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Intratesticular masses are common and widely presumed to be malignant until proven otherwise. The most common testicular tumors include germ cell and non-germ cell tumors, typically presenting as solitary, unilateral lesions. Some testicular tumors present with bilateral involvement, the most common of which is Leydig cell hyperplasia, with case reports of other synchronous and metachronous bilateral testicular tumors in the literature. Testicular plasmacytomas in the setting of multiple myeloma have been reported as well but are uncommon. Bilateral testicular plasmacytomas are extremely rare. We present sonographic features, with histopathologic correlation in a 71-year-old man who presented with scrotal pain and was found to have bilateral testicular hypoechoic masses confirmed to be plasmacytomas.

Teratomatous tissue is commonly seen in a variety of malignant testicular tumors, and while the exact determination of testicular tumor subtypes heavily relies on pathologic diagnosis, ultrasound remains the gold standard in the initial evaluation of such entities. The major groups of testicular tumors may demonstrate characteristic features which can point the radiologist toward a more pruned differential diagnosis. While it is important for the interpreting physician to be aware of such features, it is of equal necessity that they are aware of potential visual phenomena, such as acoustic streaming in the diagnosis of testicular tumors. We present a case of a testicular teratoma with acoustic streaming. This testicular tumor was confirmed to be predominantly a teratoma with a minimal element of seminoma on histopathology.