Testicular Cystic Lesions



Testicular Cystic Lesions


Bhawan K. Paunipagar, MD, DNB

Michael P. Federle, MD, FACR



DIFFERENTIAL DIAGNOSIS


Common



  • Non-Seminomatous Germ Cell Tumor


  • Intratesticular Cyst


  • Tubular Ectasia of Rete Testis


  • Tunica Albuginea Cyst


  • Testicular Abscess


Less Common



  • Tunica Vaginalis Cyst


  • Necrosis or Hemorrhage in Tumor


  • Epidermoid Cyst


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Testicular cysts are common (8-10% of men)


  • Most cystic neoplasms have “complex” features



    • Mural nodularity, hemorrhage, or necrosis


    • Flow on color Doppler imaging


Helpful Clues for Common Diagnoses



  • Non-Seminomatous Germ Cell Tumor



    • Teratomas are usually well-defined complex masses



      • Cysts are a common feature and may be anechoic or complex, depending on the cyst contents


    • Cystic necrosis of the tumor is not uncommon in other NSGCTs


  • Intratesticular Cyst



    • Simple cyst


    • 2-18 mm diameter


    • Near mediastinum testis


  • Tubular Ectasia of Rete Testis



    • Variable size cystic lesions near mediastinum testis



      • Turn transducer to elongate into tubular channels


    • No flow on color Doppler


    • May be bilateral, asymmetrical


    • Often with associated spermatocele


  • Tunica Albuginea Cyst



    • Within the tunica surrounding testis


    • Usually solitary, 2-3 mm diameter, can be septate


  • Testicular Abscess



    • Usually complication of epididymo-orchitis


    • Enlarged testis with hypoechoic or mixed pattern


    • Imaging alone cannot distinguish from tumor


Helpful Clues for Less Common Diagnoses



  • Tunica Vaginalis Cyst



    • Rare, arises from visceral or parietal layer of tunica vaginalis


    • Usually anechoic; may have septations or may contain echoes due to hemorrhage


  • Epidermoid Cyst



    • Contents are “cheesy” keratin


    • Occasionally anechoic but layered keratin often creates a lamellated, “onion skin” appearance


    • May have a calcified capsule


    • Presents as painless nodule in young man






Image Gallery









Transverse ultrasound shows a large, heterogeneous, intratesticular mass image with internal calcification image and intervening cysts image. Features suggest teratoma or teratomatous components in a mixed germ cell tumor.

Only gold members can continue reading. Log In or Register to continue

Aug 2, 2016 | Posted by in GENERAL | Comments Off on Testicular Cystic Lesions
Premium Wordpress Themes by UFO Themes