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Scrotum And Testicles
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Danilo Sirigu, MD
A 37-year-old man presents with a complaint of a painless mass in his left testicle. On examination there is testicular enlargement on the left.
Longitudinal left testicle
The testis is mostly replaced by a solid mass with poorly defined margins and heterogeneous echo pattern with infiltrating aspect. A rim of normal testicular parenchyma surrounds the mass.
Longitudinal color and power Doppler left testis
Color and power Doppler shows increased vascularity in the testicular mass.
The gross specimen shows an infiltrating mass that mostly replaces the normal testis. These tumors typically have a cream to yellow cut surface with a fleshy consistency.
In an adult male without symptoms of pain or local tenderness, and no history of trauma, the primary diagnosis of a solid mass in the testicle is testicular neoplasm.
The pathologic classification of testicular tumors includes germ cell tumors (seminoma and nonsematomatous tumors), stromal tumors, mixed germ cell-stromal tumors, and metastatic neoplasms.
Seminomas are the most common testicular neoplasm in adults and account for 40 to 50% of germ cell tumors, with a peak incidence in the 4th and 5th decades. Seminomas have the most favorable prognosis of all testicular malignancies and have a high rate of successful treatment with radiation therapy and chemotherapy.
The sonographic features of testicular neoplasms are varied. Pure seminomas are typically homogeneous hypoechoic masses without calcifications. A more heterogeneous appearance, rarely with necrosis is occasionally seen. In contrast to pure seminomas, other germ cell tumors (which often contain seminomatous components) tend to be much more heterogeneous and often contain cystic areas and coarse calcifications.
Stromal tumors are uncommon, accounting for 3 to 6% of testicular neoplasms. Sonographically these tumors are usually present as homogenous hypoechoic masses, often multiple and bilateral. Larger masses may develop a more heterogeneous appearance as a result of hemorrhage and necrosis.
Leukemia, lymphoma, and metastases may also present as testicular masses. The sonographic appearance of these lesions overlaps with that of primary testicular neoplasms, and consideration of the patient’s history becomes important in the evaluation of testicular masses in patients with other malignancy.
Most testicular neoplasms exhibit flow with color Doppler, and Doppler has not been shown to be useful in differentiation of different types of neoplasm.
• Woodward PJ, Sohaey R, O’Donoghue MJ, Green DE. Tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. RadioGraphics 2002; 22:189–216.
• Howlett DC, Marchbank ND, Sallomi DF. Ultrasound of the testis. Clin Radiol 2000; 55:595–601.
• Classen J, Souchon R, Hehr T, Bamberg M. Treatment of early stage testicular seminoma. J Cancer Res Clin Oncol 2001; 127:475–481
• Ueno T, Tanaka YO, Nagata M, et al. Spectrum of germ cell tumors: from head to toe. RadioGraphics 2004; 24:387–404.
• Vikram S. Dogra, MD, Ronald H. Gottlieb, MD,et al-; Sonography of the Scrotum ; Radiology 2003;227:18-36
This case provided courtesy Dr. Danilo Sirigu and the web site "EcoMovies". To view a wide range of high-quality video cases please visit
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Pelvis >> Scrotum And Testicles
Uncomplicated acute epididymo-orchitis
A 25-year-old male, presents with a 1-day history of acute left-sided scrotal pain. He has no history of trauma.
Acute right epididymitis
A 25 year old male presents with a 1 day history of acute right-sided scrotal pain. He has no history of trauma.
A 25 year old man presents with a dull pain in the left scrotum. There is no history of trauma or fever.
Acute left epididymitis
A 25 year old male, presents with a one day history of acute left-sided scrotal pain. He has no history of trauma.
Complicated acute epididymo-orchitis: with an epididymal abscess
A young adult male presents with a one day history of acute right scrotal pain. There is no history of trauma.
Germ cell tumor testis: NSGCT- embryonal carcinoma
A 32 year old male presents with painless left testicular swelling of 2 months duration. There is no history of trauma or fever.
Germ cell tumor testis:Seminoma
A 30 year old man presents with a painless left testicular swelling. A scrotal ultrasound was performed.
Left testicular and epididymal torsion
A 25 year old man presents with severe, acute left scrotal pain of a few hours duration. The onset was sudden and not preceded by trauma. A scrotal ultrasound was performed.
A 60 year old man presents with bilateral palpable scrotal masses. He had a vasectomy performed 25 years ago. A scrotal ultrasound was performed.
Epidermoid cyst of the testicle
A 19 year old male presented with a unilateral non tender testicular mass. The patient gives a history of gradual increase in size of the mass. A scrotal ultrasound was performed.
Complicated acute epididymo-orchitis: with testicular infarct
A 30 year old male presented with severe, acute pain in the left scrotum. A scrotal ultrasound was performed.
Germ cell tumor testis: multifocal NSGCT
A 22 year old male presents with left testicular firmness. He has no history of trauma. A scrotal ultrasound was performed.
Tunica albuginea cyst
A 32 year old male presented for a follow up testicular ultrasound. He had an initial scan performed for a palpable left scrotal swelling.
A 32 year old man presented for infertility. Semen analysis revealed oligo-asthenospermia. A scrotal and pelvic scan was performed.
Traumatic testicular rupture with cord hematoma
A young man fell into a well and sustained severe acute blunt injury to the right inguinal region. Clinically he presented with a grossly edematous penis and scrotum. The swelling extended up to ...
A 50 year old doctor with history of repeated self- limiting attacks of excruciating/shooting pain localized to the left testis. The pain subsides after a minute or two. He has no other symptoms
Benign testicular calcification
A 30 year old man presents for infertility evaluation. A scrotal ultrasound was performed.
Scrotal sac hematoma
These are serial ultrasound scans of a young man with a history of trauma to the scrotum.
Leiomyoma of the epididymis
A 59 year-old man presents with two palpable masses in right hemiscrotum. An ultrasound of the scrotum was performed.
Right undescended testis
This is a scan in a 6-month-old male child with an empty right scrotal sac. An ultrasound was performed to locate the undescended testis.
This is an incidental finding in a 35-year-old man with dull pain in the scrotum.
Atrophic right testis
This was a follow-up scan in a 35-year-old man with a previous history of right orchitis.
This is a scrotal ultrasound scan in a man with complaints of hematuria.
Cystic dilatation of the Rete Testis
A 51-year-old male presents with left scrotal enlargement.
Leydig Cell tumor
An ultrasound evaluation for varicocele was performed on a 10 year old male, with normal blood sub-beta and alpha fetoproteins markers.
Partial Testicular Torsion
A 20 year old male presented to the emergency room with severe left scrotal pain.
Acute idiopathic scrotal edema
5 year old boy with a red painful swollen scrotum
Neonatal extravaginal testicular torsion
Neonate with a scrotal swelling on the right side
This 26 YO male presented for a scrotal ultrasound as an outpatient with no specific medical history on the referral. On questioning he stated that one side of his abdomen was harder and more ...
Congenital Adrenal Hyperplasia
42 year old male presented with enlargement of both testicles
Leydig Cell Tumor of the Testicle
This is a 35 year-old male patient who presented for presurgical assessment of left Inguinal hernia. Scrotal and inguinal ultrasound was requested.
Bilateral Extravaginal Testicular Torsion
Clinical examination of the neonate revealed a swollen, red and firm scrotum bilaterally. Neither testicle could be individually palpated. No cremasteric reflex observed. No trauma to scrotum ...
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