Most solid intratesticular masses are malignant. When a solid lesion is identified on ultrasonography, malignancy must be considered initially; however, besides an intratesticular cyst, benign lesions do exist that sonologists should be aware of. One of the rarest is the intratesticular leiomyoma. We present a case of intratesticular leiomyoma and its sonographic appearance, pathologic findings, and differential diagnosis.
CASE REPORTA 52 year old white man with an unremarkable past medical history noticed a gradual, painless increase in the size of his left testicle over a period of 6 months. On physical examination his left testicle was found to be markedly enlarged, hard, and nontender, and it did not transluminate. The right testicle was normal, and the remainder of his physical examination was unremarkable. The patient's CBC, blood chemistry, clotting profile, and AFP, beta HCG, and PSA levels were within normal limits.The scrotal ultrasonogram showed a nonuniform pattern of the enlarged left testicle, with predominantly decreased echogenicity interspersed with areas of hyperechogenicity (Figs. 1, 2). It was moderately vascular on color Doppler imaging (Fig. 3). A moderate amount of left scrotal fluid (hydrocele) was present. The epididymis appeared unremarkable. The right testicle and hemiscrotum were normal.The patient underwent a radical left orchiectomy after an unsuccessful course of antibiotics. At surgery the left testis was found to be enlarged, and a firm mass measuring approximately 6.0 × 3.0 × 4.0 cm was palpable within the testis.Gross sectioning of the testis revealed a large tan spherical mass (Fig. 4). The tumor was well circumscribed, with a sharp interface between the tumor and adjoining uninvolved testis. The cut surface was white to tan in color, with a whorled pattern. No areas of hemorrhage or necrosis were identified.Histologic sections showed that the tumor was com-