Intratesticular adrenal rests diagnosed by ultrasound.

Abstract

Adrenal rest tumors of the testes may occur in conditions associated with increased circulating adrenocorticotropic hormone (ACTH), including congenital adrenal hyperplasia (CAH) and Addison disease. Sonographically, these tumors appear as multiple round, hypoechoic nodules near the testicular hilus and are usually bilateral. They may undergo extensive fibrosis and become hyperechoic with acoustic shadowing. In the absence of excess ACTH or characteristic ultrasound findings, biopsy is recommended to exclude malignancy. Because malignant degeneration is very rare, close clinical and sonographic follow-up without biopsy is generally sufficient. Serial sonograms are useful to document stability or regression of tumor size during glucocorticoid replacement therapy.

Sonographic Appearance of Testicular Adrenal Rest Tissue in Congenital Adrenal Hyperplasia

“…6 Bilateral eccentrically located intratesticular masses in patients with CAH and primary adrenal insufficiency strongly suggest intratesticular adrenal rest tumors. 7 Sonographically, they are in most cases hypoechoic lesions 3 peripherally located close to the mediastinum of the testes, are oblong, are associated with contralateral lesions, and are not clinically palpable when small. Most of these lesions are located inside of or close to the testicular hilus (86%), and they are usually bilateral (83%-100%).…”

Les tumeurs testiculaires à cellules de Leydig: à propos de quatre cas et revue de la littérature

“…Les tumeurs testiculaires secondaires à une HCS dériveraient de cellules surrénaliennes ectopiques, ayant migré au cours du dévelop-pement foetal avec les cellules gonadiques primitives à partir du sinus urogénital [20]. Les tumeurs testiculaires secondaires à une HCS sont parfois également retrouvées, de façon exceptionnelle, dans la maladie d'Addison, la maladie de Cushing, le syndrome de Nelson et chez les patients qui présentaient une résistance aux glucocorticoïdes [21]. Ces tumeurs sont bilatérales dans 83 % des cas et régressent dans 75 % des cas sous corticothérapie [22].…”

Ectopic prostate in the testicle: an unusual cause of a solid testicular mass on ultrasonography.

“…These rests may undergo fibrosis and become hyperechoic with acoustic shadowing. 12 Microlithiasis refers to calcific concretions filling the lumina of the seminiferous tubules, appearing sonographically as numerous highly echogenic foci scattered throughout the testicle. Microlithiasis has been associated with various conditions, including cryptorchidism, Klinefelter's syndrome, male pseudohermaphroditism, infertility, and intratubular germ cell neoplasia.…”