Ultrasound of malignant testicular lesions. Arne Hørlyck Department of Radiology Aarhus University Hospital, Skejby
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1 Ultrasound of malignant testicular lesions Arne Hørlyck Department of Radiology Aarhus University Hospital, Skejby
2 Testis Ultrasound is fantastic!!
3
4 Scrotum Extratesticular mass: Benign Intratesticular mass: Malignant - nearly allways But palpation is not always precise
5 Scrotum => Ultrasound examination
6 Scrotum 31 year. No symptoms. Palpable mass, uncertain if it is intratesticular. Spermatocele
7 Scrotum Let us zoom in to the testis
8 Scrotum Let us zoom in to the testis
9 Testis cancer epidemiology Incidence 10 : per year
10 Testis cancer epidemiology Incidence Death rate 0,2 : per year
11 Testis cancer epidemiology 5 year survival (all stages): 97% (95 100) Why worry about early diagnosis?
12 Ultrasound of malignant testicular lesions
13 Testis pathology Neoplasm Malignant Benign Cyst Infection Vascular Torsio Infarction Atrophy
14 Testis pathology Neoplasm Malignant Benign Cyst Infection Vascular Torsio Infarction Atrophy
15 Testis pathology Neoplasm (all ages) Malignant 90% Benign 10%
16 Testis pathology Neoplasm Germ cell 90% Seminoma 50% Non-seminoma 50% Stroma (Sertoli -, Leyding -) 5% Other (Lymphoma, metatastasis, - -) 5%
17 Testis pathology Neoplasm Malignant Benign Cyst Infection Vascular Torsio Infarction Atrophy
18 34 year. No symptoms. Palpable mass.
19 34 year. No symptoms. Palpable mass. US: Testis tumour Pathology: Seminoma
20 28 year. Left flank colic pain. Ureteral stone? CT: No stones. Suspicious retroperitoneal lymph nodes. Testis cancer?
21 28 year. Left flank colic pain. Ureteral stone? Left testis smaller, no palpable mass.
22 28 year. Left flank colic pain. Ureteral stone? Left testis smaller, no palpable mass.
23 28 year. Left flank colic pain. Ureteral stone? Left testis smaller, no palpable mass.
24 28 year. Left flank colic pain. Ureteral stone? Left testis smaller, no palpable mass. US: Testis tumour Pathology: Non-seminomatous mixed germ cell tumours
25 49 year. Growing right testis. No other symptoms. US ref.: Hydrocele?
26 49 year. Growing right testis. No other symptoms. US ref.: Hydrocele?
27 49 year. Growing right testis. No other symptoms. US ref.: Hydrocele? US: slightly enlarged right epididymis. Slightly enlarged right testis.
28 One year later: Growing right testis. Surgery. Testis 7,5 x 5 cm Pathology: Mixed germ cell tumor. 49 year. Growing right testis. No other symptoms. US ref.: Hydrocele? US: slightly enlarged right epididymis. Slightly enlarged right testis.
29
30 year. Growing left testis. Palpable mass.
31 year. Growing left testis. Palpable mass.
32 year. Growing left testis. Palpable mass. US: Left testis tumour. Bilat. highechogenic changes, microlithiasis. Pathology: Seminoma left testis Carcinoma in situ right testis
33 year. No metastasis. No chemotherapy. Scrotum radiation treatment. Follow-up: CT and US year. Growing left testis. Palpable mass. US: Left testis tumour. Bilat. high- echogenic changes, microlithiasis. Pathology: Seminoma left testis Carcinoma in situ right testis
34 year. No metastasis. No chemotherapy. Scrotum radiation treatment. Follow-up: CT and US Until 2017 no relapse. Microlithiasis in right testis. Pathology: Seminoma left testis Carcinoma in situ right testis
35 year. No metastasis. No chemotherapy. Scrotum radiation treatment. Follow-up: CT and US Until 2017 no relapse. Microlithiasis in right testis. 2018:
36 Until 2017 no relapse. Microlithiasis in right testis. 2018:
37 Until 2017 no relapse. Microlithiasis in right testis. 2018: 7 mm new tumour in right testis.
38 Until 2017 no relapse. Microlithiasis in right testis. 2018: 7 mm new tumour in right testis. Testis sparing surgery Pathology: Seminoma right testis
39 2018: One week after testis sparing surgery:
40 2018: One week after testis sparing surgery:
41 2018: One week after testis sparing surgery: US: Vital testis after testis sparing surgery
42 2 month old boy. Growing right side of scrotum. Hydrocele?
43 2 month old boy. Growing right side of scrotum. Hydrocele? US: Multiple tumours in both testes.
44 2 month old boy. Further investigation: 4 cm tumour in left adrenal gland.
45 2 month old boy. Further investigation: 4 cm tumour in left adrenal gland. Pathology: Neuroblastoma (with metastases)
46 Chemotherapy and surgery. Follow-up: MRI and US 2 month old boy. Further investigation: 4 cm tumour in left adrenal gland. Pathology: Neuroblastoma (with metastases)
47 After 3 years: No relapse.
48 After 3 years: No relapse. US: Unchanged very discrete changes in both testes.
49 73 year. Growing left testis. No other symptoms. Palpable mass.
50 73 year. Growing left testis. No other symptoms. Palpable mass.
51 73 year. Growing left testis. No other symptoms. Palpable mass. US: Left testis tumour. Lymphoma? Pathology: Diffuse large B-cell lymphoma
52 Testis pathology Neoplasm Malignant Benign Cyst Infection Vascular Torsio Infarction Atrophy
53 28 year. Growing left testis. No other symptoms. Palpable mass.
54 28 year. Growing left testis. No other symptoms. Palpable mass. US: Testis tumour Pathology: Benign epidermoid cyst
55 Case courtesy of Dr Callum Smith, Radiopaedia.org, rid: Pathology: Benign epidermoid cyst
56 5 week old boy. Swollen right side. US: Cystic changes in right testis. Follow-up: Partly regression.
57 1 year old. Still cystic-solid lesion in right testis. Surgery. Pathology: Benign teratoma
58 1 year old. Still cystic-solid lesion in right testis. Orchiectomy. Pathology: Benign teratoma
59 11 year old. Pain in right testis. US: 5 mm cysticsolid lesion Testis sparring surgery. Pathology: Benign teratoma
60 Unchanged for 6 months. Probably benign change. Neoplastic? 26 year. Pt. felt little process in left testis. Not really palpable. US: 3 mm hyperechoic lesion.
61 Testis pathology Neoplasm Malignant Benign Cyst Infection Vascular Torsio Infarction Atrophy
62 45 year. Palpable mass in left testis. Pt. is a doctor! Dilatation of rete testis
63 45 year. Palpable mass in left testis. Pt. is a doctor! Cysts follow-up 1 year, unchanged
64 Testis pathology Neoplasm Malignant Benign Cyst Infection Vascular Torsio Infarction Atrophy
65 41 year. Clinically epididymitis.
66 41 year. Clinically epididymitis.
67 41 year. Clinically epididymitis. US: Epididymitis and orchitis, small necrosis, recommend followup.
68 Pathology: Seminoma 41 year. Epididymitis and orchitis. 7 week follow-up: Subjectively well. US: Tumour with extratesticular growth.
69 Testis pathology Neoplasm Malignant Benign Cyst Infection Vascular Torsio Infarction Atrophy
70 51 year. Swollen right testis. Uncertain history.
71 51 year. Swollen right testis. Uncertain history.
72 51 year. Swollen right testis. Uncertain history.
73 51 year. Swollen right testis. Uncertain history. US: Atrophy/ infarction probably after orchitis. Pathology: Fibrosis
74 Scrotum Extratesticular mass: Benign Intratesticular mass: Malignant - nearly allways
75 Scrotum 14 year. Through 1 month mass in scrotum.
76 Scrotum Pathology: Embryonal rhabdomyosarcoma
77 Some ultrasound pictures are very old!
78 Some ultrasound pictures are very old!
79 Some ultrasound pictures are very old! Is there really nothing new?
80 Elastography In focal lesions: Hype
81 CEUS
82 CEUS
83 CEUS
84 Take home messages US discriminates between intra- and extratesticular masses ( surgery or not! ) US can characterize most intratesticular benign changes CEUS can in selected cases help to characterize intratesticular changes
85 Thank you for your attention
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