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Scrotal masses

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Scrotal masses

Publicado en: Salud y medicina
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Scrotal masses

  1. 1. • Testis • Epididymis • Spermatic cord • Their fascial coverings
  2. 2. • The first imaging procedure to evaluate the scrotum. • The study has to be performed with high frequency transducers (>10 MHz) with color Doppler facilities.
  3. 3. • MRI can be useful in the evaluation of scrotal masses as a problem-solving technique: 1. Discrepancies between US and clinical findings. 2. Diffuse, non-specific testicular involvement seen on US scanning. 3. Fibrous lesions, lipomas or hemorrhage are suspected.
  4. 4. • Testis. • Tunica albuginea. • The mediastinum testis. • The epididymis.
  5. 5. • Most solid lesions originating from the testes are malignant, while most lesions originating from extratesticular structures are benign • The most common extratesticular neoplasms are benign lipomas, usually originating from the spermatic cord, and adenomatoid tumors, most often from the epididymis.
  6. 6. • In patients with a scrotal mass, imaging is requested to answer the following five questions: 1. Is there a definite mass? 2. Is the mass intra- or extratesticular? 3. Is the mass bilateral? 4. Is the mass cystic or solid? 5. Is the nature of the lesion identifiable?
  7. 7. 1. Is there a definite mass? • US is almost 100% sensitive in the identification of presence of scrotal masses. • Diagnostic difficulties leading to false-negative results are rarely encountered, and are mostly due to: o Presence of isoechogenic intratesticular lesions o Diffuse testicular involvement, especially in children with yolk-sac tumors o Extratesticular lipomas can be difficult to identify, being often isoechoic to surrounding subcutaneous tissue.
  8. 8. 2. Is the mass intra- or extratesticular? • Differentiation can be made by US in almost all cases. • Palpation during US examination can help to localize the mass.
  9. 9. 3. Is the mass bilateral? • Testicular tumors can be bilateral (38% of lymphomas, 2% of seminomas).
  10. 10. 4. Is the lesion cystic or solid? • US can easily differentiate a solid from a cystic lesion. • A lesion may be defined as a ‘cyst’ only if it is completely anechoic, with increased through transmission and presence of thin walls, without any vegetations or irregularities.
  11. 11. 5. Is the nature of the lesion identifiable? • Identification of the nature of scrotal masses cannot be based on imaging methods alone. • Localization of the mass is important in predicting the nature of the lesion. o Most extratesticular lesions are benign o Most intratesticular masses are malignant. • The structural pattern of the mass is the second important factor to consider. o Most cystic lesions are benign, while solid nodules are more often malignant.
  12. 12. Testicular Tumors Age: • First Decade → Yolk Sac Tumors – Teratomas. • Second & Third Decade → Teratoma & Choriocarcinoma. • Forth And Fifth Decade → Seminoma.
  13. 13. Testicular Tumors Tumors Markers: • Alpha Fetoprotein → All Yolk Sac Tumors – 75% Of Embryonal Carcinoma. • Human Chorionic Gonadotrophin (hCG) → All Choriocarcinoma - 60% Embryonal Carcinoma.
  14. 14. • A common benign lesion (retention cyst). • It is a cyst filled with cheesy laminated material that appears solid on imaging.
  15. 15. • A rare benign tumor (approximately 1% of all testicular tumors). • It is a cyst filled with cheesy laminated material that appears solid on imaging.
  16. 16. • At US, the lesion is seen as rounded or oval shaped nodule with regular outer margins. • The lesion tends to be hyperechoic, sometimes calcific outer wall is seen, and an internal ’onion ring’ structure is characteristic of an epidermoid cyst. No vascular signals are seen at Doppler evaluation
  17. 17. • At MRI, a laminated appearance, with alternate low-and high- signal intensity areas can be detected on T2-weighted images.
  18. 18. • US: Seminomas are well defined and homogeneously hypoechoic
  19. 19. • On MRI, Homogeneously hypointense on T2-weighted images. Larger tumors may be more heterogeneous
  20. 20. • Non-seminomatous lesions are more heterogenous with areas of hemorrhage and calcification. • The tunica albuginea may be invaded.
  21. 21. • US findings are usually sufficient to suggest the diagnosis. The testis is typically replaced by infiltrative hypoechoic hypervascular lymphoid tissue.
  22. 22. • MR imaging findings are similar, with the testis being replaced by tissue that is low signal intensity on T1- and T2-weighted images, with low-level enhancement (less than the normal testis)
  23. 23. • “Burned-out" Germ Cell Tumor • Extra-Testicular pseudo-tumors • Testicular pseudo-tumors

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