Diagnostic ultrasound ( PDFDrive )

1900 PART V Pediatric Sonography
A SAG LT Testicle B
TRV LT Testicle
FIG. 54.44 Seminoma in 18-Year-Old Patient With Painless Left Scrotal Mass. (A) and (B) Sagittal and transverse sonograms of the left
testis demonstrate a testicular volume of 25 mL, with a lobulated, heterogeneous, relatively hypoechoic mass occupying most of the testis with
a thin rim of normal testis and a few tiny clusters of calciication, as well as multiple tiny echogenicities both inside and outside the mass
(microlithiasis).
A LT TESTIS SAG B
FIG. 54.45 Leydig Cell Tumor in 8-Year-Old Boy With 6-Month History of Precocious Puberty. (A) Sagittal sonogram of left testis demonstrates
a 1.3 × 1.0 × 1.0–cm hypoechoic, well-deined mass with peripheral areas of brighter echogenicity. (B) Color and spectral Doppler demonstrate
arterial low within the mass.
Doppler is useful in the evaluation of testicular tumors, with
degree of vascularity dependent on tumor size. Larger tumors
are usually hypervascular, but tumors less than 1.5 cm in diameter
tend to be avascular or hypovascular. 161 One may demonstrate
tumor vascular displacement or compression or a normal vascular
course. In some cases a tumor may not be obvious on gray-scale
imaging but is obvious with color Doppler imaging. RI determinations
do not aid in diagnosis. 162
he most common primary non–germ cell tumors of the
testes are Leydig cell and Sertoli cell tumors. 163 hese stromal
tumors account for about 10% of testicular neoplasms and are
usually hormone secreting. 157 Leydig cell tumors account for
about 60% of the non–germ cell tumors, and Sertoli cell tumors
about 40%. Leydig cell tumors are typically seen in patients aged
3 to 6 years and produce testosterone, which results in precocious
virilization. Patients with Sertoli cell tumors usually develop
painless masses within the irst year of life. Most are hormonally
inactive, but some secrete estrogen, which results in gynecomastia.
Both these non–germ cell tumors are slow growing and virtually
always benign in prepubertal patients. 151 hese tumors are usually
small, well-circumscribed hypoechoic lesions 103,158 (Fig. 54.45).
In larger lesions, cystic spaces may develop secondary to hemorrhage
and necrosis. Orchiectomy is curative, although tissuesparing
surgery is possible for Leydig cell tumors.
Another rare tumor is the gonadoblastoma, which is found
in phenotypic females with streak gonads or in patients with a
male karyotype and testes. 97,156,157 hese tumors are usually small,
well circumscribed, and hypoechoic. 103,158 In larger lesions, cystic
spaces may develop secondary to hemorrhage and necrosis. hey
are generally benign and are usually found at surgery to remove
intraabdominal dysplastic gonads. 156,164 Other benign testicular
masses include hemangiomas, neuroibromas, lipomas, ibromas,