Enlargement and hypervascularity of both the epididymis and testis do not exclude involvement with lymphoma or leukemia

Abstract

We present 3 cases of diffuse infiltration of the testes and epididymides by malignant lymphoma and leukemia. Gray-scale and color Doppler sonograms showed diffuse hypoechoic enlargement and hypervascularity of the involved testes and epididymides. The authors emphasize that enlargement and hypervascularity of both the epididymis and testis can be caused by lymphomatous/leukemic involvement and is not always indicative of epididymo-orchitis.

Straight Vessel Pattern and Rapid Filling Time

“…Although they did not perform Doppler sonography, Emura et al 16 believed these hypoechoic lines to represent intratesticular arteries and veins, and they concluded that a diffuse infiltration of the testicle with preservation of the basic microarchitecture of testis, epididymis, and spermatic cord is typical of malignant lymphoma. This “striated pattern” was also described in later case reports on testicular lymphoma 28 and testicular infiltration of acute leukemia 18 . On color Doppler sonography, all reports noted markedly increased vascularity in patients with testicular lymphoma 9 , 17 , 22 , 24 , 26 – 29 …”

Lymphoma of the testis and epididymis mimics chronic inflammation upon sonography

“…5 In addition, the involvement of both intra-and extratesticular structures is a well-established criterion for the diagnosis of inflammatory conditions such as epididymo-orchitis. 7 In the present case, although the patient did not have scrotal pain, we believe that the lesion involving the testis and epididymis was due to chronic inflammation as seen in tuberculosis and sarcoidosis.…”

“…However, sonographic reports of lymphoma involving both testis and epididymis are rare. 7 In that case, both the testis and epididymis, the testis and epididymis appear enlarged and hypervascular on sonograms. 7 Chronic epididymo-orchitis may be seen in patients with tuberculosis, brucellosis, syphilis, and parasitic and fungal infections.…”

“…7 In that case, both the testis and epididymis, the testis and epididymis appear enlarged and hypervascular on sonograms. 7 Chronic epididymo-orchitis may be seen in patients with tuberculosis, brucellosis, syphilis, and parasitic and fungal infections. 5 Certain sonographic signs should help differentiate between lymphoma and epididymo-orchitis.…”

“…6 In such instances, the differentiation from epididymo-orchitis and granulomatous inflammation such as tuberculosis and sarcoidosis may be difficult on sonography. 5,7 We report a case of lymphoma involving the testis and epididymis that mimicked chronic inflammation on sonography.…”