Multimodality Imaging of Paratesticular Neoplasms and Their Rare Mimics

Abstract

Extratesticular neoplasms are rare but clinically significant lesions that affect patients of all ages. These neoplasms are generally asymptomatic but may have potentially life-threatening sequelae. Lipoma is the most common primary benign paratesticular neoplasm and the most common tumor of the spermatic cord. Adenomatoid tumor is the most common tumor of the epididymis, followed by leiomyoma. In adult patients, it is imperative to consider sarcomas in the differential diagnosis of all solid tumors of the scrotum. The most common sarcomatous tumors in pediatric patients are embryonal sarcoma and rhabdomyosarcoma. Metastases, particularly from testicular, prostatic, renal, and gastrointestinal primary malignancies, can also occur. Mimics of paratesticular neoplasms including polyorchidism and splenogonadal fusion are rare but must also be considered for optimal management. Ultrasonography (US) is currently the imaging modality of choice. However, US findings are often variable and nonspecific and do not usually allow definitive characterization. Specific computed tomographic and magnetic resonance imaging findings with respect to tumor location, morphologic features, and tissue characteristics can aid in the evaluation of paratesticular neoplasms and help narrow the differential diagnosis.

Diffusion-weighted MR imaging of normal and abnormal scrotum: preliminary results

“…However, a confident preoperative characterization of various benign intratesticular entities, including dilatation of rete testis, orchitis, epidermoid cyst, infarction, fibrosis and hematoma, for which radical orchiectomy is unnecessary is important. [3][4][5][6][7][8] In these patients, a more conservative approach, as follow-up, tumor enucleation or testissparing surgery may be justified. Sonography, although the primary imaging technique for the evaluation of scrotal pathology, 1,2 because of its wide availability, low cost and high sensitivity in the identification of scrotal lesions, does not always allow a confident preoperative characterization of scrotal masses.…”

“…[3][4][5][6][7][8][9] The technique due to its wide field of view, multiplanar capabilities, high contrast and spatial resolution has proved satisfactory in the localization of a scrotal mass, in the differentiation of paratesticular masses with respect to tumor morphology and tissue characteristics, in the distinction between benign from malignant intratesticular lesions and in the evaluation of the local extent of the disease in cases of testicular carcinomas. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] The technique is mainly recommended when sonographic findings are inconclusive or inconsistent with clinical findings. 5,6 In accordance with previous reports, this study demonstrated high accuracy of conventional MR sequences in characterizing both paratesticular and intratesticular mass lesions.…”

“…[3][4][5][6][7][8][9] MR evaluation of the scrotum performs well in localizing scrotal masses, therefore differentiating intratesticular and extratesticular scrotal disorders. A preoperative characterization of the histological nature of various scrotal masses is also possible in many cases.…”

“…A preoperative characterization of the histological nature of various scrotal masses is also possible in many cases. [3][4][5][6][7][8][9] Diffusion-weighted (DW) MR imaging watches the random microscopic motion of water molecules (Brownian motion). 10,11 Recently, the technique proved useful in the detection of malignant neoplasms and the histological characterization of focal lesions in the abdomen.…”

Consulta por masa escrotal: lesiones epidimarias

“…Para realizar diagnósticos diferenciales en cuanto a otras patologías que aparecen como masas extratesticulares escrotales, se puede uti- lizar la resonancia nuclear magnética sin haberse determinado características típicas de estos tumores ni generalizarse su uso 6 .…”