Diagnostic ultrasound ( PDFDrive )

840 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
A
B
C
D
E
F
G H I
FIG. 22.23 Extratesticular Scrotal Solid Masses: Spectrum of Appearances. (A) Fibrous pseudotumor. Transverse scan shows a mass
of mixed echogenicity lateral to and separate from the testis. (B) Fibrous pseudotumor. Longitudinal scan shows a lamellated extratesticular
mass (arrow) with a central echogenic focus adjacent to the tunica of the testis (T). (C) Benign adenomatoid tumor of epididymis. Longitudinal
scan shows a hypoechoic mass (arrow) in the epididymal tail separate from the testis (T). (D) Spermatic cord lipoma. Longitudinal scan shows
an echogenic mass superior to the epididymis and testis, along the spermatic cord. (E) Liposarcoma. Transverse scan shows a large heterogeneous
mass (arrow) deep to the testis (T) in the scrotal wall or spermatic cord. (F) Liposarcoma. Contrast-enhanced axial CT image shows a heterogeneous
mass containing fat and solid components (arrow) associated with the spermatic cord in patient E, consistent with a liposarcoma. (G) Leiomyoma
of cord. Longitudinal scan shows a solid mass superior to the testis. (H) Rhabdomyosarcoma. Longitudinal extended–ield of view scan in a
12-year-old shows a large, paratesticular mass inferior to the testis. (I) Metastasis from lung carcinoma. Longitudinal scan shows a heterogenous
mass with calciications in the tail of the epididymis.
Tumors
he most common epididymal neoplasm is the benign adenomatoid
tumor, which accounts for approximately 30% of all
paratesticular neoplasms, second only to lipoma. 28 Although
most frequently located in the tail (see Fig. 22.23C), adenomatoid
tumors may occur anywhere in the epididymis and have also
been reported in the spermatic cord, as well as the tunica
albuginea, where they may grow intratesticularly. Adenomatoid
tumor may occur at any age but most oten afects patients aged
20 to 50 years. 3,145 Adenomatoid tumors are generally unilateral,
solitary, well deined, and round or oval, rarely measuring more
than 5 cm in diameter. Occasionally, they may appear plaquelike
and poorly deined. Sonography usually shows a solid,
well-circumscribed mass with echogenicity that is at least as
great as the testis, 3 although they may also be hypoechoic.
Other benign extratesticular tumors are rare and include
lipomas (see Fig. 22.23D), leiomyomas (see Fig. 22.23G),
ibromas, hemangiomas, neuroibromas, and cholesterol
granulomas. Adrenal rests may also be encountered in the
spermatic cord, testis, epididymis, rete testis, and tunica albuginea,
typically in the setting of CAH.
Papillary cystadenoma of the epididymis is a rare tumor
with a strong association with von Hippel–Lindau disease. Up
to 40% of cystadenomas are bilateral, a inding that is virtually
pathognomic for von Hippel–Lindau disease. hese tumors are
benign epithelial tumors of the epididymis, occurring in the