Sonographic detection of nonpalpable tumors in testes has been described many times. It nearly always occurs in patients with clinical manifestation of lymph node metastases or with signs of hormonal dysregulation such as gynecomasty or pubertas praecox. To our knowledge only three reports have been published of ultrasonic detection of an impalpable regressedIn 1 of these cases the tumor was found in an atrophic t e~t i s .~ In this article we present another 3 cases of a nonpalpable regressed germ-cell tumor in an atrophic testis.
CASE REPORTS
Case 1A 49-year-old male presented with abdominal pain, malaise, and night sweats for nine months. There was no past history of trauma, mumps, orchitis, cryptorchism, or inguinoscrotal surgery. Physical examination revealed an enlarged lymph node in the left supraclavicular region and an atrophic testicle on the right. Laboratory investigations, including serum a-fetoprotein (a-FP) and P-human chorionic gonadotrophins (P-HCG) only revealed an erythrocyte sedimentation rate (ESR) of 20 mm/l h. Biopsy of the left supraclavicular lymph node raised suspicion of seminoma.Ultrasonography and computed tomography (CT) of the abdomen showed enlargement of the retroperitoneal lymph nodes. With CT of the lungs, three lesions, suspected of being metastases, were found. Sonography of the scrotum demonstrated a normal left testis, 5 cm x 3 cm x 3 cm. The right testis was smaller, 3.5 cm x 2 cm x 1.75 cm, and hypoechoic. In the lower pole an irregular echogenic area with a diameter of 2 cm was found (Figure 1). After right radical orchiectomy the pathologic diagnosis was a fibrotic area in the lower pole due to a regressed germ-cell tumor.
Case 2A 21-year-old male presented with a painful left hemiscrotum for three months. There was no dysuria or hematuria. He sometimes experienced abdominal pain. There was no past history of trauma, mumps, orchitis, cryptorchism, or inguinoscrotal surgery. Physical examination revealed a translucent swelling of the left hemiscrotum, a nonpalpable left testis and epididymis, and an atrophic right testis. Further examination was unremarkable. Laboratory investigations revealed lactate dehydrogenase (LDH) of 1935 U/L, normal serum a-FP, and p-HCG of 100 ng/mL (normal: <1.0 ng/mL). Ultrasonography of the scrotum showed an enlarged left epididymis, consistent with epididymitis, and a reactive hydrocele. The left testis was normal, 5.5 cm x 3.5 cm x 3 cm. The right testis was small, 4 cm x 2.5 cm x 2.5 cm, but isoechoic with the left testis. In the upper pole two echogenic lesions with acoustic shadows were found (Figure 2). Ultrasonography of the abdomen showed enlargement of the retroperitoneal lymph nodes. After right radical orchiectomy the pathologic diagnosis was regressed germ-cell tumor with a possible teratoid component in the atrophic testis.From the