Extratesticular Lesions Research Articles

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Hematocele with blunt scrotal trauma is an uncommon cause of the testicular pain. Elastography is the new recent advance in the field of ultrasound. USG and elastography findings of the acute hematocele is described in this aricle. Testicular trauma is the third most common cause of acute scrotal pain,1 and high-frequency ultrasonography (USG) with a linear array transducer is the first preferred modality for testicular trauma evaluation. Extra testicular haematoceles or blood collections inside the tunica vaginalis are the most common findings in the scrotum after blunt injury.2 On clinical assessment, haematocele appears as a hard mass like swelling and causes pain in the scrotum. In the majority of cases, spontaneous resolution occurs with the support of conservative therapy,3 even if treated conservatively, may result in infection, discomfort, or atrophy in undiagnosed broad hematoceles and testicular hematomas over time.4 A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. A typical testis is 5 x 3 x 2 cm in diameter and has an intermediate echogenicity. The tunica albuginea is a fibrous covering that protects the testis from damage from the external injuries. It is located on top of the tunica vasculosa, which is made up of capsular arteries. A testis with its coverings, epididymis, and spermatic cord are all contained in each hemiscrotum. With its high tensile strength, the tunica albuginea plays an important role in shielding the testis from trauma. It can withstand a force of up to 50 kg without bursting. The testicular parenchyma is made up of several lobules, each of which is made up of several seminiferous tubules that lead to dilated spaces inside the mediastinum called the rete testis through the tubuli recti. The epididymis is made up of a head, neck, and tail that protects the superolateral part of the testis. The epididymis' tail ends in the spermatic cord as the vas deferens. The epididymal head is a 5 – 12 mm pyramidal structure that sits atop the testis' superior pole. The head is almost isoechoic to the testis. The epididymis has a 2 – 4 mm thick body.5 The patient lies in a supine position with the scrotum covered by a towel positioned between the thighs during scrotal ultrasound. A high-frequency lineararray transducer with a frequency range of 7 – 14 MHz is preferred. The scrotum is always soft to the touch after trauma, making scanning difficult. It should be attempted to examine both the testes and the epididymis in their entirety, as well as any extra testicular lesions. The testes are assessed in two planes: longitudinal and transverse. Each testis and epididymis should be compared to the contralateral testis and epididymis in terms of size and echogenicity. Transverse scrotal imaging is important for depicting both testes and comparing their gray-scale and colour Doppler appearances.

Clinico - Sonological and pathological evaluation of extratesticular scrotal lesion

The study of 155 patients with extra testicular scrotal lesions presented to SSG Hospital Baroda from December 2015 to November 2016 the following points can be emphasized. The commonest age group presenting with scrotal lesions was in the range of 31-40 years. Unilateral presentation was more common than bilateral presentation. The commonest presentation was scrotal swelling followed by pain and other associated complains of fever and urinary complaints. The commonest finding was cystic followed by inflammatory, and neoplasm being rare. Among cystic hydrocele was the main pathology followed by epididymal cystic lesions. Epididymitis was more common than epididymorchitis followed by Fournier’s gangrene in inflammatory lesions. The commonest site of involvement was tunica vaginalis followed by epididymis and scrotal wall lesions. Ultrasonography helped to differentiate extra testicular lesions from intratesticular lesions in nearly all the cases, as well as the site of involvement but was not useful in confirming the etiology. FNAC was found useful in not only coming onto a final diagnosis but also had role in finding the etiology.

Imaging of scrotal masses.

Testicular cancer is responsible for approximately 0.1% of all cancer deaths in the USA, and seminoma is the most common type of testicular tumor. Ultrasonography is the primary imaging modality for accessing testicular and extratesticular lesions, while magnetic resonance imaging can be used for problem solving in lesion characterization in certain cases. CT imaging is usually performed for retroperitoneal staging of testicular cancer metastasis and follow-up after treatment. Extratesticular masses are common, yet rarely malignant. Imaging plays an important role in primary diagnosis of testicular cancer and differentiating it from common non-neoplastic findings. The purpose of this article is to review various imaging findings in testicular and extratesticular masses.

Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging.

Diagnostic workup of scrotal lesions should begin with a complete clinical history and physical examination, including analysis of risk factors such as family history of testicular cancer, personal history of tumor in the contralateral testis, and cryptorchidism, followed by imaging. Scrotal ultrasonography (US) with a combination of gray-scale and color Doppler techniques has been the first-line imaging modality for evaluation of testicular and extratesticular lesions because of its low cost, wide availability, and high diagnostic accuracy. However, US has limitations related to operator dependence, the relatively small field of view, and lack of tissue characterization. Magnetic resonance (MR) imaging, because of its superior soft-tissue contrast and multiplanar capabilities, is increasingly being used as a supplemental diagnostic problem-solving tool in cases where scrotal US findings are inconclusive or nondiagnostic. In addition to morphology, lesion location, and tissue characterization (eg, fat, blood products, granulation tissue, and fibrosis), scrotal MR imaging provides important information that can affect surgical planning and improve patient care. MR imaging also is helpful for differentiating testicular and extratesticular lesions, distinguishing between benign and malignant lesions, and evaluating the local extent of disease. This review discusses the anatomy and MR imaging features of testicular and extratesticular neoplastic and nonneoplastic conditions and describes relevant MR imaging techniques. ©RSNA, 2018 Contact information that appeared in the print version of this article was updated in the online version on May 14, 2018.

Clinical, radiological, cytological, and microbiological assessment of painful extratesticular lesions.

Introduction:Most of the painful extratesticular scrotal lesions are erroneously diagnosed and treated in our clinical practice. Therefore, this study was undertaken to analyze the usefulness of a combination of clinical, radiological, cytological, and microbiological assessment in establishing the accurate diagnosis of this lesion.Aim:To study the Clinical, Radiological, Cytological and Microbiological assessment of painful extra-testicular lesions and their correlation with each other in establishing the accurate diagnosis of these lesions.Objectives:The objectives of the study were to assess the diagnostic significance of clinical, radiological, cytological, and microbiological methods and their correlation in establishing the accurate diagnosis of painful extratesticular lesions.Materials and Methods:This cross-sectional study was carried out in Departments of Surgery, Radiology, Pathology, and Microbiology, University College of Medical Sciences and GTB Hospital over the period of 2 years. During this period, we were able to accommodate 75 patients in the study, who presented with pain and swelling in the scrotum and clinically found to have extratesticular swellings. Radiological assessment was done on the 1st day of visit, using Grayscale ultrasonography along with Color Doppler of these lesions. For cytological assessment, ultrasound-guided fine-needle aspiration cytology and microbiological assessment were done from the aspirate remaining after making cytology slide.Statistical Analysis:Data analysis was done using SPSS statistical software. Kappa statistics were used to find the degree of agreement or concordance between clinical, radiological, cytological, and microbiological findings.Results:Clinically 71 patients were found to have tender extratesticular swellings, whereas in four patients, these swellings were nontender on clinical examination. Radiologically, epididymitis was found in 32 patients. Only in 37 patients out of 75, a definite diagnosis could be made on cytology. The microbiological examination did not give any positive results.Conclusion:Painful extratesticular scrotal lesion often poses a diagnostic dilemma in the mind of treating physician. Clinical findings of these lesions may be corroborated through radiological, cytological, and microbiological assessment in an endeavor to arrive at a definitive diagnosis with a defined etiology.

Distinctive Features of Testicular Neoplasms: Seminoma versus Mixed Germ Cell Tumor

HomeRadioGraphicsVol. 37, No. 4 Previous IlluminationsDistinctive Features of Testicular Neoplasms: Seminoma versus Mixed Germ Cell TumorAletta Ann Frazier Aletta Ann Frazier Author AffiliationsAmerican Institute for Radiologic Pathology, Silver Spring, Maryland, and University of Maryland School of Medicine, Baltimore, Maryland ([email protected]).Aletta Ann Frazier Published Online:Jul 11 2017https://doi.org/10.1148/rg.2017174007MoreSectionsFull textPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished online: July 11 2017Published in print: July 2017 FiguresReferencesRelatedDetailsRecommended Articles Testicular Seminoma and Its Mimics: From the Radiologic Pathology ArchivesRadioGraphics2017Volume: 37Issue: 4pp. 1085-1098Testicular Germ Cell Tumors: Classification, Pathologic Features, Imaging Findings, and ManagementRadioGraphics2021Volume: 41Issue: 6pp. 1698-1716Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR ImagingRadioGraphics2018Volume: 38Issue: 3pp. 806-830Association between Testicular Microlithiasis and Testicular Neoplasia: Large Multicenter Study in a Pediatric PopulationRadiology2017Volume: 285Issue: 2pp. 576-583Multimodality Imaging Approach to Ovarian Neoplasms with Pathologic CorrelationRadioGraphics2020Volume: 41Issue: 1pp. 289-315See More RSNA Education Exhibits Testicular Germ Cell Tumors: Current Update on Classification, Pathology, Imaging Findings, and Management Digital Posters2020Radiologic-Pathologic Correlation of Intratesticular and Extratesticular Lesions: US, MR and CTDigital Posters2020Sizing up the Scrotum: Multimodality Approach to Scrotal Neoplasms with Pathology CorrelationDigital Posters2019 RSNA Case Collection Testicular SeminomaRSNA Case Collection2020Pineal Germinoma RSNA Case Collection2021Left breast hamartomaRSNA Case Collection2020 Vol. 37, No. 4 Metrics Altmetric Score PDF download

Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale, colour Doppler and contrast-enhanced ultrasound.

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.

Scrotal imaging.

Pathological lesions within the scrotum are relatively rare in imaging except for ultrasonography. The diseases presented in the paper are usually found in men at the age of 15–45, i.e. men of reproductive age, and therefore they are worth attention. Scrotal ultrasound in infertile individuals should be conducted on a routine basis owing to the fact that pathological scrotal lesions are frequently detected in this population. Malignant testicular cancers are the most common neoplasms in men at the age of 20–40. Ultrasound imaging is the method of choice characterized by the sensitivity of nearly 100% in the differentiation between intratesticular and extratesticular lesions. In the case of doubtful lesions that are not classified for intra-operative verification, nuclear magnetic resonance is applied. Computed tomography, however, is performed to monitor the progression of a neoplastic disease, in pelvic trauma with scrotal injury as well as in rare cases of scrotal hernias involving the ureters or a fragment of the urinary bladder.

2091749 Evaluation of Intra And Extratesticular Lesions with real Time Elastography: Comparison of Strain Ratio Versus Color Map Visual Grading

2091749 Evaluation of Intra And Extratesticular Lesions with real Time Elastography: Comparison of Strain Ratio Versus Color Map Visual Grading

Tubular Ectasia of Rete Testis with Spermatocele.

A 55-year-old male patient presented with a slowly enlarging, painless, large soft mass lesion in left scrotal sac for 6 month. On clinical examination the mass lesion could not be separated from testis, hence provisional diagnosis of testicular tumour was made. For further evaluation scrotal ultrasound was performed. In the region of the clinically palpable lump, ultrasound revealed a unilocular, well-circumscribed cystic lesion with moderately thick wall and fine internal echoes [Table/Fig-1]. The size of lesion was approximately 4.5 x 5 cm. It was located cranial to testis, partially replacing left epididymis. No internal or peripheral flow was detected on colour Doppler study. Mild fluid was also noted in scrotal sac, which was consistent with hydrocele. Right testis and epididymis were normal. [Table/Fig-1]: Gray scale ultrasound image of left scrotal sac shows a well circumscribed, rounded, unilocular cystic lesion with low level internal echoes located superior to left testis consistent with the diagnosis of spermatocele Ultrasound examination also revealed a cluster of multiple, small, anechoic cysts located in the region of testicular mediastinum [Table/Fig-2]. No solid component or calcification was seen. No evidence of any obvious arterial or venous flow was noted in the cysts on colour Doppler study [Table/Fig-3]. [Table/Fig-2]: Transverse (A), longitudinal (B) gray scale ultrasound images of left testis shows a cluster of multiple small anechoic cystic structures noted in the region of testicular mediastinum with hydrocele [Table/Fig-3]: Transverse colour Doppler ultrasound image of left testis shows numerous small cysts with no colour flow On the basis of characteristic ultrasound and Doppler findings final diagnosis was made of tubular ectasia of rete testis and spermatocele. Because of benign nature of this condition patient was reassured and ask for 6 monthly follow up. Tubular ectasia of the rete testis is a benign clinical entity in which cystic dilation of rete testis results from partial or complete obliteration of the efferent ducts [1]. The obstruction may occur at different levels and may be classified into intra- or extra-testicular. In testicular lesions, the obstruction generally resulting from previous inflammatory episodes like orchitis, while in extra-testicular lesions, traumatic tearing of epididymis, obstruction from epididymitis, spermatoceles and tunica albuginea cyst and post-vasectomy or other scrotal surgeries are the common causes [2]. Typically this condition affects patients older than 50 year of age. Bilateral lesions have been reported in 29 to 69% of cases [3]. Spermatocele and epididymis cysts are commonly associated with this condition. Ultrasonography is usually the first and only modality needed to diagnose this condition. Sonographic findings of tubular ectasia of rete testis consists of a cluster of several anechoic rounded and serpiginous tubular structures located in the mediastinum testis without any solid areas or calcific foci. They do not cause mass effect on the adjacent testicular parenchyma. Colour Doppler shows no arterial or venous flow within cystic lesions [4]. Spermatoceles are common extra-testicular lesions caused by cystic dilation of efferent ductules in the region of head of epididymis. On ultrasonography, it appears as a unilocular or multilocular hypoechoic cystic lesion located superior to and separate from testis. It is usually small in size ranging from 1-2cm in size. However large lesions upto 8 cm in size have been reported in the literature [5]. Spermatocele may show low-level echogenic internal echoes due to proteinaceous fluid containing dead sperms. MRI is usually not indicated because of typical appearance on ultrasound. However, if done in doubtful cases, reveals a cluster of round or serpiginous lesions in the hilum of testis, which appear hypointense TI-weighted and hyperintense on T2- weighted images. The main differential diagnosis includes intra-testicular varicocele and cystic dysplasia of testis. Intra-testicular varicocele is a rare entity, which can give similar appearance on B-mode ultrasonography, however colour Doppler and pulsed Doppler evaluation shows colour flow with characteristic venous spectral waveform that augments during Valsalva maneuver [6]. Cystic dysplasia of testis is thought to be a congenital condition unlike tubular ectasia of rete testis which is an acquired condition. It is seen in children and has similar appearance to tubular ectasia of rete testis [7]. Other differential diagnosis includes epididymal cystadenoma, teratoma, non-Hodgkin’s lymphoma and seminiferous tubules dilatation secondary to testicular neoplasms [1]. Tubular ectasia of rete testis and spermatocele are benign entities With characteristics features on gray scale and colour Doppler examination. This condition should be recognized in older individuals and its awareness can prevent unnecessary investigations and surgical intervention.

Value of diffusion weighted magnetic resonance imaging in diagnosis and characterization of scrotal abnormalities

BackgroundMRI of scrotal lesions represents an important diagnostic tool in the evaluation of scrotal diseases. Diffusion weighted (DW) MR imaging is a promising technique which proved to improve tissue characterization. AimTo assess the diagnostic value and role of DWMR imaging in the detection and characterization of scrotal lesions. ResultsA prospective study included 50 scrotal lesions (35 intratesticular and 15 extra testicular) with 50 normal testes used as control. DW sequences were obtained using a b factor of 0, 500 and 900s/mm22. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scrotal lesions was calculated. There was significant difference between apparent diffusion coefficient (ADC) values of testicular malignancies, normal testis and benign intratesticular lesions, and the ADC values of benign extra testicular lesions from those of normal epididymis. The overall accuracy of conventional imaging, DW imaging alone and DWMR combined with conventional sequences in the characterization of intratesticular lesions was 90%, 87% and 100%, respectively. ConclusionOur findings suggest that DWMR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.

Testicular, epididymal and adnexal ultrasound: a pictorial review. Part 2: Epididymal and Adnexal ultrasound

Ultrasound is the primary imaging modality for testicular and scrotal assessment, with no risk of ionising radiation to radiosensitive tissue. Scrotal ultrasound is reliable in distinguishing between intratesticular and extratesticular lesions and characterising them as cystic or solid. High-resolution images are reproducible with the added advantage of further characterisation by using colour Doppler assessment or Valsalva manoeuvres. This pictorial review covers the anatomy of the epididymis and adnexa, and describes the ultrasound appearances of a range of extratesticular pathologies including congenital, benign, post-surgical, infective and vascular conditions collated over a two-year period at our institution.

US in the assessment of acute scrotum

BackgroundThe acute scrotum is a medical emergency . The acute scrotum is defined as scrotal pain, swelling, and redness of acute onset. Scrotal abnormalities can be divided into three groups , which are extra-testicular lesion, intra-testicular lesion and trauma. This is a retrospective analysis of 164 ultrasound examination performed in patient arriving in the emergency room for scrotal pain.The objective of this article is to familiarize the reader with the US features of the most common and some of the least common scrotal lesions.MethodsBetween January 2008 and January 2010, 164 patients aged few month and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analyzed. The presentation symptoms including scrotal pain, painless scrotal mass or swelling, and trauma.ResultsOf 164 patients, 125 (76%) presented with scrotal pain, 31 (19%) had painless scrotal mass or swelling and 8 (5%) had trauma. Of the 125 patients with scrotal pain, 72 had infection,10 had testicular torsion, 8 had testicular trauma, 18 had varicocele, 20 had hydrocele, 5 had cryptorchidism, 5 had scrotal sac and groin metastases, and 2 had unremarkable results. In the 8 patients who had history of scrotal trauma, US detected testicular rupture in 1 patients, scrotal haematomas in 2 patients .Of the 19 patients who presented with painless scrotal mass or swelling, 1 6 had extra-testicular lesions and 3 had intra-testicular lesions. All the extra-testicular lesions were benign. Of the 3 intra-testicular lesions, one was due to tuberculosis epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcomaConclusionsUS provides excellent anatomic detail; when color Doppler and Power Doppler imaging are added, testicular perfusion can be assessed

Clinico-radiological and pathological evaluation of extra testicular scrotal lesions

Background:Scrotal ultrasound, though reliable in distinguishing between intratesticular and extratesticular lesions and characterizing them as cystic and solid, cannot distinguish benign from malignant pathology. Although fine needle aspiration cytology (FNAC) has proved to be of great diagnostic importance in testicular lesions, its scope in extratesticular lesions is largely unexplored.Aim:To evaluate extratesticular scrotal lesions cytologically and compare it with their clinical, radiological, and histological findings.Materials and Methods:Sixty five patients with extratesticular scrotal lesions were assessed clinically, radiologically, and cytologically. Histopathology was done in 45 cases where surgical exploration was undertaken. All the data were then analyzed and correlated.Results:Extratesticular lesions accounted for 72.2% of the scrotal swellings. Of these, the epididymis is most commonly involved (61.5% cases) with the commonest type of lesion being cystic (49.3% cases). Ultrasonography preferably with color doppler is highly useful for the evaluation of the scrotum. Apart from distinguishing extratesticular from testicular and cystic from solid lesions, it has an important role in identifying individual lesions, thus reducing the list of differential diagnosis. Fine needle aspiration cytology contributed to a definitive diagnosis in 47.7% cases. It helps classify cystic masses on the basis of their contents and defines the etiology of chronic inflammatory lesions, apart from corroborating with the clinico-radiological diagnosis. Histological evaluation was possible only in cases where surgery was performed and helps further define the diagnosis.Conclusion:Fine needle aspiration cytology is essentially non-traumatic and easy to carry out and should be a technique of choice for the study of scrotal pathology, main advantage being avoidance of delays in diagnosis.

Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results

Magnetic resonance (MR) imaging of the scrotum represents an important supplemental diagnostic tool in the evaluation of scrotal diseases. Diffusion-weighted (DW) MR imaging is a developing technique, proved to improve tissue characterization. We evaluated the feasibility and diagnostic performance of DW MR imaging in the detection and characterization of scrotal lesions. We retrospectively evaluated 31 scrotal lesions (23 intratesticular and 8 extratesticular) in 26 men. All MR examinations were performed on a 1.5-T unit, using a pelvic-phased array coil. DW sequences were obtained using a single shot, multislice spin echo planar diffusion pulse sequence and a b factor of 0 and 900 s mm(-2). The DW MR characteristics and the apparent diffusion coefficient (ADC) values of normal scrotal contents and scrotal diseases were evaluated. Comparison between the ADC values of normal scrotum, benign lesions and scrotal malignancies was performed. The accuracy of conventional sequences, DW images alone and DW imaging combined with conventional images in differentiating benign from malignant scrotal lesions was calculated. The ADC values of testicular malignancies were different from those of normal testis and benign intratesticular lesions, and the ADC values of benign extratesticular lesions from those of normal epididymis (P<0.05). The overall accuracy of conventional imaging, DW imaging alone and DW MR combined with conventional sequences in the characterization of intratesticular lesions was 91%, 87% and 100%, respectively. Our findings suggest that DW MR imaging and ADC values may provide valuable information in the diagnosis and characterization of scrotal diseases.

Benign non-cystic scrotal tumors and pseudotumors

There is a wide spectrum of benign, non-cystic scrotal lesions that show characteristic histo-morphology and natural history. While sonography is the preferred modality for the diagnosis of both testicular and extratesticular masses, MRI is used as a problem-solving modality when sonographic findings are inconclusive. This article reviews the cross-sectional imaging features of benign, non-cystic, intra- and extratesticular lesions. Definitive diagnosis of benign scrotal lesions may lead to conservative management including testicular preserving surgery.

Papillary Adenocarcinoma of Rete Testis Mimics Inflammatory Lump: A Case Report

We presented a rare extratesticular neoplasm, papillary adenocarcinoma of rete testis, which manifested variable symptoms and mimicked most frequently seen benign extratesticular lesions. Due to its rarity, the treatment is therefore uncertain. Our patient's clinical manifestations mimicked an inflammatory lump and underwent radical orchiectomy after pathological report had been confirmed. Unlike other reports, our patient survives and has a good outcome. No definite predictor and tumor marker can be used to define the prognosis. Early diagnosis and surgical treatment may have a good outcome.

US of the Tunica Vaginalis Testis: Anatomic Relationships and Pathologic Conditions

Extratesticular lesions are common incidental findings at ultrasonography (US) among men and boys. Most lesions originate from or depend on the tunica vaginalis, a mesothelium-lined sac with a visceral layer and a parietal layer. The tunica vaginalis is formed when the superior portion of the processus vaginalis closes during embryologic development. Abnormal closure of the processus vaginalis leads to congenital anomalies of the tunica vaginalis, such as complete or partial patency of the processus vaginalis, spermatic cord hydrocele, and inguinoscrotal hernia. The proximity of the visceral layer to the testis explains the reactive involvement seen in epididymo-orchitis, with resultant pyocele or abscess formation. The tunica vaginalis also may be affected by inflammatory and traumatic disorders such as scrotal calculi, fibrous pseudotumor, or hematocele. These lesions manifest as solid or heterogeneous tumorlike masses. Lesions of mesothelial origin, such as adenomatoid tumor, tunica cyst, and mesothelioma, may involve the tunica vaginalis. Entrapped mesenchymal cells can lead to lipoma, leiomyoma, or sarcoma, although these tumors are uncommon in the tunica vaginalis. US is not useful for differentiating between benign and malignant tumors; however, some characteristic findings may help in planning the best surgical approach. Knowledge of the embryologic development, anatomic relationships, and pathologic disorders of the tunica vaginalis is essential to narrow the differential diagnosis of an extratesticular lesion. In most cases, US findings in combination with clinical assessment can indicate whether nonsurgical management or testis-sparing surgery is warranted.

Role of ultrasonography in diagnosis of scrotal disorders: a review of 110 cases

ObjectiveTo determine the role of ultrasonography in diagnosis of scrotal disorders.Materials and methodsThis study was carried out after institutional review board approval was granted, and informed consent was waived. Between January 2005 and January 2007, 144 patients aged 12 years and older with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analysed. The presentation symptoms were divided into three groups including scrotal pain, painless scrotal mass or swelling, and others. Surgery was performed in 32 patients.ResultsOf 144 patients, 110 had clinical follow-up and constituted the material of this study. The patients ranged in age from 13 to 82 years (mean 38.6 years). Of 110 patients, 84 (76.4%) presented with scrotal pain, 21 (19%) had painless scrotal mass or swelling and 5 (4.5%) had other symptoms. Of the 84 patients with scrotal pain, 52 had infection, 4 had testicular torsion, 7 had testicular trauma, 10 had varicocele, 4 had hydrocele, 1 had epididymal cyst, 1 had scrotal sac and groin metastases, and 5 had unremarkable results. Of the 21 patients who presented with painless scrotal mass or swelling, 18 had extratesticular lesions and 3 had intratesticular lesions. All the extratesticular lesions were benign. Of the 3 intratesticular lesions, one was due to tuberculous epididymo-orchitis, one was non-Hodgkin’s lymphoma, and one was metastasis from liposarcoma. Of the 5 patients who presented with other symptoms, 4 had undescended testes, and 1 had gynaecomastia. US gave incorrect diagnosis in only one patient with scrotal pain.ConclusionThe most common cause of scrotal pain was infection. The most common cause of scrotal mass or swelling was extratesticular lesion. US plays an important role in the diagnosis of scrotal disorders and in planning for proper management.

Scrotal masses : radiologic pathologic correlation

The attendee will learn about the most common intratesticular masses and their sonographic features with attention to differentiating features. Specifie leave alone lesions (tubular ectasia and epidermoid cysts) which may be mistaken for testicular neoplasms will be described. Testicular microlifhiasis will be reviewed. In addition, the attendee will be shown the spectrum of paratesticular disorders and their differentiating characteristics. Solid intratesticular masses are considered malignant until proven otherwise and surgery is performed for diagnosis and treatment. Tubular ectasia and epidermoid cysts are benign lesions which may be mistaken for testicular neoplasms. With an onion skin lesion, the urologist should be alerted to the possibility of an epidermoid cyst so that more conservative surgery can be performed. While solid and cystic extratesticular lesions are usually benign, radiologists should be aware of the more common malignancies. The first line imaging test for a scrotal mass is ultrasound, which can readily determine if the mass is intratesticular or extratesticular. Most intratesticular solid lesions are malignant and most extratesticular lesions are non neoplastic. This lecture will describe the sonographic findings of intratesticular and extratesticular masses and lesions with correlative imaging modalities when these add diagnostic value.