Multiparametric ultrasound imaging characteristics of multiple testicular adrenal rest tumours in congenital adrenal hyperplasia

Abstract

Introduction Testicular adrenal rest cell tumours (TART) are rare benign adrenocorticotropic hormone-dependent testicular tumours, which can develop in patients with congenital adrenal hyperplasia. If left untreated, they can cause testicular tissue damage and infertility. Ultrasound is the imaging modality of choice allowing for non-invasive diagnosis provided that characteristic features are seen. In recent times, magnetic resonance imaging characteristics have also been described to aid diagnosis. Case Report This case describes the imaging features of multiple bilateral TART in a young patient with congenital adrenal hyperplasia. Traditional greyscale and colour Doppler ultrasound demonstrated intratesticular, predominantly hypoechoic areas, with increased surrounding colour Doppler flow. In addition, contrast-enhanced ultrasound and strain elastography were performed, showing increased TART vascularisation and increased stiffness in the hypoechoic areas. Subsequent magnetic resonance imaging confirmed bilateral lobulated, well demarcated, intratesticular lesions, which appeared predominantly isointense on T1-weighted imaging, hypointense on T2-weighted imaging, with heterogeneous enhancement following gadolinium administration. Discussion This case illustrates the sonographic features including greyscale, colour Doppler, contrast and elastography ultrasound of TART in a patient with congenital adrenal hyperplasia. Both contrast-enhanced ultrasound and elastography can provide information about tissue properties not normally derived from conventional ultrasound and aid accurate diagnosis. Additional magnetic resonance imaging is not normally required with typical ultrasound appearances. The unusual findings seen on the ultrasound examination were likely secondary to poor compliance with treatment. Conclusion Familiarity and recognition of characteristic and uncommon imaging features of these tumours are important to avoid misdiagnosis and surgical intervention.

Testicular adrenal rest tumors (TART) secondary to congenital adrenal hyperplasia: A case report emphasizing early detection and management

“…Strain elastography provides additional information by adding stiffness as an additional qualitative and quantitative measure of tissue properties. Malignant lesions are usually considered “harder” (less compressible and stiffer) than benign lesions [20] .…”

Imaging of Pediatric Testicular and Para-Testicular Tumors: A Pictural Review

“…CEUS and strain elastography could be performed, showing increased vascularization and increased stiffness in the hypoechoic areas [71]. MRI usually shows bilateral lobulated, well-demarcated, intra-testicular lesions that appear predominantly isointense or slightly hyperintense on T1-weighted imaging and hypointense on T2-weighted imaging, with heterogeneous and marked enhancement after gadolinium administration as compared with normal parenchyma [69,71].…”

Multiparametric Ultrasound for Focal Testicular Pathology: A Ten-Year Retrospective Review

“…These modalities have shown promise in distinguishing malignant from benign lesions [16,17], guiding management decisions towards more conservative, organ-preserving strategies [18][19][20][21]. Since their adoption in 2008, CEUS and SE have become integral to the multidisciplinary evaluation of testicular abnormalities in our institution [22][23][24][25][26][27][28][29][30][31][32][33][34], marking a significant advance in our approach to scrotal pathology.…”