Multiparametric Sonography of Hematologic Malignancies of the Testis: Grayscale, Color Doppler, and Contrast‐Enhanced Ultrasound and Strain Elastographic Appearances With Histologic Correlation

Abstract

Primary testicular lymphoma is rare and appears with nonspecific findings on grayscale and color Doppler sonography. We present 8 patients further examined with contrast-enhanced sonography, strain elastography, and histologic analysis after orchiectomy. Seven of 8 patients had a diagnosis of large B-cell lymphoma, and 1 of 8 had a diagnosis of granulocytic sarcoma, with solitary lesions (2 of 8), multiple lesions (3 of 8), or entire testicular involvement (3 of 8). Lesions appeared hypoechoic (7 of 8) or isoechoic (1 of 8), all with increased vascularity on color Doppler sonography and a nonbranching linear pattern of intratumoral vessels (7 of 8). Contrast-enhanced ultrasound (CEUS) confirmed this pattern and showed increased enhancement in all lesions. On strain elastography, all lesions were hard, with an elasticity score of greater than 4. Multiparametric sonography of testicular lymphoma identifies increased vascularity on color Doppler and contrast-enhanced ultrasound and increased lesion stiffness on strain elastography.

Evaluation of Intratesticular Lesions With Strain Elastography Using Strain Ratio and Color Map Visual Grading: Differentiation of Neoplastic and Nonneoplastic Lesions

“…In our study, the VES demonstrated a specificity of 45.5% in diagnosing malignancy and 57.89% in diagnosing neoplasms. We observed hard SE characteristics in a number of nonneoplastic lesions including cysts, hematomas, infarctions, rete testis, and scars (Figure ); in all of these etiologies, hard elastographic properties have been previously reported …”

The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology

“…Moreover, CEUS increases the accuracy of ultrasound on tumor blood supply determination 1617. However, the scrotal ultrasonography with a combination of gray-scale and color Doppler techniques has still been the first-line imaging modality for evaluation of testicular tumors because of its low cost, wide availability, and high diagnostic accuracy 1819. In summary, as a noninvasive examination, scrotal ultrasonography may greatly increase the diagnostic accuracy of testicular tumors and should be considered as the primary preoperative examination for all the patients.…”

Elastography of focal testicular lesions: current concepts and utility

“…In a cohort of six patients with histological confirmation of primary testicular lymphoma, all lesions appeared hard; five of six showed a VES of 5, and the other had a VES of 4 (Fig. 5) [18].…”