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Testicular Tumour: What we
should know
Amir
Overview
• Risk factor: Crypto-orchidism, infertility, FHx
• Seminoma is most common
• Majority cases: 18-35yrs
• P/c: Painless, testicular swelling.
• In a 2014 statistics: of 8820 new cases, 380
will die.
Background
• Originate in the lumbar; descends downwards.
• 97% male born with testes in scrotum at birth.
– Most undescended move into scrotum by 3month
• Adult testis measures ~3x3x5cm
• Testicular artery originates from aorta; right
vein into IVC and left vein into left renal vein.
Classification
• Young pt: 95% is germ cell, 5% sex-cord
stroma.
– Germ cell: 50% are seminomas, 50% NSGCT
– Sex cord stroma: Leydig cell, Sertoli, thecomas
• Older pt (>60): Lymphoma (esp NHL) is most
common.
Ultrasound
• Intra-testicular vs Extra-testicular
– Intra likely malignant
• Solid vs Cystic
– Solid more likely malignant
• Internal vascularity
• Microlithiasis
– Calcification in seminiferous tubules
• US has 92% sensitivity and 95% specificity in the right
clinical setting
• Certain features more common with certain tumor
The issue with Microlithiasis
• Loosely a/w tumour
• Classic microlithiasis - >5/image
• ˜5% of normal patient
• However, higher rate of malignancy in patient
with classic microlithiasis
Features
• Seminoma: Homogenous, hypoechoic w/out
calcification or cystic area
• NSGCT: Heterogeneous (cystic area) with
calcification
• Mixed germ cell: May involute aka “burned-
out”; outstrips blood supply then regress in
size
• Lymphoma: Diffusely hypoechoic with focal
mass with vascularity within
Seminoma
NSGCT
Burned out appearance
Lymphoma
Non-tumorous Lesion
• Infarction: Heterogeneous hypoechoic with
lack of internal flow within (avascular)
• Hematoma: Ill-defined hypoechoic areas with
lack of flow within the areas, shows resolution
over 2-4wks
• Infection: Increased color flow, shows
resolution over 2-4wks
Infarction
Hematoma
Infection
• Epidermoid cyst: Well-defined hypoechoic
intratesticular mass with “onion ring”
appearance – concentric layers. No vascularity.
MRI
• Seminoma: Homogenous signal
• Mixed germ cell: Heterogeneous signal
• Teratoma: Bulk fat with signal loss on fat
saturated images
• Malignant: Enhancement with washed out
pattern
• Benign: Continuous enhancement which plateaus
off
Testicular tumour

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Testicular tumour

  • 1. Testicular Tumour: What we should know Amir
  • 2. Overview • Risk factor: Crypto-orchidism, infertility, FHx • Seminoma is most common • Majority cases: 18-35yrs • P/c: Painless, testicular swelling. • In a 2014 statistics: of 8820 new cases, 380 will die.
  • 3. Background • Originate in the lumbar; descends downwards. • 97% male born with testes in scrotum at birth. – Most undescended move into scrotum by 3month • Adult testis measures ~3x3x5cm • Testicular artery originates from aorta; right vein into IVC and left vein into left renal vein.
  • 4. Classification • Young pt: 95% is germ cell, 5% sex-cord stroma. – Germ cell: 50% are seminomas, 50% NSGCT – Sex cord stroma: Leydig cell, Sertoli, thecomas • Older pt (>60): Lymphoma (esp NHL) is most common.
  • 5. Ultrasound • Intra-testicular vs Extra-testicular – Intra likely malignant • Solid vs Cystic – Solid more likely malignant • Internal vascularity • Microlithiasis – Calcification in seminiferous tubules • US has 92% sensitivity and 95% specificity in the right clinical setting • Certain features more common with certain tumor
  • 6. The issue with Microlithiasis • Loosely a/w tumour • Classic microlithiasis - >5/image • ˜5% of normal patient • However, higher rate of malignancy in patient with classic microlithiasis
  • 7.
  • 8. Features • Seminoma: Homogenous, hypoechoic w/out calcification or cystic area • NSGCT: Heterogeneous (cystic area) with calcification • Mixed germ cell: May involute aka “burned- out”; outstrips blood supply then regress in size • Lymphoma: Diffusely hypoechoic with focal mass with vascularity within
  • 10. NSGCT
  • 13. Non-tumorous Lesion • Infarction: Heterogeneous hypoechoic with lack of internal flow within (avascular) • Hematoma: Ill-defined hypoechoic areas with lack of flow within the areas, shows resolution over 2-4wks • Infection: Increased color flow, shows resolution over 2-4wks
  • 17. • Epidermoid cyst: Well-defined hypoechoic intratesticular mass with “onion ring” appearance – concentric layers. No vascularity.
  • 18.
  • 19. MRI • Seminoma: Homogenous signal • Mixed germ cell: Heterogeneous signal • Teratoma: Bulk fat with signal loss on fat saturated images • Malignant: Enhancement with washed out pattern • Benign: Continuous enhancement which plateaus off