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Kühn AL, Scortegagna E, Nowitzki KM, Kim YH. Ultrasonography of the scrotum in adults. Ultrasonography 2016; 35:180-97. [PMID: 26983766 PMCID: PMC4939719 DOI: 10.14366/usg.15075] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022] Open
Abstract
Ultrasonography is the ideal noninvasive imaging modality for evaluation of scrotal abnormalities. It is capable of differentiating the most important etiologies of acute scrotal pain and swelling, including epididymitis and testicular torsion, and is the imaging modality of choice in acute scrotal trauma. In patients presenting with palpable abnormality or scrotal swelling, ultrasonography can detect, locate, and characterize both intratesticular and extratesticular masses and other abnormalities. A 12-17 MHz high frequency linear array transducer provides excellent anatomic detail of the testicles and surrounding structures. In addition, vascular perfusion can be easily assessed using color and spectral Doppler analysis. In most cases of scrotal disease, the combination of clinical history, physical examination, and information obtained with ultrasonography is sufficient for diagnostic decision-making. This review covers the normal scrotal anatomy as well as various testicular and scrotal lesions.
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Affiliation(s)
- Anna L Kühn
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Eduardo Scortegagna
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Kristina M Nowitzki
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Young H Kim
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical Center, Worcester, MA, USA
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Domínguez A, Casanova G, Hannaoui N, Banús JM. Quiste epidermoide testicular. Rev Int Androl 2012. [DOI: 10.1016/s1698-031x(12)70072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Patel K, Sellars ME, Clarke JL, Sidhu PS. Features of testicular epidermoid cysts on contrast-enhanced sonography and real-time tissue elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:115-122. [PMID: 22215776 DOI: 10.7863/jum.2012.31.1.115] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A series of 7 testicular epidermoid cysts were imaged by contrast-enhanced sonography to assess internal vascularity and by real-time tissue elastography to grade stiffness by a visual and strain ratio quantification scoring system. No internal vascular enhancement was seen on contrast-enhanced sonography; the 3 largest lesions showed rim enhancement. On the real-time elastographic color display, all lesions were predominantly blue ("hard"), and the lesions analyzed for the strain ratio had a mean value of 43.57. Contrast-enhanced sonography depicts the absence of vascular flow, and real-time elastography shows that the epidermoid cysts are hard. This combination of information will help further characterize these lesions.
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Affiliation(s)
- Ketul Patel
- Department of Radiology, King's College London, King's College Hospital, London, England
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Alvarez DM, Bhatt S, Dogra VS. Sonographic spectrum of tunica albuginea cyst. J Clin Imaging Sci 2011; 1:5. [PMID: 21915386 PMCID: PMC3169895 DOI: 10.4103/2156-7514.73503] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 10/02/2010] [Indexed: 11/04/2022] Open
Abstract
Tunica albuginea (TA) cyst is the most common extratesticular benign mass, which is usually palpable. Ultrasound examination is the imaging modality of choice to characterize palpable testicular lesions. This pictorial essay presents the spectrum of sonographic features of TA cysts in order to assist radiologists in making the correct diagnosis and avoid unnecessary surgeries.
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Affiliation(s)
- Daniel M Alvarez
- Department of Radiology, Hospital San Jose Tec de Monterrey, Monterrey, Mexico
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Nair R, Abbaraju J, Rajbabu K, Anjum F, Sriprasad S. Tubular ectasia of the rete testis: a diagnostic dilemma. Ann R Coll Surg Engl 2009; 90:W1-3. [PMID: 18831860 DOI: 10.1308/147870808x303119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tubular ectasia of the rete testis is a pathologically benign process with complex and varied aetiology. It must be differentiated from neoplastic disease of the testis clinically with patient age, mode of presentation, tumour marker status and the characteristic ultrasound and Doppler study findings. Awareness and diagnosis of this clinical entity can prevent unnecessary surgical intervention in these patients.
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Affiliation(s)
- Rajesh Nair
- Department of Urology, Darenth Valley Hospital, Dartford, Kent, UK.
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Kratzik C, Schatzl G, Lackner J, Marberger M. Transcutaneous high-intensity focused ultrasonography can cure testicular cancer in solitary testis. Urology 2006; 67:1269-73. [PMID: 16678890 DOI: 10.1016/j.urology.2005.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 12/01/2005] [Accepted: 12/01/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To report the long-term results in 7 patients (including the 5-year results in 3 patients) after high-intensity focused ultrasonography (HIFU) combined with irradiation to treat testicular tumors in a solitary testis. METHODS Transcutaneous HIFU ablation of testicular tumors is based on a technique using a piezoceramic transducer operating at 4.0 MHz with a site intensity of 1600 to 2000 W/cm2. In a Phase II trial, 7 patients with the typical sonographic pattern of a tumor in a solitary testis were treated with transcutaneous HIFU, as a minimally invasive organ-preserving approach, followed 6 weeks later by prophylactic testicular irradiation (range 18 to 20 Gy). The aim was to ablate the entire cancer in a single therapeutic HIFU session. In all 7 patients, the contralateral testis had previously been removed because of testicular cancer. RESULTS One patient received two cycles of chemotherapy for a single suspicious retroperitoneal lymph node diagnosed 6 months after HIFU. The other 6 protocol-treated patients remained tumor free at a mean follow-up of 42 months (range 3 to 93). One patient, who had refused postoperative irradiation, developed a recurrent tumor within 6 months. No patient showed any signs of clinical hypogonadism, and the International Index of Erectile Function score was normal for all patients. No androgen substitution was necessary. The only adverse effect noted was a small thermal lesion of the scrotum in 1 patient. CONCLUSIONS Despite the lack of tumor histologic examination, transcutaneous HIFU followed by irradiation permits a minimally invasive, organ-preserving, curative treatment for tumors in a solitary testis.
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Affiliation(s)
- C Kratzik
- Department of Urology, University of Vienna Medical School, Vienna, Austria
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Abstract
Ultrasound plays an important role and adds essential information in diagnosing benign intrascrotal lesions. Characterization of benign intrascrotal lesions with sonography, in combination with clinical assessment, can lead to nonsurgical management or testicular sparing surgery. We present important sonographic features of benign intrascrotal lesions, including extratesticular lesions: adenomatoid tumors, papillary cystadenomas, spermatoceles, hydroceles, varicoceles, hernias; and intratesticular lesions: tunica albuginea cysts, testicular simple cysts, epidermoid cysts, tubular ectasia of the rete testis, intratesticular varicoceles, adrenal rest tumors, and splenogonadal fusion. The goal of this review is to provide the radiologist with a better understanding of benign lesions that occur in the scrotum.
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Affiliation(s)
- Shweta Bhatt
- Deparment of Imaging Sciences University of Rochester School of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA
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Aguilera Tubet C, López Rasines G, Roca Edreira A, Martín García B, Hernández Rodríguez R, Portillo Martín JA, Gutiérrez Baños JL, Gómez Correas MA, Del Valle Schaan JI, Rado Velázquez MA, Ruiz Izquierdo F, Ballestero Diego R. [Testicular epidermoid cyst: uncommon lesion of difficult preoperative diagnosis]. Actas Urol Esp 2005; 29:905-8. [PMID: 16353779 DOI: 10.1016/s0210-4806(05)73364-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.
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Affiliation(s)
- C Aguilera Tubet
- Servicio de Urologia, Hospital Universitario Marques de Valdecilla, Santander
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Su CM, Lee YL, Huang SP, Chou YH, Huang CH. Testicular sparing surgery for bilateral epidermoid cysts of the testes: a case report. Kaohsiung J Med Sci 2004; 20:83-5. [PMID: 15481556 DOI: 10.1016/s1607-551x(09)70089-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We report the case of a 12-year-old boy with bilateral epidermoid cysts of the testes diagnosed preoperatively from ultrasonography, magnetic resonance imaging, and negative tumor markers. The cysts were treated using bilateral testicular sparing surgery through a scrotal approach after intraoperative frozen section. We also discuss the diagnosis and management of epidermoid cyst of the testis and briefly review the literature.
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Affiliation(s)
- Chin-Ming Su
- Department of Urology, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
Benign intratesticular lesions are rare, but recognition is important to avoid unnecessary surgical intervention. The ultrasonographic (US) features that help differentiate benign from malignant intratesticular lesions are emphasized by the authors. Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage (infarction). US features of cystic malignant neoplasms that help in differentiation of them from benign cystic lesions are also presented. The US appearance of epidermoid cysts varies with the maturation, compactness, and quantity of keratin present. Of the cystic malignant testicular tumors, which can occur anywhere in testicular parenchyma, teratomas are the most frequent to manifest as cystic masses. An abnormal rind of parenchyma with increased echogenicity usually surrounds these lesions. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. These cysts contain spermatozoa and can be septate. The US findings of intratesticular varicocele are similar to those of extratesticular varicocele and include multiple anechoic, serpiginous, tubular structures of varying sizes. Improvements in gray-scale and Doppler US technology allow subtle distinctions between benign and malignant testicular lesions that were not possible a decade earlier.
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Affiliation(s)
- V S Dogra
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106, USA.
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Dogra VS, Gottlieb RH, Rubens DJ, Oka M, Di Sant Agnese AP. Testicular epidermoid cysts: sonographic features with histopathologic correlation. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:192-196. [PMID: 11329161 DOI: 10.1002/1097-0096(200103/04)29:3<192::aid-jcu1018>3.0.co;2-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Testicular epidermoid cysts are rare, accounting for 1% of all testicular tumors. We present the sonographic appearances of epidermoid cysts in 3 cases, together with the histopathologic correlation. In case 1, sonography showed an intratesticular hypoechoic mass with a well-defined echogenic rim; the mass measured 1.8 x 1.5 x 1.5 cm, and there was no evidence of calcification. In case 2, sonography showed a well-circumscribed mass measuring 1.3 x 1.3 x 1.0 cm, with alternating hypoechoic and hyperechoic rings (onion-ring appearance) and no calcifications. In case 3, sonography showed a 2.4- x 2.3- x 2.3-cm, well-circumscribed, oval mass with a heterogeneous echotexture and an outer hypoechoic halo. The mass contained plaque-like regions of increased echogenicity, with peripheral acoustic shadowing from refraction artifact. Hypoechoic clefts were visualized posterior to the plaque-like areas. The triad of findings-sonographic appearance of an onion ring, avascularity on Doppler sonography, and negative results of tumor marker studies-is highly suggestive of an epidermoid cyst.
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Affiliation(s)
- V S Dogra
- Department of Radiology, Mercy Medical Center, North Eastern Ohio Universities College of Medicine, 1320 Mercy Drive NW, Canton, Ohio 44708, USA
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