Testicular Tumor Ultrasound Characteristics and Association with Histopathology

Abstract

Introduction: This study was undertaken to develop knowledge of ultrasound characteristics of germ cell testicular neoplasms, associate these characteristics with histopathologic tumor types, and lay a foundation for study of ultrasound findings in benign versus malignant testicular lesions. Materials and Methods: The medical records and ultrasound images of 107 patients with testicular tumor were reviewed. Demographic and clinical characteristics and ultrasound findings of patients with seminoma were compared to those of patients with non-seminoma. Results: 55 patients had seminoma (1 bilateral) and 52 non-seminoma. Ultrasound images of seminoma were more often hypoechoic, homogeneous, and lobulated than those of non-seminoma (p < 0.001). Images of non-seminoma were more often heterogeneous and cystic (p < 0.001). There was no difference in tumor size, multiplicity, presence of calcium or lesion margination. Testicular microlithiasis was more common in seminoma (p < 0.02). Conclusion: Careful analysis of ultrasound images can permit an educated assessment of testicular tumor histopathology.

Contemporary diagnostic work-up of testicular germ cell tumours

“…Solid neoplasms are typically visualized as hypoechoic areas of irregular shape (Figure 1) but other echoic features might be observed depending on the tissue composition of the neoplasm. 20 Anechoic patterns are found in liquid lesions, whereas hyperechoic patterns are associated with dense tissue areas. Mixed teratomatous GCTs can, therefore, display all patterns of echogenicity-hypoechoic patterns in the solid parts, anechoic patterns in the cystic compartments, and hyperechoic areas consisting of cartilage or calcifications ( Figure 2).…”

Imaging of Bilateral Synchronous Testicular Tumors of Different Histologic Types and Implications for Surgical Management

“…We believe that this retrospective review of the sonography findings allowed us to suggest that each pair of lesions was possibly made of tumors of different histologic types. In fact, although it is not possible to identify the histologic nature of testicular masses with certainty, it is known that a lesion presenting on sonography with a hypoechoic and homogeneous pattern is more likely a seminoma, and nonseminomatous lesions are quite often more echogenic and heterogeneous, with teratomas commonly showing internal cystic areas 11 . Furthermore, although not in all cases, there are features that suggest a preoperative diagnosis of epidermoid cysts, such as an internal “onion ring” appearance, the presence of peripheral calcifications, and lack of internal vascularization on color Doppler imaging 12 .…”

“…In fact, although it is not possible to identify the histologic nature of testicular masses with certainty, it is known that a lesion presenting on sonography with a hypoechoic and homogeneous pattern is more likely a seminoma, and nonseminomatous lesions are quite often more echogenic and heterogeneous, with teratomas commonly showing internal cystic areas. 11 Furthermore, although not in all cases, there are features that suggest a preoperative diagnosis of epidermoid cysts, such as an internal "onion ring" appearance, the presence of peripheral calcifications, and lack of internal vascularization on color Doppler imaging. 12 In one of our cases, these findings prompted evaluation of the mass with contrast-enhanced sonography and contrast-enhanced MRI; both confirmed that the lesion was completely avascular.…”

Characteristics of symptomatic men with testicular microlithiasis – A Danish cross‐sectional questionnaire study

“…Seminoma was the most frequent cancer subtype in both groups. TML has been suggested associated with seminoma (McDonald et al, 2012;Sharmeen et al, 2015;Pedersen et al, 2016). Of the 29 seminomas, a total of 23 (79.3%) men did not have TML and six (20.7%) were diagnosed with TML.…”