Table 2 Clinical and radiological findings of tumor mimickers in the male genital tract (part-2)
From: Identifying the deceiver: the non-neoplastic mimickers of genital system neoplasms
Disease | Imaging findings | Auxiliary clinical information |
|---|---|---|
Testicular hematoma | Acute phase (US): Iso-hyperechoic mass with no apparent internal vascularity Resolution phase (US): Hypoechoic lesion with gradual decrease in size Single or multiple lesions can be seen. Concomitant imaging findings of scrotal trauma such as hematocele MRI: T1 hyperintensity (subacute phase), T2 hypointensity (chronic phase), no internal enhancement | History of trauma is suggestive. Resolution during follow-up is expected. May complicate with testicular necrosis, compression atrophy or secondary infections. Incidental diagnosis of testicular tumors after scrotal trauma should also be kept in mind |
Segmental testicular infarction | US: Solid-appearing wedge-shaped heterogeneous lesion without apparent vascularity MRI: Well-defined heterogeneous parenchymal areas with absence of enhancement. Hemorrhagic changes may be seen as T1 hyperintense areas. Rim enhancement may be observed | Testicular pain. Young adults. Underlying causes may be infection, trauma, vasculitis, or hematologic diseases. Follow-up imaging is required to rule out malignancy |
Leydig’s cell hyperplasia | US: Small, multifocal, frequently bilateral parenchymal nodules with internal vascularity and variable echogenicity MRI: T2 hypointense nodules with avid contrast enhancement | Rare. Mostly seen in asymptomatic patients with normal serum tumor markers. May coexist with Klinefelter syndrome |
Testicular adrenal rests | US: Bilateral, multiple, well-defined hypoechoic nodular lesions with no apparent mass effect located in the mediastinum testis. Tend to appear as heterogeneous hyperechoic masses as they get larger. Internal vascularity is variable. Posterior acousting shadowing may be observed MR: T1 iso-hyperintense, T2-hypointense lesions with avid enhancement | History of congenital adrenal hyperplasia or Cushing’s syndrome. May cause infertility. Regression after glucocorticoid therapy can be seen |
Tubular ectasia of rete testis | US: Multiple cystic-tubular anechoic structures replacing the mediastinum testis. Internal vascularity, calcification, presence of solid component are not expected. Bilateral involvement is common MRI: T2-hyperintense cystic structure with no internal enhancement | Over the age of 45. History of previous scrotal surgery and vasectomy. It should be kept in mind that testicular tumors may also cause post-obstructive rete testis dilation |
Cystic dysplasia of rete testis | Unilateral, multicystic lesion compressing the surrounding parenchyma in the mediastinum testis It may be useful to control ipsilateral renal anomalies such as renal agenesis or multicystic dysplastic kidney | Seen in the pediatric age group. Unilateral painless scrotal swelling. May coexist with ipsilateral renal anomalies. Testicular compression atrophy may develop Negative serum tumor markers |
Paratesticular inflammatory pseudotumor | US: Paratesticular lesions with variable echogenicity and mild-to-moderate internal vascularity. Posterior acoustic shadowing and intralesional calcifications may be seen MRI: T1 and T2 hypointense lesions with gradual contrast enhancement | Uncommon. May be related to previous surgery, trauma, infection or inflammation. Could be secondary to the IgG4-RD |
Paratesticular tuberculoma | US: Well-circumscribed hypoechoic lesions with calcifications and mild internal vascularity. Extension to the scrotal wall or testicular parenchyma may be seen MRI: T1-hyperintense and T2-hypointense paratesticular lesions | Rare. History of immunosuppression or intravesical BCG instillation. Histopathological examination is required for definitive diagnosis |
Polyorchidism | US: Solid nodular lesion with similar echogenicity and echotexture to the normal testes MRI: Homogeneous solid lesions with intermediate T1 and high T2 signal intensity similar to testes | Rare congenital anomaly. More common on the-left side. Extra testis is smaller than normal testes, and mostly located within the scrotum adjacent to the lower pole |
Splenogonadal fusion | Continuous form: Long parenchymal or fibrous cord extending from the spleen to the testis Discontinuous form: Homogeneous solid iso-hypoechoic lesion with internal vascularity In case of suspicion, Tc99m-sulfur colloid scintigraphy can help detection and prevent orchiectomy | Rare congenital anomaly. More common on the left-side. Commonly associated with inguinal hernia and cryptorchidism |