Beyond germ cell tumors, unusual testicular and extra-testicular masses and mass-like lesions: MRI and US pictorial review

AlGhamdi, Maram; AlYami, Muath; Faqeeh, Samah; AlKubeyyer, Bassam; AlShabyli, Nayef; Alayed, Abdullah

doi:10.1016/j.clinimag.2020.12.033

Cited by 4 publications

(12 citation statements)

References 38 publications

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“…The literature search found a total of 1106 articles (tumors, n = 584; acute scrotum, n = 193; undescended testes, n = 178; and infertility, n = 151). Ultimately, 83 articles were deemed relevant and used as the literature basis of this review (tumors, n = 50; acute scrotum, n = 6; undescended testes, n = 7; and infertility, n = 20) 6–9,13,24–33,35,43,48–110 . The flow chart of the selection process is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Scrotal mpMRI is highly recommended for the characterization of intratesticular lesions, in cases of equivocal US findings 24 . MRI is highly sensitive in the characterization of benign intratesticular lesions, by depicting the presence of fluid, fat, fibrous tissue, blood products, myxoid, and granulation tissue 6–9,11,12,14,24–30,33–37,42,48,50–53,56 . The overall accuracy of MRI in the characterization of benign testicular diseases has been reported 87.5%, and the NPV 100% 48 .…”

Section: Resultsmentioning

confidence: 99%

“…However, the results are controversial. For example, some researchers have reported that SARS-CoV-2 was not detected in the male reproductive tract, [25][26][27][28][29][30][31][32][33][34] while others reported that SARS-CoV-2 RNA was found in the semen or testes of COVID-19 patients. 35,36 There are also unknown factors regarding COVID-19 and male reproduction.…”

Section: Introductionmentioning

confidence: 99%

“…Multiparametric MRI (mpMRI) of the scrotum has emerged as a valuable supplemental technique for the investigation of scrotal pathology 7–9,11,12,15,24–46 . Scrotal MRI due to the wide field of view and multiplanar capabilities depicts in excellent anatomic detail both testes, epididymides, spermatic cords, and inguinal regions.…”

Section: Introductionmentioning

confidence: 99%

“…Scrotal MRI allows differentiation between intratesticular and paratesticular lesions and accurate tissue characterization, by showing the presence of fat, hemorrhage, fibrosis, fluid content, and contrast‐enhancing tissue. MRI findings may narrow differential diagnosis, helping in planning more precise treatment strategies and reducing the need of unnecessary surgical explorations 7–9,11,12,15,24–46 …”

Section: Introductionmentioning

confidence: 99%

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When to ask for an MRI of the scrotum

et al. 2021

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Background: Multiparametric MRI (mpMRI) of the scrotum has been established as a useful second-line diagnostic tool for the investigation of scrotal diseases. Recently, recommendations on clinical indications for scrotal MRI were issued by the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology. Objective: To update current research on when to ask for an MRI of the scrotum. Methods: PubMed database was searched for original articles and reviews published during 2010-2021.Results: Eighty-three articles fulfilled the search criteria. Scrotal MRI is mainly recommended after inconclusive US findings or inconsistent with the clinical examination and should be asked in the following cases: differentiation between intratesticular and paratesticular lesions (in rare cases of uncertain US findings), characterization of paratesticular and intratesticular lesions (when US findings are indeterminate), discrimination between germ cell and sex cord-stromal testicular tumors, local staging of testicular malignancies (in patients planned for testis-sparing surgery), differentiation between seminomas and non-seminomatous tumors (when immediate chemotherapy is planned and orchiectomy is delayed), assessment of acute scrotum and scrotal trauma (rarely needed, in cases of non-diagnostic US findings) and detection and localization of undescended testes (in cases of inconlusive US findings). Although preliminary data show promising results in the evaluation of male infertility, no established role for mpMRI still exists. Conclusion:Multiparametric MRI of the scrotum, by assessing morphologic and functional data represents a valuable problem-solving tool, helping to improve our understanding on the nature of scrotal pathology and the process of spermatogenesis. The technique may improve patient care and reduce the number of unnecessary surgical procedures.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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When to ask for an MRI of the scrotum

et al. 2021

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Ewing’s sarcoma of the male external genitalia: a case report and review of the literature

et al. 2022

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Background Ewing’s sarcoma (ES) within the genitourinary tract are relatively unheard of and those within the external male genitalia are even rarer. To our knowledge, this is the first known case of primary ES within the paratesticular region in an adult. Case presentation We present a case of a 24-year-old man with a right sided testicular mass on examination that was initially characterized as an adenomatoid tumor on ultrasound. After the patient was lost to follow up over the course of 9 months, the testicular mass grew significantly and was excised with pathology revealing primary paratesticular Ewing’s sarcoma. This rare case emphasizes the importance of elucidating between the broad differentials of paratesticular masses, including the rare presentation of primary ES and adds a review of the literature of ES in the external male genitalia. Conclusions Rare differentials such as this case should be considered in patients with paratesticular masses. Further diagnostic and management algorithms for extraosseous Ewing Sarcoma, particularly in the adult population, are warranted.

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Testicular Germ Cell Tumours—The Role of Conventional Ultrasound

Belfield

Findlay-Line

2022

Cancers

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Testicular tumours are the most common tumours found in young males and germ cell tumours account for 95% of testicular tumours. Ultrasound is the first-line radiological investigation for imaging of the testis. This article outlines how to undertake an ultrasound examination, including optimal patient position, scanning technique and imaging parameters. Classification of germ cell tumours is provided, and salient imaging features of different tumours are described. Difficulties and pitfalls of ultrasound are described, including tumours found after a trauma presentation, orchitis causing diagnostic difficulties and imaging of small testicular lesions. Other uses of ultrasound are outlined, including looking for a primary testicular tumour following the discovery of retroperitoneal lymph nodes, imaging when tumour-makers increase, local recurrence in the scrotum, and for solid organ biopsy in metastatic disease. Conclusion: Ultrasound remains the first-line of investigation for imaging of the testis, and conventional ultrasound still plays a large role in imaging. On ultrasound alone, accurate morphological characterisation of tumours remains a challenge, despite the imaging features that can be seen in different tumour types. Therefore, histology following orchidectomy of a germ cell tumour remains the gold standard for accurate tumour characterisation.

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Beyond germ cell tumors, unusual testicular and extra-testicular masses and mass-like lesions: MRI and US pictorial review

Cited by 4 publications

References 38 publications

When to ask for an MRI of the scrotum

When to ask for an MRI of the scrotum

Ewing’s sarcoma of the male external genitalia: a case report and review of the literature

Testicular Germ Cell Tumours—The Role of Conventional Ultrasound

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