Dr lokesh kumar meena

Dept of Radiodignosis MGIMS ,

Sevagram wardha

Incidence Testicular tumors are rare.

1 – 2 % of all malignant tumors.

Most common malignancy in men in the 15 to 35 year age group.

Benign lesions represent a greater percentage of cases in children than in adults.

CLASSIFICATION I. Primary Neoplasms of Testis.

A. Germ Cell Tumor.

B. Non-Germ Cell Tumor .

II. Secondary Neoplasms.

III. Paratesticular Tumors.

Germ cell tumors 1. Seminomas - 40% (a) Classic Typical Seminoma (b) Anaplastic Seminoma (c) Spermatocytic Seminoma

2. Embryonal Carcinoma - 20 - 25%

3. Teratoma - 25 - 35% (a) Mature (b) Immature

4. Choriocarcinoma - 1%

5. Yolk Sac Tumour

Sex cord/ gonadal stromal tumors (5 to 10% )

1. Specialized gonadal stromal tumor(a) Leydig cell tumor(b) sertoli cell tumor

2. Gonadoblastoma

3. Miscellaneous Neoplasms(a) Carcinoid tumor(b) Tumors of ovarian epithelial sub

types

II. SECONDARY NEOPLASMS OF TESTIS A. Reticuloendothelial Neoplasms

B. Metastases

III.PARATESTICULAR NEOPLASMS A. Adenomatoid

B. Cystadenoma of Epididymis

C. Desmoplastic small round cell tumor

D. Mesothelioma

E. Melanotic neuroectodermal

Classic Seminoma 82-85% of seminomas

Mostly men in 30’s

Rarely occurs in adolescents or infants

Clear cytoplasm, dense nucleus

Synctiotrophoblasts in 10-15% Elevated B-HCG in 10%

hCG up to 500 ng/ml

Lymphocytes in 20%

Seminoma imaging…. microcalcification

A large mass in the testes. Mass is markedly hypoechoic and inhomogenous with irregular, poorly defined margins.

On color doppler imaging, the mass shows increased vascularity and feeding vessels.

These ultrasound images suggest a diagnosis of Germ cell tumour of the testes, probably a seminoma.

Seminoma. Focal increase in vascular signal with irregularbranching.

Seminoma. (a) right testis demonstrates a hydrocele(arrow), diffuse microlithiasis (arrowheads), and a homogeneous mass with no definite normal testicular parenchyma. (b) Doppler US image shows a generalized increase in testicular vascular flow

This is another seminoma. On sonograms, a seminoma is often more homogeneous than nonseminomatous cancers

This is a seminoma. Sometimes epididymalinvasion can be noted on sonograms.

Non-seminomatous germ cell tumor.

USG shows a focal lesion having a heterogenous echotexture with solid and cystic components (asterix)

heterogeneous echogenicity, and small cystic areas

Mixed germ cell tumor composed of two or more types of germ cell tumour.

They are considered to be part of non-seminomatousgerm cell tumours.

Overall they account for over 10% of all testicular cancers

Mixed germ cell tumor

Partly solid and partly cystic testicular mass that proved to be a mixed germ cell tumor

Mixed germ cell tumor

Heterogeneous,predominantly hypoechoic mass, with scattered areas of hypoechogenicity (arrowheads). Normal testicular parenchyma is compressed peripherally by the tumor and contains diffuse microlithiasis (arrow).(b) Doppler US image shows normal peripheral vascularity with absence of central flow.

This is a mixed germ cell tumor. Testicular cancers can be ill-defined and subtle.

Malignant teratoma. A well defined hypoechoic mass (open arrows) with a peripheral focus of calcification (curved arrow).

Embryonal Carcinoma

Embryonal cell carcinoma with a vascularized tumor with calcifications

Testicular choriocarcinoma

Choriocarcinoma in a 16-year-old boy who presented with enlarged inguinal lymph nodes. US image demonstrates a mixed solid and cystic mass in the left testis (arrowheads).

“Testicular choriocarcinoma with cannon-ball metastases in lung.”

Dilated rete testes can mimic a cystic neoplasm, but they are usually elongated on orthogonal views and clearly located in the testicular mediastinum.

Testicular sarcoid can mimic seminoma when it presents as a solid-appearing testicular mas

a 27-year-old man with testicular discomfort. A, Sonogram showing a homogeneously hypoechoic tumor in the anterior aspect of the testis.B, Power Doppler image showing circumferential blood flow around the tumor.

Leydig Cell Tumors of the Testis

Lymphoma and leukaemia most common metastatic testicular tumours.

Primary testicular leukaemia is rare, but leukaemic infiltration is not uncommon in children. The testis may be a site for leukaemic cells during chemotherapy.

The most frequent sonographic appearance is diffuse enlargement with hypoechogenicity. Hypervascularity is typical.

Focal well-marginated masses have been described in chronic lymphocytic leukaemia.

left testis is large and hypoechoic compared to the normal right testis.

Epididymitis. Image of the testis demonstrates enlarged, thickened, and heterogeneous epididymis. Doppler shows an increase in vascular flow.

Testicular torsion

(a) Longitudinal

US scan of the right hemiscrotum shows a round supratesticular mass (M), which represents an edematous spermatic cord. There are several anechoic structures (arrowheads) within the mass, which probably represent obstructed and dilated lymphatic vessels.

(b) Bilateral transverse color Doppler images show no color flow signals in the right testis, which is enlarged and has heterogeneous echogenicity. Reactive hydrocele (h) and thickening of the scrotal wall.

Varicocele. Multiple sepiginous ,tubular hypoechic structure of

diameter more then 2mm.

Generally seen posterior or lateral to the testis.

More common on left side b/c of longer course of left testicular vein.

Grading on USG (on valsalva)

Grade 1 : 2-2.5 mm ,grade 2 : 2.5-3mm, grade 3 : 3mm

Varicocele. Color Doppler demonstrates multiple serpentine vascular channels within the scrotum, which become more prominent after Valsalva maneuver.

Orchitis.

Color Doppler of the scrotum reveals-hypoechoic testis with -markedly increased vascularity,

compared with normal echogenic testis showing normal vascularity.

Hematocele. One week following a direct blow to the scrotum, US

reveals complex fluid with septation and debris indicative of hematocele in the cavity of the tunica vaginalis.

The scrotal wall is thickened.

Septations and loculations are common

Pyocele has a similar appearance.

Anechoic fluid without septations is characteristic of hydrocele .

Bloody fluid contains low-intensity echoes that often layer.

testis is swollen and has markedly heterogeneous echogenicity. A central complex fluid collection (arrow) was proven to be an abscess

Testicular Abscess

Spermatocele

- Found only at the superior pole of the testis adjacent to the mediastinum.

- Oval/round cystic mass with echogenic, often layering, fluid.

- May appear solid if completely filled with echogenic fluid.

- Septations are common.

- Solitary, with size up to 2-3-cm diameter.

Large cystic extratesticular mass (S) with septations and debris above the upper pole of the testis (T) is characteristic for spermatocel