Multiple, Synchronous Lesions of Differing Histology Within the Same Testis: Ultrasonographic and Pathologic Correlations

Abstract

Multiple focal lesions identified at imaging within the testis are not always of the same histology. This can be suspected in some cases basing on US texture. Recognition that lesions are multiple and an indication of their locations within the testis is the most important role of imaging and may help pathologists correctly sample the specimen to establish nature of each of them. Presence of multiple lesions is regarded as a contraindication to testicular sparing surgery. In two of our patients, one lesion was benign. Then, when the procedure is indicated all lesions have to be sampled and assessed by pathologists before deciding between conservative or radical technique.

Sonographic Diagnosis of Unilateral Synchronous Testicular Tumors

“…Cicero et al described that most of the identified discordant tumors had distinct ultrasonographic appearances, an important consideration for radiologists, as identification of tumors with possible discordant histology can guide pathological examination and treatment options. [7] Lesions with different histology should be suspected when the masses have different echotexture, as seen in the presented case report. Ultrasound appearance reflects gross morphology, which differs among the different types of testicular tumors.…”

“…[9] Discordant histology is similarly lesions of different histology within the same testis. [7] The largest seminoma non-seminoma pair reported in Cicero et al was 2.0 cm and 3.5 cm, respectively. In this case study, we have reported the largest unilateral synchronous seminoma and non-seminoma pair, at 4.2 cm and 2.3 cm, respectively.…”

“…The presence of unilateral synchronous testicular tumors of discordant histology is a rare finding. [7] Most publications on synchronous testicular tumors have described bilateral tumors with a wide range of reported rates of cases with discordant histology. In an analysis of 3984 patients with testicular cancer, Holzbeirlein et al identified 58 patients (1.5%) with bilateral tumors, 10 of which were synchronous (17%) and 7 (70%) of which had discordant pathology.…”

“…The presence of multiple testicular masses is an important consideration when treating testicular tumors, as multiple tumors may be a contraindication to testicular sparing surgery. [7] Identification of all tumor types present is critical, as cancer staging, treatment, and surveillance depend on the identification of the highest risk tumor type. [12]…”

Splenogonadal fusion evaluation using Contrast Enhanced Ultrasound and Elastography. A case report.

“…US has an essential role in the diagnosis of scrotal masses as the first-line imaging modality in the diagnosis of testicular pathologies [9,10]. In B-mode splenogonadal fusion can be identified as a mass within the scrotal sac of low reflectivity, which may appear to be fused to the testis [11,12].…”