Grayscale and Color Doppler Features of Testicular Lymphoma

Abstract

Pooled data from 16 radiology centers were retrospectively analyzed to seek patients with pathologically proven testicular lymphoma and grayscale and color Doppler images available for review. Forty-three cases were found: 36 (84%) primary and 7 (16%) secondary testicular lymphoma. With unilateral primary lymphoma, involvement was unifocal (n = 10), multifocal (n = 11), or diffuse (n = 11). Synchronous bilateral involvement occurred in 6 patients. Color Doppler sonography showed normal testicular vessels within the tumor in 31 of 43 lymphomas (72%). Testicular lymphoma infiltrates through the tubules, preserving the normal vascular architecture of the testis. Depiction of normal testicular vessels crossing the lesion is a useful adjunctive diagnostic criterion.

Pitfalls in Imaging for Acute Scrotal Pathology

“…In a recently published series of 43 cases of testicular lymphoma, color Doppler US demonstrated normal testicular vessels within the tumor tissue in 72% of cases. 25 This feature has been described also in other infiltrative neoplasms like plasmacytoma and leukemia. Importantly, nonneoplastic diseases such as chronic granulomatous orchitis and other inflammatory conditions may present with the same grey-scale and Doppler sonographic features as lymphoma.…”

“…At ultrasound, lymphoma presents with single or multiple focal regions of decreased echogenicity of variable size, or as a diffuse enlargement and decreased echogenicity of the entire testis; the normal testicular shape is maintained and there may be A B hypervascularization of the entire testis. 25 Pain may be present, and involvement of the epididymis is common.…”

“…In lymphoma the distribution of vessels within the lesion may be relatively normal. 25,26 Identification of normal testicular vessels with a regular course crossing the tumor tissue is a relatively specific feature characterizing lymphomas and other infiltrative tumors and allowing differentiation from massforming lesions (Fig. 8).…”

“…Ultimately, biopsy is often necessary to establish the diagnosis in the absence of clinical signs and symptoms of inflammation. 25…”

Overview of ultrasound applications for assessing scrotal disorders

“…The testes may be affected by systemic hematologic diseases such as leukemia and lymphoma or may be affected by metastasizing extratesticular solid tumors. Non‐Hodgkin B‐cell lymphoma is the most frequent testicular malignancy in patients older than 60 years, which is typically unilateral and usually painless (Figure ) . The testicular manifestations of lymphomas and leukemias present on US images as unifocal or multifocal hypoechoic and hypervascularized lesions .…”