EURORAD ESR

Case 9988

MR imaging in the characterisation of benign intratesticular mass lesion

Author(s)
Tsili AC1, Argyropoulou MI1, Ntoulia A1, Tsampalas S2, Silakos A2, Gousia A3, Astrakas L4, Sofikitis N2, Tsampoulas K1

1 Department of Clinical Radiology
2 Department of Urology
3 Department of Pathology
4 Department of Physics
University Hospital of Ioannina, Greece.
 
Patient
male, 45 year(s)
 
 
  • Figure 1
    Sonographic examination of the scrotum
     

    Sagittal sonographic image of the right testis depicts an upper pole intratesticular mass (arrow). The lesion is sharply demarcated, inhomogeneous, mainly hypoechoic.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Comparative studies; Special Focus: Pathology;

    Transverse ultrasound image shows a small-sized right testis, with an intratesticular, hypoechoic mass lesion (cursors), measuring 13 x 9 mm.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Comparative studies; Special Focus: Pathology;

    Colour Doppler image reveals absence of lesion vascularity.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: Ultrasound; Procedure: Comparative studies; Special Focus: Pathology;
     
     
  • Figure 2
    MR imaging examination of the scrotum, unenhanced images
     

    Axial T1-weighted image shows right intratesticular lesion, slightly hyperintense, when compared to normal testicular parenchyma (not shown in this image).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Comparative studies; Special Focus: Pathology;

    Transverse T2-weighted image depicts right intratesticular mass (arrow), mainly homogeneous, with very low signal intensity, when compared to normal testis. A left hyperintense intratesticular lesion (arrowhead) is...

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Comparative studies; Special Focus: Pathology;

    Coronal T2-weighted image shows right testicular mass (arrow), extremely hypointense, when compared to normal testicular parenchyma. The lesion is well delineated, surrounded by a hypointense halo.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Comparative studies; Special Focus: Pathology;
     
     
  • Figure 3
    DW MR images
     

    Diffusion-weighted image (b=900 s/mm2) in transverse plane depicts lesion hypointensity (arrow).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Comparative studies; Special Focus: Pathology;

    Corresponding ADC map (Figure 4a). The ADC values of the lesion (arrow) were 1.22 s/mm2 (arrow), compared to those of the normal contralateral testis (1.11 s/mm2).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR-Diffusion/Perfusion; Procedure: Comparative studies; Special Focus: Pathology;
     
     
  • Figure 4
    MR imaging examination, post-contrast images
     

    Coronal dynamic contrast-enhanced subtracted image at delayed (180 sec) phase depicts peripheral lesion enhancement (arrow).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Comparative studies; Special Focus: Pathology;

    Time-signal intensity curve of right intratesticular mass, with the ROI placed in peripherally enhancing halo shows strong lesion enhancement, with gradual progressive increase of signal intensity.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Comparative studies; Special Focus: Pathology;

    Time-signal intensity curve of normal left testis reveals slow and progressive increase of signal intensity throughout the examination.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Comparative studies; Special Focus: Pathology;
     
     
  • Figure 5
    Histologic sections
     

    Testicular parenchyma with haemorrhagic necrosis (right) and atrophic tubules (left) (H-E X100).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: PACS; Procedure: Biopsy; Special Focus: Pathology;

    Small atrophic tubules with thick, hyalinised basement membrane and rare spermatogonia (H-E X200).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: PACS; Procedure: Biopsy; Special Focus: Pathology;
     
     
Sagittal sonographic image of the right testis depicts an upper pole intratesticular mass (arrow). The lesion is sharply demarcated, inhomogeneous, mainly hypoechoic.
 
Transverse ultrasound image shows a small-sized right testis, with an intratesticular, hypoechoic mass lesion (cursors), measuring 13 x 9 mm.
 
Colour Doppler image reveals absence of lesion vascularity.
 
Axial T1-weighted image shows right intratesticular lesion, slightly hyperintense, when compared to normal testicular parenchyma (not shown in this image).
 
Transverse T2-weighted image depicts right intratesticular mass (arrow), mainly homogeneous, with very low signal intensity, when compared to normal testis. A left hyperintense intratesticular lesion (arrowhead) is also detected, located in the mediastinum testis.
 
Coronal T2-weighted image shows right testicular mass (arrow), extremely hypointense, when compared to normal testicular parenchyma. The lesion is well delineated, surrounded by a hypointense halo.
 
Diffusion-weighted image (b=900 s/mm2) in transverse plane depicts lesion hypointensity (arrow).
 
Corresponding ADC map (Figure 4a). The ADC values of the lesion (arrow) were 1.22 s/mm2 (arrow), compared to those of the normal contralateral testis (1.11 s/mm2).
 
Coronal dynamic contrast-enhanced subtracted image at delayed (180 sec) phase depicts peripheral lesion enhancement (arrow).
 
Time-signal intensity curve of right intratesticular mass, with the ROI placed in peripherally enhancing halo shows strong lesion enhancement, with gradual progressive increase of signal intensity.
 
Time-signal intensity curve of normal left testis reveals slow and progressive increase of signal intensity throughout the examination.
 
Testicular parenchyma with haemorrhagic necrosis (right) and atrophic tubules (left) (H-E X100).
 
Small atrophic tubules with thick, hyalinised basement membrane and rare spermatogonia (H-E X200).
 
 
 
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