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Alnemer M, Felemban JM, Mansoor A, Butt SA. Primary Testicular Lymphoma Mimicking Germ-Cell Tumor: A Case Report. Cureus 2023; 15:e48990. [PMID: 38111410 PMCID: PMC10726302 DOI: 10.7759/cureus.48990] [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] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
There are 1% to 2% of lymphoma cases that include the testis as primary testicular non-Hodgkin lymphoma (NHL). In 35% of cases, it involves both testes and is usually seen as a painless testicular mass. Therefore, in most cases, the management option is radical orchiectomy. The overall prognosis in these cases is poor, as most cases are associated with systemic disease. We report a case of a 42-year-old male who presented with painless right scrotal swelling for three months. The only serologic marker of solid tumors that was elevated was βHCG; others were unremarkable. Ultrasonography was initially ordered as well and showed a heterogeneous intra-testicular lesion of relatively low echogenicity. According to the given age, epidemiology, and clinical presentation, the suspicion of a germ cell tumor was highly likely. Therefore, a right radical inguinal orchiectomy was done, and the specimen was sent for histopathology, which came back as B-cell non-Hodgkin lymphoma. The clinical presentation and the overall picture of the investigations made in this case mimicked a germ cell tumor presentation.
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Affiliation(s)
| | | | - Ali Mansoor
- Urology, Dammam Medical Complex, Dammam, SAU
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2
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Chalfant V, Nguyen MT. Bilateral Testicular Burkitt's Lymphoma in a Child. Urology 2023; 173:e20-e23. [PMID: 36473588 DOI: 10.1016/j.urology.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
Primary non-Hodgkin's lymphoma (NHL) represents less than 5% of testicular malignancies and most often occurs in elderly men (>60 years old). We present a case of a 6-year-old boy who presented with bilateral, painless testicular swelling. Imaging studies showed bilateral heterogenous infiltrative process without focal mass. Serum testicular tumor markers were negative. Incisional testicular biopsies revealed a highly aggressive metastatic Burkitt's lymphoma with involvement of the pancreas and bone marrow. Chemotherapy was initiated with good response and showed resolution of the testicular lesions.
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Affiliation(s)
- Victor Chalfant
- Department of Urology, Creighton University School of Medicine, Omaha, NE
| | - Michael T Nguyen
- Department of Pediatric Urology, Phoenix Children's Hospital, Phoenix, AZ.
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3
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Xue N, Zhang S, Wang G. The value of contrast-enhanced ultrasonography in the diagnosis of primary testicular non-neoplastic and neoplastic lesions in adults. BMC Urol 2022; 22:210. [PMID: 36550425 PMCID: PMC9783712 DOI: 10.1186/s12894-022-01163-9] [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: 08/29/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Different pathological types of testicular tumors are treated differently. Malignant germ cell tumors require radical orchiectomy, while benign tumors may only need mass enucleation. Contrast-enhanced ultrasonography (CEUS) is more sensitive than conventional ultrasonography in displaying tumor microvessels, which helps distinguish between benign and malignant tumors. METHODS This was a retrospective analysis of 35 patients with pathological-confirmed primary testicular non-neoplastic and neoplastic lesions in our hospital from February 2017 to February 2022. Conventional ultrasonography and CEUS imaging findings of included lesions were retrospectively analyzed and their diagnostic values were compared with the pathological results. RESULTS There were 13 cases of benign testicular lesions (including 1 case of spontaneous hematoma, 2 cases of segmental infarctions, 5 cases of epidermoid cysts, 2 cases of Sertoli cell tumors, and 3 cases of Leydig cell tumors) and 23 cases of malignant testicular lesions (including 10 cases of seminomas, 1 case of embryonal carcinoma, 2 cases of mixed germ cell tumors, 2 cases of spermatocytic tumors, and 8 cases of lymphomas). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates of conventional ultrasound in diagnosing benign testicular tumors by "onion skin-like" echo (epidermoid cysts) and peripheral annular blood flow were 30.8%, 100.0%, 100.0%, 71.9% and 75.0%, respectively. All testicular non-neoplastic lesions and epidermoid cysts showed no enhancement by CEUS. All Sertoli-Leydig cell tumors (SLCTs)' CEUS imaging showed uniform high enhancement (no necrosis area), fast forward, and slow backward. 80.0% (12/15) malignant germ cell tumors showed heterogeneous enhancement and fast forward and fast backward in CEUS. All lymphomas showed fast forward and fast backward, and 87.5% (7/8) of them showed uniform high levels of enhancement in CEUS. According to CEUS without enhancement (non-neoplastic lesions and epidermoid cysts) and uniform high enhancement with fast forward and slow backward (SLCT), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for diagnosing benign testicular tumors were all 100.0%. Compared with conventional ultrasound, the difference was statistically significant (p = 0.004). CONCLUSIONS CEUS could accurately distinguish between benign and malignant testicular tumors, as well as differentiate specific pathological types (testicular focal infarction, epidermoid cysts, spermatocytic tumors, SLTC and lymphoma). Accurate preoperative diagnosis is critical for guiding the selection of appropriate treatment plans for different pathological types of testicular tumors.
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Affiliation(s)
- Nianyu Xue
- grid.416271.70000 0004 0639 0580Department of Ultrasonography, Ningbo First Hospital, 59 Liu Ting Street, Ningbo, 315010 Zhejiang China
| | - Shengmin Zhang
- grid.416271.70000 0004 0639 0580Department of Ultrasonography, Ningbo First Hospital, 59 Liu Ting Street, Ningbo, 315010 Zhejiang China
| | - Guoyao Wang
- grid.416271.70000 0004 0639 0580Department of Ultrasonography, Ningbo First Hospital, 59 Liu Ting Street, Ningbo, 315010 Zhejiang China
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4
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Koch K, Oschlies I, Klapper W. [Lymphomas and other hematological neoplasms in the testicles]. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:441-448. [PMID: 36149452 DOI: 10.1007/s00292-022-01121-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The testis may be infiltrated by hematological neoplasias. However, only few entities present as primary testicular diseases. OBJECTIVES To present hematological neoplasias in the testis, especially primary testicular hematological diseases. MATERIALS AND METHODS Selective literature research ( http://www.ncbi.nlm.nih.gov ) was combined with the clinico-pathological experience of the authors. RESULTS We present the experience of the lymph node registry Kiel with hematological neoplasias of the testis and develop a staining recommendation. According to our data, the testis is mainly involved by diffuse large B‑cell lymphomas (~70% of cases) followed by precursor cell neoplasias (~20%). Most precursor cell neoplasias are disseminated diseases involving the testis. Primary testicular lymphomas are nearly exclusively diffuse large B‑cell lymphomas that show specific clinical, pathological, and molecular features discriminating them from nodal/disseminated lymphomas. Primary testicular follicular lymphomas, which have been described in the literature, seem to be extremely rare. CONCLUSION Primary testicular lymphomas are predominantly diffuse large B‑cell lymphomas. The diagnosis is possible with few immunohistochemical stainings. However, histology cannot replace clinical staging to discriminate primary testicular lymphoma from secondary infiltration by a nodal/disseminated disease.
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Affiliation(s)
- Karoline Koch
- Institut für Pathologie, Sektion Hämatopathologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, Haus U33, 24105, Kiel, Deutschland.
| | - Ilske Oschlies
- Institut für Pathologie, Sektion Hämatopathologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, Haus U33, 24105, Kiel, Deutschland
| | - Wolfram Klapper
- Institut für Pathologie, Sektion Hämatopathologie, Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Straße 3, Haus U33, 24105, Kiel, Deutschland
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5
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Muacevic A, Adler JR. Concomitant Presence of Spermatic Cord and Testicular Non-Hodgkin's Lymphoma With Recurrence: A Case Report on a Rare Entity. Cureus 2022; 14:e30182. [PMID: 36397887 PMCID: PMC9648422 DOI: 10.7759/cureus.30182] [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] [Accepted: 10/11/2022] [Indexed: 11/22/2022] Open
Abstract
Primary testicular non-Hodgkin's lymphoma (PTNHL) with contiguous involvement of the spermatic cord is a rare occurrence and presentation of the disease, and it mostly involves elderly men between the sixth and eighth decades of life. PTNHL is a rare form of primary testicular malignancy that accounts for 1% of all non-Hodgkin's lymphoma cases and 5-10%of all testicular malignancies. This case report discusses a 73-year-old man who presented with right-sided inguinoscrotal swelling for six months, which had progressively increased in size. The patient was referred to the surgical department, and the examination revealed a hard-palpable mass with thickening of the cord. The initial imaging included an ultrasound, demonstrating a heteroechoic mass inseparable from the right testis with evidence of mild increased internal vascularity. Due to the high suspicion of malignancy, a right orchidectomy was performed. The patient subsequently developed another swelling after seven months, over the right inguinal region, which had progressively increased in size. MRI of the pelvis and CT of the abdomen and chest revealed a lobulated, intermediate intense lesion in the right inguinoscrotal region. This case report demonstrates the importance of radiological imaging in assessing and detecting the characteristics of concomitant lesions by using various imaging modalities and assessing the extent of spread. In addition, radiological imaging helps in the early diagnosis of the disease and facilitates prompt and early treatment to achieve favorable outcomes for the patient. The radiologist should include a differential diagnosis of PTNHL when imaging for a painless inguinoscrotal mass.
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Di Domenico D, Barone B, Del Biondo D, Napolitano L, Fusco GM, Cirillo L, Reccia P, De Luca L, Zito AR, Napodano G, Amato C, Stanislao I, Viscusi V, Crocetto F. Abnormal presentation of a bilateral, synchronous and plurimetastatic medium and large cell testicular lymphoma: A case report. Mol Clin Oncol 2022; 17:124. [PMID: 35832469 PMCID: PMC9264319 DOI: 10.3892/mco.2022.2557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/17/2022] [Indexed: 11/05/2022] Open
Abstract
Primary testicular lymphoma (PTL) accounts for 1-2% of all cases of non-Hodgkin's lymphoma, with a higher incidence in patients aged >60 years. The most common histological subtype is diffuse large-cell B lymphoma. By contrast, the bilateral synchronous and multimetastatic clinical presentation is a rare and unusual clinical presentation. In testicular masses, orchiectomy is essential for histopathological evaluation of the disease and definition of the immunophenotypic structure. The present study reported the case of a paucisymptomatic 54-year-old patient, who presented with erectile dysfunction and increasing testicular volume. Although clinical assessment and ultrasound examination showed an abnormal structure, highly suspicious for testicular cancer, the subsequent bilateral radical orchiectomy permitted the diagnosis of an unusual and rare PTL with multiple metastases reported at the PET/CT scan. In conclusion, the rare and aggressive disease represented by PTL requires a multidisciplinary approach and an aggressive treatment in order to provide the best care for patients affected.
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Affiliation(s)
- Dante Di Domenico
- Department of Urology, Hospital ‘Sacro Cuore di Gesù’ Fatebenefratelli, I-82100 Benevento, Italy
| | - Biagio Barone
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, I-80147 Naples, Italy
| | - Luigi Napolitano
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | - Giovanni Maria Fusco
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | - Luigi Cirillo
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | - Pasquale Reccia
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | - Luigi De Luca
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | | | - Giorgio Napodano
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, I-80147 Naples, Italy
| | - Carmen Amato
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | - Irene Stanislao
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
| | - Vincenzo Viscusi
- Department of Urology, Hospital ‘Sacro Cuore di Gesù’ Fatebenefratelli, I-82100 Benevento, Italy
| | - Felice Crocetto
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University ‘Federico II’, I-80131 Naples, Italy
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Khdhir M, El Annan T, El Amine MA, Shareef M. Complications of lymphoma in the abdomen and pelvis: clinical and imaging review. Abdom Radiol (NY) 2022; 47:2937-2955. [PMID: 35690955 PMCID: PMC10509750 DOI: 10.1007/s00261-022-03567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/18/2023]
Abstract
Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.
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Affiliation(s)
- Mihran Khdhir
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
| | - Tamara El Annan
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | | | - Muhammed Shareef
- Department of Radiology and Biomedical Imaging, Yale New Haven Hospital, New Haven, CT, USA
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8
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Marie E, Navallas M, Katz DS, Farajirad E, Punnett A, Davda S, Shammas A, Oudjhane K, Vali R. Non-Hodgkin Lymphoma Imaging Spectrum in Children, Adolescents, and Young Adults. Radiographics 2022; 42:1214-1238. [PMID: 35714040 DOI: 10.1148/rg.210162] [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
In children, adolescents, and young adults (CAYA), non-Hodgkin lymphoma (NHL) is characterized by various age-related dissimilarities in tumor aggressiveness, prevailing pathologic subtypes, and imaging features, as well as potentially different treatment outcomes. Understanding the imaging spectrum of NHL in CAYA with particular attention to children and adolescents is critical for radiologists to support the clinical decision making by the treating physicians and other health care practitioners. The authors discuss the currently performed imaging modalities including radiography, US, CT, MRI, and PET in the diagnosis, staging, and assessment of the treatment response. Familiarity with diagnostic imaging challenges during image acquisition, processing, and interpretation is required when managing patients with NHL. The authors describe potentially problematic and life-threatening scenarios that require prompt management. Moreover, the authors address the unprecedented urge to understand the imaging patterns of possible treatment-related complications of the therapeutic agents used in NHL clinical trials and in practice. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Eman Marie
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - María Navallas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Douglas S Katz
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Elnaz Farajirad
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Angela Punnett
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Sunit Davda
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Amer Shammas
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Kamaldine Oudjhane
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
| | - Reza Vali
- From the Department of Diagnostic Imaging, McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5 (E.M.); Department of Diagnostic Imaging, Hospital Universitario 12 de Octubre, Madrid, Spain (M.N.); Department of Radiology, NYU Winthrop Hospital, Mineola, NY (D.S.K.); LHSC Victoria Hospital, Western Ontario University, London, ON, Canada (E.F.); Department of Pediatrics, Division of Hematology/Oncology (A.P.), Department of Diagnostic Imaging (K.O), Division of Nuclear Medicine (A.S., R.V.), The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Great Ormond Street Hospital for Children, NHS, London, England (S.D.); and Department of Medical Imaging, University of Toronto, Toronto, ON, Canada (K.O.)
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9
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Hermann AL, L’Herminé-Coulomb A, Irtan S, Audry G, Cardoen L, Brisse HJ, Vande Perre S, Pointe HDL. Imaging of Pediatric Testicular and Para-Testicular Tumors: A Pictural Review. Cancers (Basel) 2022; 14:3180. [PMID: 35804952 PMCID: PMC9265135 DOI: 10.3390/cancers14133180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
Pre- and post-pubertal testicular tumors are two distinct entities in terms of epidemiology, diagnosis and treatment. Most pre-pubertal tumors are benign; the most frequent are teratomas, and the most common malignant tumors are yolk-sac tumors. Post-pubertal tumors are similar to those found in adults and are more likely to be malignant. Imaging plays a pivotal role in the diagnosis, staging and follow-up. The appearance on ultrasonography (US) is especially helpful to differentiate benign lesions that could be candidates for testis-sparing surgery from malignant ones that require radical orchidectomy. Some specific imaging patterns are described for benign lesions: epidermoid cysts, mature cystic teratomas and Leydig-cell tumors. Benign tumors tend to be well-circumscribed, with decreased Doppler flow on US, but malignancy should be suspected when US shows an inhomogeneous, not-well-described lesion with internal blood flow. Imaging features should always be interpreted in combination with clinical and biological data including serum levels of tumor markers and even intra-operative frozen sections in case of conservative surgery to raise any concerns of malignity. This review provides an overview of imaging features of the most frequent testicular and para-testicular tumor types in children and the value of imaging in disease staging and monitoring children with testicular tumors or risk factors for testicular tumors.
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Affiliation(s)
- Anne-Laure Hermann
- Department of Pediatric and Prenatal Imaging, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France; (S.V.P.); (H.D.L.P.)
| | - Aurore L’Herminé-Coulomb
- Department of Pathology, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France;
| | - Sabine Irtan
- Department of Pediatric Surgery, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France;
| | - Georges Audry
- Department of Imaging, Institut Curie, 75005 Paris, France; (G.A.); (L.C.); (H.J.B.)
| | - Liesbeth Cardoen
- Department of Imaging, Institut Curie, 75005 Paris, France; (G.A.); (L.C.); (H.J.B.)
| | - Hervé J. Brisse
- Department of Imaging, Institut Curie, 75005 Paris, France; (G.A.); (L.C.); (H.J.B.)
| | - Saskia Vande Perre
- Department of Pediatric and Prenatal Imaging, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France; (S.V.P.); (H.D.L.P.)
| | - Hubert Ducou Le Pointe
- Department of Pediatric and Prenatal Imaging, Armand-Trousseau Hospital, APHP, Sorbonne University, 75012 Paris, France; (S.V.P.); (H.D.L.P.)
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10
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Contrast-enhanced and microvascular ultrasound imaging features of testicular lymphoma: report of five cases and review literature. BMC Urol 2022; 22:6. [PMID: 35067228 PMCID: PMC8785503 DOI: 10.1186/s12894-022-00957-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background To retrospectively investigate the grey-scale, Doppler, contrast-enhanced and microvascular ultrasound of five patients with primary testicular lymphoma of our institute through review literature analysis. Methods From January to November 2020, five patients with primary testicular lymphoma confirmed by histology were preoperatively investigated with a standardized sonographic protocol including contrast-enhanced and microvascular ultrasound. Results Conventional ultrasound showed localized hypoechogenicity represented with solitary (2 of 5), multiple lesions (2 of 5), or entire testicular involvement (1 of 5). Increased blood flow appeared in color Doppler ultrasound with straight vascular sign (4 of 5). In contrast-enhanced ultrasound images confirmed this pattern (4 of 5) and presented hyper enhancement with enlarged range. On microvascular ultrasound imagings, all lesions were presented with straight and parallel course of intralesional vessels (5 of 5). Conclusions Here, we identified an increased vascularity with enlarged range on contrast-enhanced ultrasound along with a linear nonbranching pattern by vascular sign on microvascular ultrasonographic of testicular lymphoma.
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11
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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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12
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Lewicki A, Freeman S, Jędrzejczyk M, Dobruch J, Dong Y, Bertolotto M, Dietrich CF. Incidental Findings and How to Manage Them: Testis- A WFUMB Position Paper. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2787-2802. [PMID: 34303560 DOI: 10.1016/j.ultrasmedbio.2021.05.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 06/13/2023]
Abstract
Testicular incidentalomas are non-palpable, asymptomatic lesions, most frequently detected on ultrasound examinations. Each incidentaloma should undergo a standardized diagnostic workup to exclude malignancy and recognize other potentially significant non-malignant conditions that may first present with an incidental finding on scrotal ultrasound. This position statement of the World Federation of Ultrasound in Medicine and Biology (WFUMB) summarizes the available evidence on management of testicular incidentalomas and describes efficient management strategies with particular reference to the role of ultrasound techniques.
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Affiliation(s)
- Andrzej Lewicki
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Simon Freeman
- Imaging Directorate, Derriford Hospital, University Hospitals Plymouth NHS Trust. Derriford Road, Plymouth, Devon, United Kingdom
| | - Maciej Jędrzejczyk
- Department of Diagnostic Imaging, Faculty of Medical Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Jakub Dobruch
- Department of Urology, Postgraduate Medical Education Centre, Professor Witold Orłowski Independent Public Clinical Hospital, Warsaw, Poland
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
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13
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Koh SY, Lee S, Lee SB, Cho YJ, Choi YH, Cheon JE, Kim WS. Shear-wave elastography for the assessment of testicular involvement of hematologic malignancies in children and young adults: a feasibility study. Ultrasonography 2021; 41:325-334. [PMID: 34674454 PMCID: PMC8942732 DOI: 10.14366/usg.21072] [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: 03/26/2021] [Accepted: 09/06/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to assess the feasibility of shear-wave elastography (SWE) for assessing the testicular involvement of hematologic malignancies in children and young adults. Methods Eight patients (mean age, 11.0 years; range, 0.8 to 20 years) with biopsy-confirmed testicular involvement of hematologic malignancy between January 2018 and December 2020 were retrospectively evaluated. Multiparametric ultrasound examinations, including grayscale, color Doppler ultrasonography (CDUS), and SWE, were performed. Stiffness was measured in the involved testicular area and contralateral normal parenchyma. If there was bilateral testicular involvement, the stiffness of the involved area and the adjacent normal echoic parenchyma was measured on one testis. The Mann-Whitney U test was used to compare stiffness values. Results On grayscale, the testicular lesions were noted as a solitary mass in one patient, multiple lesions in four patients, and diffuse involvement in three patients. On CDUS and SWE, all patients demonstrated increased vascularity, and the stiffness of the involved area was higher than the values of normal parenchyma (the involved area vs. normal parenchyma, 11.6 kPa [3.9-20.2 kPa] vs. 2.9 kPa [1.1-3.7 kPa], P=0.003). The ratio of stiffness between the involved area and normal parenchyma was 3.4, ranging from 1.9 to 5.1. One patient showed decreased stiffness on follow-up SWE after treatment (affected testis vs. normal testis: initial, 13.8 vs. 3.2 kPa; 1 year later, 2.2 vs. 2.4 kPa). Conclusion Increased testicular stiffness on SWE in children and young adults with hematologic malignancies suggests the possibility of testicular involvement.
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Affiliation(s)
- Seok Young Koh
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Seul Bi Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
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14
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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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15
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Kim MJ, Lee YH, Kim YR. Unusual Presentation of a Testicular Lymphoma Mimicking a Missed Testicular Torsion: A Case Report. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:1287-1291. [PMID: 36238396 PMCID: PMC9432361 DOI: 10.3348/jksr.2020.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/15/2020] [Accepted: 02/01/2021] [Indexed: 11/17/2022]
Abstract
Testicular lymphoma is an uncommon testicular tumor that usually presents as a painless mass. It usually shows hypervascularity on color Doppler ultrasound (US) and a mild enhancement on enhanced CT or MRI. We present an unusual case of a testicular lymphoma mimicking a missed testicular torsion in a 67-year-old male patient with right scrotal swelling and intermittent pain for 2 months. Color Doppler US demonstrated the absence of vascularity in the enlarged right testis, and the initial diagnosis was a missed testicular torsion. CT demonstrated a poorly enhancing mass rather than a missed testicular torsion with enhanced small nodular foci at the periphery. The final pathological diagnosis was testicular lymphoma.
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16
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Lotti F, Bertolotto M, Maggi M. Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal. Andrology 2021; 9:1331-1355. [PMID: 34089245 DOI: 10.1111/andr.13062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ultrasonography is the gold standard imaging method for scrotal investigation. Colour Doppler ultrasonography, contrast-enhanced ultrasonography and sonoelastography allow sonographers to assess size, echotexture, vascular features and stiffness of the scrotal organs and abnormalities. Scrotal ultrasonography has been used to investigate male reproductive health, scrotal pain, masses and trauma. However, ultrasonography thresholds/classifications used to distinguish normal and pathologic features of the scrotal organs have changed over time, and have not yet been fully standardized. OBJECTIVES To evaluate historical trends for the standards in scrotal ultrasonography: what was, what is and what will be normal. METHODS An extensive Medline search was performed identifying the most relevant studies in the English language from inception to date. RESULTS We provide here (i) a brief overview of the history of ultrasonography, (ii) current indications for scrotal ultrasonography and (iii) previous and current normal values, cut-offs and classifications of the main colour-Doppler ultrasonography parameters/characteristics of the scrotal organs, as derived from recent guidelines and evidence-based studies. In addition, we report recommendations and the clinical utility of contrast-enhanced ultrasonography and sonoelastography. Finally, we discuss critical issues needing further evidence and future directions to fill in the current gaps. DISCUSSION Several studies on scrotal ultrasonography are available. However, guidelines/recommendations dealing with specific ultrasonography applications have been published only in recent years. More recently, the European Academy of Andrology published evidence-based scrotal colour-Doppler ultrasonography reference ranges/normative parameters derived from a cohort of healthy, fertile men. In addition, a standardization of the methodology to evaluate qualitative and quantitative colour-Doppler ultrasonography parameters was reported. Other international societies reported indications, methodological standards, clinical utility and limitations of contrast-enhanced ultrasonography and sonoelastography. CONCLUSIONS To date, colour-Doppler ultrasonography normative values for the scrotal organs are available. However, a wide international consensus on assessment and classification of several ultrasonography parameters is still lacking. An alignment of the world societies on these issues is advocated.
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Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Michele Bertolotto
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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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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18
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Kumar Madaan P, Jain P, Sharma A, Malik A, Nair Misra R. Imaging of primary testicular lymphoma with unusual intraabdominal spread along the spermatic cord and gonadal vein. Radiol Case Rep 2020; 16:419-424. [PMID: 33363674 PMCID: PMC7750148 DOI: 10.1016/j.radcr.2020.12.003] [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: 11/22/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022] Open
Abstract
Primary testicular lymphoma (PTL) is a rare Testicular neoplasm found in elderly patients. Imaging features in PTL presenting with contiguous involvement of spermatic cord and extension along gonadal vein have been rarely detailed before. We describe a case of a 50-year-old male who presented with complaints of scrotal swelling and abdominal discomfort. Imaging, which included Ultrasonography and contrast-enhanced computed tomography of chest-abdomen, showed features of aggressive-looking bilateral testicular mass lesions with the distinctive feature of contiguous spread along the spermatic cord and gonadal vein till retroperitoneum and disseminated chest and abdominal metastases. The distinctive feature of contiguous extension along the spermatic cord and gonadal vein can help suggest a diagnosis of PTL on imaging.
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19
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Palumbo C, Mazzone E, Mistretta FA, Knipper S, Tian Z, Perrotte P, Montorsi F, Shariat SF, Saad F, Simeone C, Briganti A, Antonelli A, Karakiewicz PI. Primary lymphomas of the genitourinary tract: A population-based study. Asian J Urol 2020; 7:332-339. [PMID: 32995277 PMCID: PMC7498952 DOI: 10.1016/j.ajur.2019.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/14/2019] [Accepted: 07/01/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We performed a population-based analysis focusing on primary extranodal lymphoma of either testis, kidney, bladder or prostate (PGUL). METHODS We identified all cases of localized testis, renal, bladder and prostate primary lymphomas (PL) versus primary testis, kidney, bladder and prostate cancers within the Surveillance, Epidemiology, and End Results database (1998-2015). Estimated annual proportion change methodology (EAPC), multivariable logistic regression models, cumulative incidence plots and multivariable competing risks regression models were used. RESULTS The rates of testis-PL, renal-PL, bladder-PL and prostate-PL were 3.04%, 0.22%, 0.18% and 0.01%, respectively. Patients with PGUL were older and more frequently Caucasian. Annual rates significantly decreased for renal-PL (EAPC: -5.6%; p=0.004) and prostate-PL (EAPC: -3.6%; p=0.03). In multivariable logistic regression models, older ager independently predicted testis-PL (odds ratio [OR]: 16.4; p<0.001) and renal-PL (OR: 3.5; p<0.001), while female gender independently predicted bladder-PL (OR: 5.5; p<0.001). In surgically treated patients, cumulative incidence plots showed significantly higher 10-year cancer-specific mortality (CSM) rates for testis-PL, renal-PL and prostate-PL versus their primary genitourinary tumors. In multivariable competing risks regression models, only testis-PL (hazard ratio [HR]: 16.7; p<0.001) and renal-PL (HR: 2.52; p<0.001) independently predicted higher CSM rates. CONCLUSION PGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder. Relative to primary genitourinary tumors, PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL, even after adjustment for other-cause mortality.
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Affiliation(s)
- Carlotta Palumbo
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco A. Mistretta
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Sophie Knipper
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Paul Perrotte
- Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Francesco Montorsi
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Shahrokh F. Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Claudio Simeone
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Antonelli
- Urology Unit, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Brescia, Italy
- Corresponding author.
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
- Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Schwarze V, Marschner C, Rübenthaler J, Negrão de Figueiredo G, Clevert DA. Overview of ultrasound applications for assessing scrotal disorders. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1047-1056. [PMID: 31840876 DOI: 10.1002/jum.15197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
The scrotum may be affected by a plethora of different disorders such as infections, vasculopathies, trauma, and manifestations of primary and secondary malignant masses. In addition to the patient's medical history and clinical examination, ultrasound represents the imaging modality of choice to assess scrotal disorders. Time-consuming contrast-enhanced ultrasound and elastography can provide further information to distinguish between benign and malignant testicular mass lesions. The following invited Special Communication gives a comprehensive overview of differential diagnoses of the scrotum and their corresponding sonomorphologic correlates based on representative cases of the Interdisciplinary Ultrasound Center of the University Hospital Munich.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | | | - Dirk-Andre Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
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21
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Karaosmanoglu AD, Uysal A, Onur MR, Hahn PF, Ayhan AS, Ozmen MN, Akata D, Karcaaltincaba M. Primary lymphomas of the intraabdominal solid organs and the gastrointestinal tract: spectrum of imaging findings with histopathological confirmation. Abdom Radiol (NY) 2019; 44:2988-3005. [PMID: 31209544 DOI: 10.1007/s00261-019-02100-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unlike nodal lymphoma, primary lymphomas of the intraabdominal organs are uncommon neoplasms whose diagnosis may be challenging in certain clinical circumstances. Despite this difficulty for imaging diagnosis, there are several imaging features on ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography that may suggest the correct diagnosis. The scope of this review is to describe and illustrate the imaging features of primary lymphoma of intraabdominal organs providing clues to the diagnosis, together with their pathological correlations.
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22
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Nepal P, Ojili V, Songmen S, Kaur N, Olsavsky T, Nagar A. "The Great Masquerader": Sonographic Pictorial Review of Testicular Tuberculosis and its Mimics. J Clin Imaging Sci 2019; 9:27. [PMID: 31448178 PMCID: PMC6702864 DOI: 10.25259/jcis-14-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/18/2019] [Indexed: 11/07/2022] Open
Abstract
Testicular tuberculosis (TB) is an uncommon presentation of extrapulmonary TB. Although rare in incidence, it is a great masquerader and should be kept in consideration while assessing focal abnormalities involving the testis. Ultrasound findings alone may be non-specific and mimic other diagnoses including infection, inflammation, tumor, infarct, and trauma. The main objective of this sonographic pictorial review is to discuss the imaging findings, specific differentiating features against each differential and use of ancillary imaging findings whenever available. Concurrent involvement of epididymis, septated hydrocele, scrotal wall edema, and calcification of tunica vaginalis provides strong evidence in an appropriate setting. Available extratesticular ancillary imaging findings must be correlated for correct diagnosis due to non-specific imaging and clinical presentation. Misdiagnosis of scrotal TB may lead to otherwise avoidable epididymo-orchiectomy.
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Affiliation(s)
- Pankaj Nepal
- Departments of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Vijayanadh Ojili
- Departments of Radiology, University of Texas Health, San Antonio, TX, USA
| | | | - Neeraj Kaur
- Departments of Radiology, University of Texas Health, San Antonio, TX, USA
| | - Thomas Olsavsky
- Departments of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | - Arpit Nagar
- Departments of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
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23
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Rocher L, Ksouri A, Maxwell F, Bresson B, Hindawi G, Balasa C, Bellin MF, Albiges L. [Testicular tumors: A diagnostic challenge of imaging]. Bull Cancer 2019; 106:875-886. [PMID: 31088679 DOI: 10.1016/j.bulcan.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Reviewing the characterization and the follow-up imaging of testicular tumors. MATERIAL AND METHODS Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: Testicular tumors; Color Doppler ultrasound; US elastography; Magnetic resonance imaging; Contrast enhanced sonography. RESULTS Ultrasound remains the basic exam for the tumor characterization. Among the other techniques, MRI, elastography, contrast enhanced ultrasound, although still in evaluation, will be increasingly used in the future. The frequency of benign Leydig cell tumors justifies a testicular preservation approach, through improvement of characterization, monitoring or tumorectomy. The follow-up of testicular lesions must be indicated on precise indications: follow-up of the contralateral testicle in the case of germi cell tumor, follow-up by of a supposed benign lesion, such as a small Leydig cell tumor in an infertile patient, follow-up when ultra-sound findings are not sufficiently worrying to require immediate diagnosis but which include pejorative criteria. The tumor markers and the extension screening remain systematic. CONCLUSION The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on clinical biological data and suspected nature of the tumor at imaging.
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Affiliation(s)
- Laurence Rocher
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France.
| | - Aïda Ksouri
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Florian Maxwell
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Bertrand Bresson
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France
| | - Ghina Hindawi
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Cristina Balasa
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France
| | - Marie France Bellin
- Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France
| | - Laurence Albiges
- Institut Gustave-Roussy, département d'oncologie, 114, rue Edouard-Vaillaxnt, 94805 Villejuif, France
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Bigliardi E, Denti L, De Cesaris V, Bertocchi M, Di Ianni F, Parmigiani E, Bresciani C, Cantoni AM. Colour Doppler ultrasound imaging of blood flows variations in neoplastic and non-neoplastic testicular lesions in dogs. Reprod Domest Anim 2018; 54:63-71. [DOI: 10.1111/rda.13310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Enrico Bigliardi
- Department of Veterinary Science; University of Parma; Parma Italy
| | - Laura Denti
- Department of Veterinary Science; University of Parma; Parma Italy
| | | | - Mara Bertocchi
- Department of Veterinary Science; University of Parma; Parma Italy
| | | | | | - Carla Bresciani
- Department of Veterinary Science; University of Parma; Parma Italy
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25
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Abstract
PURPOSE OF REVIEW Management of genitourinary malignancy is likely to encompass a large portion of most of the urologist's practice. The challenge for the modern urologist is not only in understanding the management of commonly seen genitourinary malignancies, but also in recognizing unusual variants and their differences in management. This is evermore important as new technologies have refined the ability to identify rare entities. This review presents a brief overview of the various genitourinary malignancy subtypes seen within urology. RECENT FINDINGS All major organ subtypes are highlighted along with an overview of the current understanding of their associated malignancies. An update on the current state management paradigms as well as future directions is also outlined. SUMMARY After reading this review, the urologist should have a deeper understanding of the breadth of disorders in genitourinary oncology and a clearer approach to the management of these problems. Additionally, ongoing avenues for research are highlighted.
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26
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Bertolotto M, Muça M, Currò F, Bucci S, Rocher L, Cova MA. Multiparametric US for scrotal diseases. Abdom Radiol (NY) 2018; 43:899-917. [PMID: 29460046 DOI: 10.1007/s00261-018-1510-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Multiparametric US is increasingly recognized as a valuable problem-solving technique in scrotal pathologies. Compared to conventional Doppler modes, contrast-enhanced ultrasonography (CEUS) has higher sensitivity in assessing the presence or absence of flows, and to improve differentiation between poorly vascularized tumors and non-neoplastic, avascular lesions. Characterization of benign and malignant complex cysts is improved. In trauma patients, CEUS can help evaluating the viability of testicular parenchyma. In patients with severe epididymo-orchitis, it allows unequivocal assessment of post-inflammatory ischemic changes and abscess formation. CEUS does not add significantly to conventional Doppler modes in spermatic cord torsion. Attempt of differentiating benign and malignant tumors remains a research tool. In the clinical practice, elastography has a limited role for tumor characterization. The majority of malignant tumors are stiff at elastography, but they may display soft areas, or appear globally soft. A quantitative evaluation of testicular stiffness is feasible using shear-wave elastography. Potential clinical applications for elastographic modes could include work-up of infertile patients.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Matilda Muça
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Francesca Currò
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Stefano Bucci
- Department of Urology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
| | - Laurence Rocher
- Department of Radiology, Hôpital de Bicêtre, 78 Avenue du General Lecters, 94270, Paris, France
| | - Maria Assunta Cova
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Strada di Fiume 447, 34149, Trieste, Italy
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27
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Marko J, Wolfman DJ, Aubin AL, Sesterhenn IA. Testicular Seminoma and Its Mimics: From the Radiologic Pathology Archives. Radiographics 2017; 37:1085-1098. [PMID: 28574809 DOI: 10.1148/rg.2017160164] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Testicular seminoma is the most common malignant tumor of the testis. It classically manifests as a painless mass. Radiologic evaluation with high-frequency ultrasonography (US) is critical for diagnosis. Seminomas are usually homogeneously hypoechoic masses at US. In challenging cases, magnetic resonance (MR) imaging may help confirm that a mass is intratesticular and provide data for local staging. Computed tomography (CT) provides valuable information for staging, including the presence and size of retroperitoneal lymph nodes. Testicular seminoma is treated with radical inguinal orchiectomy and is highly curable even at advanced stages of disease. Several neoplastic and nonneoplastic conditions may mimic testicular seminoma at imaging. Benign mimics include segmental infarction, hematoma, infection, epidermoid cyst, adrenal rests, sarcoidosis, splenogonadal fusion, and sex cord-stromal tumors. Malignant mimics include nonseminomatous germ cell tumors, lymphoma, and metastases. These conditions are individually reviewed with emphasis on features that allow differentiation from seminoma. Spermatocytic tumor, formerly known as spermatocytic seminoma, accounts for only 1% of testicular tumors. It is distinct from classic seminoma, with unique histologic, molecular, and genetic features. It affects an older patient population than classic seminoma and demonstrates indolent clinical behavior. Radiologists serve a key role in diagnosis, staging, and surveillance of patients with seminoma. A thorough knowledge of related clinical, radiologic, and pathologic findings will help the radiologist contribute to high-quality interdisciplinary care of affected patients.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Darcy J Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Alex L Aubin
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Isabell A Sesterhenn
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
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28
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Kachramanoglou C, Rafailidis V, Philippidou M, Bertolotto M, Huang DY, Deganello A, Sellars ME, Sidhu PS. Multiparametric Sonography of Hematologic Malignancies of the Testis: Grayscale, Color Doppler, and Contrast-Enhanced Ultrasound and Strain Elastographic Appearances With Histologic Correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:409-420. [PMID: 28032907 DOI: 10.7863/ultra.16.02013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 05/06/2016] [Indexed: 06/06/2023]
Abstract
Primary testicular lymphoma is rare and appears with nonspecific findings on grayscale and color Doppler sonography. We present 8 patients further examined with contrast-enhanced sonography, strain elastography, and histologic analysis after orchiectomy. Seven of 8 patients had a diagnosis of large B-cell lymphoma, and 1 of 8 had a diagnosis of granulocytic sarcoma, with solitary lesions (2 of 8), multiple lesions (3 of 8), or entire testicular involvement (3 of 8). Lesions appeared hypoechoic (7 of 8) or isoechoic (1 of 8), all with increased vascularity on color Doppler sonography and a nonbranching linear pattern of intratumoral vessels (7 of 8). Contrast-enhanced ultrasound (CEUS) confirmed this pattern and showed increased enhancement in all lesions. On strain elastography, all lesions were hard, with an elasticity score of greater than 4. Multiparametric sonography of testicular lymphoma identifies increased vascularity on color Doppler and contrast-enhanced ultrasound and increased lesion stiffness on strain elastography.
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Affiliation(s)
| | | | | | | | - Dean Y Huang
- Department of Radiology, King's College Hospital, London, England
| | | | - Maria E Sellars
- Department of Radiology, King's College Hospital, London, England
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, London, England
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29
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Rafailidis V, Robbie H, Konstantatou E, Huang DY, Deganello A, Sellars ME, Cantisani V, Isidori AM, Sidhu PS. Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2016; 24:23-33. [PMID: 27433272 DOI: 10.1177/1742271x15626195] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 12/13/2015] [Indexed: 12/27/2022]
Abstract
Extra-testicular lesions are usually benign but present with nonspecific grey-scale sonography findings. This study assesses conventional sonographic characteristics in the differentiation of extra-testicular tumoural from inflammatory lesions and whether contrast-enhanced ultrasound has a role. A retrospective database analysis was performed. All patients were examined by experienced sonographers employing standard techniques combining grey-scale, colour Doppler sonography and contrast-enhanced ultrasound. Features recorded were: clinical symptoms, size, location, echogenicity, colour Doppler sonography and contrast-enhanced ultrasound enhancement. Vascularity on colour Doppler sonography and contrast-enhanced ultrasound was graded and compared. The lesions were classified as tumoural or inflammatory. The Chi-square test was used to analyse the sonographic patterns and kappa coefficient to measure the agreement between colour Doppler sonography and contrast-enhanced ultrasound. A total of 30 lesions were reviewed (median diameter 12 mm, range 5-80 mm, median age 52 years, range 18-86 years), including 13/30 tumoural and 17/30 inflammatory lesions. Lesions were hypoechoic (n = 12), isoechoic (n = 6), hyperechoic (n = 2) or mixed (n = 10). Grey-scale characteristics of tumoural vs. inflammatory lesions differed significantly (P = 0.026). On colour Doppler sonography, lesions had no vessels (n = 16), 2-3 vessels (n = 10) and ≥4 vessels (n = 4). On contrast-enhanced ultrasound, lesions showed no vascularity (n = 17), perfusion similar to testis (n = 7) and higher (n = 6). All abscesses identified (n = 9) showed no vascularity on both colour Doppler sonography and contrast-enhanced ultrasound. There was good agreement between these techniques in evaluating vascularity (κ = 0.719) and no significant difference between colour Doppler sonography and contrast-enhanced ultrasound of tumoural vs. inflammatory lesions (P > 0.05). The grey-scale appearances of extra-testicular lesions are essential for characterisation. Colour Doppler sonography and contrast-enhanced ultrasound findings are not useful in that respect. Contrast-enhanced ultrasound is excellent in establishing absence of vascularity.
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Affiliation(s)
- Vasileios Rafailidis
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Hasti Robbie
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Eleni Konstantatou
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Dean Y Huang
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Annamaria Deganello
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Maria E Sellars
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
| | - Vito Cantisani
- Department of Radiology, Sapienza University of Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Paul S Sidhu
- King's College London, Department of Radiology, King's College Hospital, Denmark Hill, London, UK
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30
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Bertolotto M, Cantisani V, Valentino M, Pavlica P, Derchi LE. Pitfalls in Imaging for Acute Scrotal Pathology. Semin Roentgenol 2016; 51:60-9. [DOI: 10.1053/j.ro.2016.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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31
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Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol 2015; 26:2268-78. [DOI: 10.1007/s00330-015-4059-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/04/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023]
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