Diagnostic ultrasound ( PDFDrive )

CHAPTER 22 The Scrotum 825
A
B
C
D E F
FIG. 22.6 Nonseminomatous Germ Cell Tumor: Spectrum of Appearances. (A) and (B) Mixed germ cell tumor. (A) Longitudinal scan
shows a large tumor with cystic changes occupying most of the testis and invading the tunica (arrow). (B) Transverse scan shows a heterogeneous,
mixed germ cell tumor that has 85% teratoma elements. (C) Embryonal carcinoma. Longitudinal scan shows relatively homogeneous tumor
(arrow). (D) Yolk sac, or Endodermal sinus tumor. Longitudinal scan shows a mildly heterogenous tumor extending to the mediastinum (arrow).
(E) Teratoma. Longitudinal scans shows a large heterogeneous mass with cystic foci and scattered calciications. (F) Choriocarcinoma. Longitudinal
scan shows a relatively homogeneous tumor (arrows).
A
B
FIG. 22.7 Occult Testicular Seminoma With Retroperitoneal Metastases. (A) Contrast-enhanced CT scan shows extensive retroperitoneal
adenopathy from seminoma. (B) Longitudinal sonographic scan shows occult homogeneous hypoechoic seminoma. The physical examination of
the testis was negative.
tumor outgrowing its blood supply. Tumors are typically clinically
occult with the afected testis normal or small on palpation.
Histologic analysis may reveal no residual tumor, although
intratubular malignant germ cells may be present. 25,28,54 hese
lesions, also known as “Azzopardi tumors,” have a variable
sonographic appearance; they can be hypoechoic or hyperechoic
or seen as focal calciications. Although sonographic appearance
is not speciic for a “burned-out” or regressed tumor, indings
are suggestive in the context of histologically proven testicular
metastases. 56
Non–Germ Cell Tumors
Sex Cord–Stromal Tumors. Sex cord–stromal tumors
account for 3% to 6% of all testicular neoplasms. he prevalence
is greater in the pediatric population where non–germ cell tumors
account for 10% to 30% of all testicular neoplasms. he term