Intratesticular Simple Cyst - Ultrasound and Elastography Appearance

Simple intratesticular cysts are unusual lesions. They are mostly non-palpable and diagnosed incidentally. A fifty year old patient was presented for scrotal sonography due to vague scrotal pain. On examination, a 6.8 x 5.4 mm intratesticular hypoechoic lesion was seen with imperceptible walls and posterior acoustic enhancement which is an indication of cystic lesion. This cyst contained echogenic mobile material indicating benign nature of the lesion (Figure 1). Strain elastography revealed typical blue green red (BGR) sign confirming cystic nature of lesion. (Figure 2) Benign intra testicular lesions are uncommon, but proper diagnosis is important so that unnecessary surgical intervention is prevented. Benign lesions involve tubular ectasia, abscess, intra testicular varicocele, intratesticular simple cysts, epidermoid cyst, tunica albuginea cyst and hemorrhage.1 Gray-scale ultrasonography (USG) along with Color-Doppler ultrasound wherever possible mostly gives accurate diagnosis leading to appropriate treatment.2 Features of simple cyst on USG include an imperceptible wall, an anechoic center and through transmission. Simple cysts are incidental finding most commonly in males of age 40 years and above. Variable in size having diameter of two mili meters to two centimeters. These are commonly single, in some cases multiple cysts have also been found. Simple cysts are commonly found near the mediastinum of testis but can also be found in other parts of testis. Also, these are linked with extra testicular spermatoceles. On local examination, even large simple testicular cysts are generally not palpable as they are not firm. Tunica albuginea cysts are very firm. So, we can easily differentiate between tunica albuginea cyst and simple testicular cyst.3 Sometimes testicular cysts contain echoic material which is mobile with change in position (Figure 2). The mobility of material suggests whether the cyst is benign or if fixed, it can be a cyst of neoplastic etiology. 4 The 3 - layer pattern (blue / green / red layers) visible in smaller cystic areas is known as the BGR sign and is visible in a few elastography systems. This pattern is taken into consideration as beneficial because it highlights the cystic nature of the lesion and has been proven to be true even in cases of cystic lesions with inner echogenic material.

Adult Granulosa Cell Tumor of the Testis: A Case Report with a Review of the Literature

Adult granulosa cell tumor (AGCT) of the testis represents a very rare testicular neoplasm that is poorly understood clinically. Here we report the case of a 22-year-old male who presented with unspecific scrotal symptoms. Scrotal sonography disclosed a 6 mm hypoechoic intratesticular lesion. Histological examination after orchiectomy revealed a homogeneous and well demarcated neoplasm with monomorphic cells with nuclear grooving and microfollicular formation of the so-called Call-Exner bodies. Immunohistology showed positive stainings of vimentin, calretinin, and inhibin with negative stainings of the typical germ cell tumor markers. Thus, the diagnosis of a benign AGCT was made. The patient is well one year after surgery. A total of 91 previous AGCT cases were identified in the literature. Median age of the cases reported to date is 44 years, median tumor size 3.2 cm. 54.3% of the AGCT cases were located on the left side. 12 cases (13.2%) were of malignant nature. Testis-sparing surgery would be the treatment of choice, but only two of all cases had received that procedure. The present report aims to increase the clinical knowledge of AGCT and specifically to increase the clinician’s vigilance with respect to testis-sparing surgery in probably benign testicular masses.

Epididymal Cysts: Are They Associated With Infertility?

Scrotal sonography is commonly used for evaluation of the infertile male. While epididymal cysts are frequently observed during sonographic assessment, their presence has uncertain import. This study is a retrospective case-control sonographic and chart review comparison of infertile men and fertile volunteers to clarify the possible association of epididymal cysts and infertility. The study included 91 consecutively recruited patients from January 2012 to December 2014. The infertile group consisted patients with male factor infertility who underwent scrotal sonography ( n = 67). The fertile group consisted of men requesting vasectomy who were recruited for study involvement and consented to undergo scrotal sonography ( n = 24). The main outcome measure was infertility. The existence of epididymal cysts on scrotal sonography was the main risk factor. Predictably, the only sonographic findings associated with infertility were small testes (right: t(df = 89) = −2.52; left: t(df = 89) = −2.28, both p = .01) and the presence of a varicocele, χ2(df = 1) = 5.766 with p = .02. The infertile men were also younger and more likely to use alcohol. Of the 91 men studied, 71% demonstrated epididymal cysts (73% of infertile and 67% of fertile men). Epididymal cysts were not be associated with infertility, χ2(df = 1) = 0.362 with p = .55. This occurrence of epididymal cysts is the highest ever reported (71% of all men). While the occurrence of epididymal cysts in this cohort is unexplained, our observation that these cysts are not associated with infertility will be useful for those clinicians counseling patients observed to have these structures.

Burned-out in a mixed germ cell tumor of the testis: The problem of pT0. Case report

Germ cell tumors constitute the majority of all testicular tumors, which are relatively rare overall and are mainly encountered in young adults and teenagers. The term ‘burned-out’ germ cell tumor refers to the presence of a metastatic germ cell tumor with histological regression of the primary testicular lesion. Clinical examination of the testes and scrotal sonography is the initial diagnosis of such neoplasms. We report an unusual case of a burned-out testicular tumor with metastases to retroperitoneal lymphnodes in an asymptomatic patient with right testicular hypoechoic nodule associated with multiple calcifications of the testicular parenchyma.