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Review
. 2021 Sep;82(5):1053-1065.
doi: 10.3348/jksr.2021.0110. Epub 2021 Sep 27.

[Imaging of Scrotal Tumors]

[Article in Korean]
Seungsoo Lee, Young Taik Oh, Dae Chul Jung
Review

[Imaging of Scrotal Tumors]

[Article in Korean]
Seungsoo Lee et al. Taehan Yongsang Uihakhoe Chi. 2021 Sep.

Abstract
in English, Korean

Ultrasonography is effective for imaging superficial organs, such as the scrotum. Using a high-frequency transducer, ultrasonography can identify the location and characteristics of scrotal lesions with high accuracy. The primary role of ultrasound (US) in the evaluation of a scrotal mass is to determine if it is intratesticular or extratesticular. Additional clinical information and other imaging options may be needed to diagnose benign tumors and pseudo-tumors. MRI is an effective problem-solving tool in cases with nondiagnostic US findings. CT is helpful for staging testicular cancer and localizing undescended testis. This review covers the imaging features of testicular and extratesticular tumors.

음낭 종양은 고환, 부고환, 정삭, 고환막 등에서 발생하며 악성 가능성을 평가하는데 가장 중요한 요소는 병변의 위치이다. 추가적인 영상 소견과 임상 정보를 종합하여 효과적으로 진단 할 수 있다. 초음파검사는 표재성 기관인 음낭을 관찰하기 용이하며, 우수한 영상 품질을 바탕으로 병변의 유무뿐만 아니라 위치와 성상까지 확인 가능하다. 초음파검사로 감별이 어려울 경우에는 자기공명영상을 이용하여 지방, 출혈, 섬유화, 조영증강 등 추가적인 종양의 특징을 확인하는 것이 진단에 도움이 된다. 전산화단층촬영은 고환암의 병기결정이나 복강 내 미하강고환의 위치를 탐색하는데 유용하다. 본 종설에서는 고환 내외에서 발생하는 음낭 종양의 영상 소견을 살펴보고자 한다.

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Conflict of interest statement

Conflicts of Interest: Dae Chul Jung has been a Section Editor of the Journal of the Korean Society of Radiology since 2019; however, he was not involved in the peer reviewer selection, evaluation, or decision process of this article. Otherwise, no other potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1. Epidermoid cyst in a 20-year-old male.
A. Ultrasound image shows a mass with concentric hyperechoic rings (arrowhead). B. T2-weighted MR image shows heterogeneous signal intensity surrounded by a low-signal-intensity rim (arrowhead). C. Photograph of the gross specimen shows lamellated layers of keratin in the mass (arrowhead).
Fig. 2
Fig. 2. Adrenal rest tumor in a 22-year-old male.
A. Contrast-enhanced T1-weighted MR image shows a bilaterally enhanced mass (arrowheads) at the mediastinum of both the testes. B. Ultrasound image shows an isoechoic lobular mass (arrowhead). C. A decrease in the size of the mass (arrowhead) is noted after glucocorticoid treatment.
Fig. 3
Fig. 3. Leydig cell hyperplasia in an undescended testis of a 58-year-old male.
A. Ultrasound image shows a heterogeneous echogenic nodule (arrowhead) in an undescended testis. B. Photograph of the gross specimen shows a lobular tan-yellow nodule (arrowhead).
Fig. 4
Fig. 4. Leydig cell tumor in a 27-year-old male.
A. Ultrasound image shows a slightly hypoechogenic and homogeneous mass (arrowhead). B. Photograph of the gross specimen shows a well-dermarcated mass with mild hemorrhage (arrowhead).
Fig. 5
Fig. 5. Seminoma associated with cryptorchidism in a 34-year-old male.
A. Ultrasound image shows a hypoechoic mass (arrowhead) in the left inguinal canal. B. Contrast-enhanced CT image shows a slightly enhancing mass (arrowhead) in the left inguinal area.
Fig. 6
Fig. 6. Seminoma and para-aortic lymph node metastasis in a 27-year-old male.
A. Ultrasound image shows a huge mass replacing the testis with multiple echogenic dots (arrowhead) and septa-like structures (arrow). B. CT image shows enlarged lymph nodes in the left para-aortic area, at the level of the renal hilum (arrowhead).
Fig. 7
Fig. 7. Seminoma and pulmonary metastases in a 30-year-old male.
A. Ultrasound image shows a mass (arrowhead) replacing the testis and invading the spermatic cord. B. CT images shows multiple pulmonary metastases (arrowheads).
Fig. 8
Fig. 8. Mixed-germ cell tumor with embryonal cell carcinoma (50%), mature teratoma (40%), and choriocarcinoma (10%) in a 20-year-old male.
Ultrasound image shows a lobular mass with separated solid (arrow) and cystic (arrowhead) components.
Fig. 9
Fig. 9. Separate seminoma and mix-germ cell tumor with embryonal carcinoma (30%), yolk sac tumor (20%), and immature teratoma (50%) in a 32-year-old male.
A. Ultrasound image shows a lobular hypoechogenic seminoma (arrow) with microlithiasis. The mixed-germ cell tumor (arrowhead) shows mild heterogeneity and small cystic regions. B. Photograph of the gross specimen shows a tan-yellowish homogeneous seminoma (arrow) and a mixed-germ cell tumor (arrowhead) with hemorrhage and cystic regions.
Fig. 10
Fig. 10. Burned-out tumor and metastatic retroperitoneal embryonal cell carcinoma in a 42-year-old male.
A. CT image shows metastatic lymphadenopathy (arrowheads) in the retroperitoneum. B. Ultrasound image shows an ill-defined hypoechoic area (arrowhead) associated with an overt mass. C. Photograph of the gross specimen shows no overt lesions (arrowhead). Testicular atrophy with Sertoli cell only tubules and tubular hyalinization was noted on microscopy (not shown).
Fig. 11
Fig. 11. Spermatocytic tumor in male aged 58-year-old (A) and 34-year-old (B).
A. Ultrasound image shows a lobular hypoisoechoic mass (arrowhead) replacing the testis. B. Ultrasound image shows a heterogeneous mass (arrowhead) with multifocal cystic changes.
Fig. 12
Fig. 12. Testicular lymphoma in a 58-year-old male.
A. Ultrasound image shows an ill-defined isoechoic infiltrative lesion (arrowhead) involving the entire testis. B. The color Doppler image shows markedly increased vascularity.
Fig. 13
Fig. 13. Adenomatoid tumor in a 24-year-old male.
A. Ultrasound image shows a well-defined isoechoic mass (arrowhead) in the epididymal tail. B. Photograph of the gross specimen shows a resected solid mass.
Fig. 14
Fig. 14. Sperm granuloma in a 53-year-old male.
Ultrasound image shows a hypoechoic mass (arrowhead) in the epididymal tail.
Fig. 15
Fig. 15. Lipoma in a 48-year-old male.
A. Ultrasound image shows an isoechoic mass (arrowhead) in the left inguinal canal and scrotum. B. CT image shows a low-attenuating mass (arrowhead). C. Photograph of the gross specimen shows a huge fatty mass.
Fig. 16
Fig. 16. Dedifferentiated liposarcoma in a 42-year-old male.
A. CT image shows a huge mass in the left scrotum. Fat component (arrowhead) of the mass shows abrupt transition to a heterogeneously enhancing component (arrow) iso-attenuating to the muscle. B. Photograph of the gross specimen shows a resected solid mass with fat (arrowhead) and a discrete dedifferentiated component (arrow).
Fig. 17
Fig. 17. Extratesticular lymphoma in a 67-year-old male.
A. Ultrasound image shows a huge hypoechoic mass (arrowhead) surrounding the testis. B. The color Doppler image shows increased vascularity in the mass compared to the testis.
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