Table 1 Clinical and radiological findings of tumor mimickers in the male genital tract (part-1)
From: Identifying the deceiver: the non-neoplastic mimickers of genital system neoplasms
Disease | Imaging findings | Auxiliary clinical information |
|---|---|---|
Chronic bacterial prostatitis | Linear, less mass-forming lesions with ill-defined borders. Lobar distribution or diffuse involvement of the peripheral zone. Low T2 signal. Tends to have less diffusion restriction than neoplasms. Early arterial enhancement may be seen | Systemic symptoms are not expected. Fluctuant PSA elevation, decrease in PSA levels after antibiotic treatment. In challenging cases, targeted prostate biopsy may be needed |
Prostatic tuberculosis | Nodular form: T1-isointense, T2-hypointense multiple nodules of varying sizes with restricted diffusion. Extraprostatic extension is mostly not expected Diffuse form: More common form. Restricted diffusion may be seen | History of systemic tuberculosis or intravesical BCG instillation Targeted prostate biopsy is required for definitive diagnosis |
Prostatic involvement of granulomatous with polyangiitis | Low T2 signal. Low ADC values. Can simulate prostate cancer and prostatic abscesses | Medical history for granulomatous polyangiitis. Histopathological examination is needed |
IgG4-related prostatitis | There is not much radiological information in the literature due to the rarity of the disease. FDG-avid lesions | Rare. History of IgG4-RD and accompanying organ involvements may be clue |
Mumps orchitis | Acute phase: Enlarged testis with increased vascularity. Scrotal wall thickening and epididymal involvement are common Chronic phase: Atrophy with parenchymal heterogeneity | Seen in pubertal and postpubertal period. Infertility. Medical history for mumps Negative serum tumor markers may be helpful |
Tuberculous orchitis | Generally coexists with epididymal involvement (heterogeneously enlarged epididymis) US: Diffusely enlarged homogeneous/heterogeneous hypoechoic testis or multiple small-sized hypoechoic nodules. Scrotal abscesses, sinus tracts, skin thickening, complex hydrocele, calcification MR: Mostly seen as T2 hypointense, T1 hyperintense lesions with variable enhancement | Isolated testicular involvement is rare. History of tuberculosis or immunosuppression may be suggestive. Typical clinical findings of acute infection are not expected. Microbiological and histopathological examinations are required for definitive diagnosis |
Xanthogranulomatous orchitis | Large, heterogeneous masses without apparent vascularity. Parenchymal calcifications, cystic changes and epididymal involvement may also accompany | Very rare. Increased coexistence with diabetes. Urine cultures may grow E. coli and P. aeruginosa |
Testicular malakoplakia | Unilateral testicular enlargement, heterogeneous mass with cystic areas and intratesticular abscesses may be seen | Rare inflammatory disease. May present with symptoms related to epididymoorchitis. Histopathological examination is required for definitive diagnosis |
Testicular abscess | US: Hypoechoic lesions with ill-defined “shaggy” walls. Increased perilesional and absent intralesional vascularity. May appear solid-like, and mimic testicular neoplasms MRI: Contrast enhancing wall and intralesional non-enhancing component | May be secondary to the bacterial epididymo-orchitis, pre-exiting hematomas or infarct areas. Clinical history, symptoms and acute phase reactants may be helpful Percutaneous FNAB or even surgery may be required |
Testicular necrotising vasculitis | US: Heterogeneous hypoechoic focal parenchymal lesion with variable internal vascularity Multifocal involvement may also be seen | History of polyarteritis nodosa (as the most common), granulomatosis with polyangiitis, Churg-Strauss syndrome, giant cell arteritis, Henoch-Schonlein purpura |
Testicular involvement in IgG4-RD | There is not much information in the literature due to the rarity of the disease. In one case report, hypoechoic focal mass is defined | Extremely rare. History of IgG4-RD and accompanying organ involvements |
Testicular sarcoidosis | Multiple hypoechoic testicular lesions with/without epididymal involvement. May also present with solitary mass. Internal vascularity is not expected on color Doppler US | Uncommon. Patient demographics. History of sarcoidosis. Elevated serum ACE levels may be helpful |