic IMT may also be seen among elderly men. Here, we report two cases of inflammatory myofibroblastic tumor involving the spermatic cord. SIMILAR CASES PUBLISHED: There are seven cases entitled "inflammatory myofibroblastic tumor of spermatic cord" in the literature. In our study we present two cases that had a spermatic cord IMT. Furthermore, one of these cases was 82 years of age and is the oldest patient presented in the literature.
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Affiliation(s)
- Huseyin Aydemir
- From the Urology Clinic, Sakarya Universitesi Egitim ve Arastirma Hastanesi, Sakarya
| | - Salih Budak
- From the Urology Clinic, Sakarya Universitesi Egitim ve Arastirma Hastanesi, Sakarya
| | - Zeynep Kahyaoglu
- From the Pathology Department, Sakarya Research and Education Hospital, Turkey
| | - Sukru Kumsar
- From the Urology TC Saglik Bakanligi Haydarpasa Numune Egiim ve Arastirma Hastanesi, Istanbul, Turkey
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45
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Goldberg H, Wong LM, Dickson B, Catton C, Yap SA, Alkasab T, Evans A, van der Kwast T, Jewett MAS, Hamilton RJ. Long-term oncological outcomes of patients with paratesticular sarcoma. BJU Int 2019; 124:801-810. [DOI: 10.1111/bju.14775] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hanan Goldberg
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Lih-Ming Wong
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Surgery; St. Vincent's Hospital Melbourne; University of Melbourne; Parkville Victoria Australia
| | - Brendan Dickson
- Department of Pathology and Laboratory Medicine; Mount Sinai Hospital, New York, NY, USA, and University of Toronto; Toronto ON Canada
| | - Charles Catton
- Department of Radiation Oncology; Princess Margaret Cancer Center; University Health Network; University of Toronto; Toronto ON Canada
| | - Stanley A. Yap
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
- Department of Urology; University of California Davis; Sacramento CA USA
| | - Thamir Alkasab
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Andrew Evans
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Theodorus van der Kwast
- Department of Pathology; Toronto General Hospital; University Health Network; University of Toronto; Toronto ON Canada
| | - Michael A. S. Jewett
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
| | - Robert J. Hamilton
- Departments of Surgery and Surgical Oncology (Division of Urology); Princess Margaret Cancer Centre; University Health Network; University of Toronto; Toronto ON Canada
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46
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Arslan A, Ulus S, İnce Ü, Tekant G, Karaarslan E. A rare case of paratesticular leiomyoma in a child. Turk J Urol 2019; 45:154-156. [PMID: 30875294 DOI: 10.5152/tud.2018.28813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/16/2017] [Indexed: 11/22/2022]
Abstract
Leiomyomas are benign, slow-growing, smooth muscle tumors, which can occur at many locations in the body. The male genitourinary tract is seldom affected and scrotal leiomyomas are extremely rare. Most of the scrotal leiomyomas are localized in the testis, epididymis, spermatic cord, subcutaneous tissue, tunica albuginea, and scrotal skin and only a few of them are reported in the origin of isolated tissue without paratesticular structures in the paratesticular region. We are presenting a case of solitary paratesticular leiomyoma in a child, which is very rare in terms of lesion location and patient age, and describing the imaging features of this lesion.
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Affiliation(s)
- Aydan Arslan
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Sila Ulus
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Ümit İnce
- Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Gonca Tekant
- Department of Pediatric Surgery, İstanbul University Cerrahpasa School of Medicine, İstanbul, Turkey
| | - Ercan Karaarslan
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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47
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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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48
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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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49
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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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50
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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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