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Pelvis » Scrotum And Testicles

Testicular Seminoma

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Author(s) :

Danilo Sirigu, MD

Presentation 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.

Caption: Longitudinal left testicle

Description: 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.

Caption: Longitudinal color and power Doppler left testis

Description: Color and power Doppler shows increased vascularity in the testicular mass.

Caption: Gross specimen

Description: 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.

Differential Diagnosis Neoplasm
Focal orchitis
Hematoma

Final Diagnosis Testicular Seminoma

Discussion 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.

Case References •   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

Technical Details This case provided courtesy Dr. Danilo Sirigu and the web site "EcoMovies". To view a wide range of high-quality video cases please visit http://www.ecomovies.it

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