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Pelvis » Scrotum And Testicles
Germ cell tumor testis:Seminoma
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Author(s) :
Chaitali Shah, FRCR
Presentation A 30 year old man presents with a painless left testicular swelling. A scrotal ultrasound was performed.
Caption: Sagittal sonogram of the left testis.
Description: A parasagittal plane at the lateral margin of the left testis demonstrants an irregularly marginated hypoechoic lesion. A few bright echogenic foci are visualized within the hypoechoic area.
Caption: Transverse sonogram of the left scrotum.
Description: In the midline two hypoechoic intratesticular lesions are seen. Both appear solid and mildly lobulated. The larger mass appears homogeneous,shows strongly enhanced sound transmission possibly suggesting a rapidly growing, highly cellular lesion.
Caption: Transverse midline color Doppler image.
Description: Hypervascularity of the left testis becomes obvious in comparison to the normal right testis. The hypervascularity is mainly associated with the central lesion.
Caption: Transverse sonogram of the left testis.
Description: More medially the mases are less well-seen and less distinctly marginated. Additional echogenic foci, including a large one that shadows, are seen scattered throughout the testicular parenchyma. A small hydrocele is demonstrated.
Caption: Color Doppler of the left testis.
Description: The smaller of the two masses appears hypervascular as compared to the rest of the testicular parenchyma.
Differential Diagnosis Testicular lymphoma, primary malignancy, leukemia or metastases with testicular microlithiasis
Final Diagnosis Left primary testicular malignancy with microlithasis
Discussion This is an exemplenary case that demonstrates the appearance of solid tumors in the testis.

The larger tumor in this case here shows the typical features of a seminoma. Testicular seminomas are uniformly cellular on histology and therefore exhibit a homogeneous echotexture on ultrasound. Areas of hemorrhage and necrosis are not very commonly seen with seminomas. On Doppler studies, these masses show increased internal vascularity.

The smaller tumor seen here shows the features of a non-germ cell tumor and is more likely to be one [click here to read about features of NSGCT]
Follow Up A left orchiectomy was performed. Histopathology revealed the larger tumor to be a seminoma, while the smaller tumor showed features of embryonal carcinoma.
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