Fig. 23

Bilateral paratesticular tuberculomas. A 63-year-old male with known metastatic renal cell carcinoma being treated with chemotherapy and bladder cancer treated with intravesical BCG therapy now presenting with bilateral scrotal masses. a Gray scale US image of the right hemiscrotum shows an extratesticular hypoechoic mass (arrows) adjacent to the lower pole of the right testis (asterisk). Intralesional calcifications were also noted (arrowheads). On color Doppler US, there was a mild vascularity within this lesion. b Gray scale US image of the left hemiscrotum shows a large heterogeneous hypoechoic mass (arrows) adjacent to the lower pole of the left testis (asterisk), compressing the testicular parenchyma and extending into the testis and scrotal wall (arrowheads). c Color Doppler US of the left hemiscrotal lesion reveals widespread internal vascularity. Imaging findings were considered suspicious for malignant neoplastic processes, and bilateral inguinal orchiectomy performed. Extensive inflammation with conglomerate caseating granulomas and dystrophic calcifications were seen on the pathologic specimens. Histopathological examination confirmed paratesticular tuberculoma on the right side and paratesticular, intratesticular and scrotal tuberculomas on the left side