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73 Cards in this Set
- Front
- Back
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What are the indications for looking at the scrotum
5 |
palpable mass
acute pain chronic pain trauma infertility |
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What are the two types of palpable masses of the scrotum
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intratesticular
extratesticular |
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What is the ddx of an intratesticula solid mass on US
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neoplasm
adrenal rest sarcoid infarct |
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What is the ddx for a intratesticular cystic mass
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cystic teratoma
intratesticular cyst eperdermoid cyst tubular ectasia of rete teste |
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What is the ddx of an intratesticular mass with calcification
4 |
burned out GCT
granulomatous disease post inflam/ischemia test microlithiasis |
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What is the only neoplastic cystic mass
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cystic teratoma
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What is the only neoplastic mass with calcium
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burned out GCT
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What is 9 out 10 causes of a solid intratesticular mass
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neoplasm
(others..adrenal rest, sarcoid and infarct) |
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What is the cause of 90-95% of testicular neoplasm
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GCT (other than teratoma)
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which GCT is more common seminoma or non-seminomatous
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about equal but maybe non-seminomatous is slightly more common.
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What has a better prognosis seminoma or non-seminomatous
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seminoma (highly radiosensitive)
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What percent of seminomas are diagnosed when confined to the testicle
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70% (stage 1)
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Are seminomas malignant
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yes
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Are non- seminomas malignant
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variable, but when they are it is a worse prognosis
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What are 4 examples of non-seminomatous gct
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teratoma, embryonal, endodermal sinus (yolk sac), and choriocarcinoma
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What percent of non-seminomatous tumors are found in stage 2 or 3
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60%
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What is better to have;seminoma or non-seminoma
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seminoma
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What are the US characteristics of a seminoma
3 |
hypoechoic
homogeneous flow on doppler |
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What happens to the US characteristics of a seminoma when a seminoma becomes large
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they become heterogenous when large
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What appears more complex; seminoma or non-seminomatous gct
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non-seminomatous
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What are the US characterisitics of a non-seminomatous GCT
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hetergeneous
cystic change calcification positive doppler flow |
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If a suspect neoplastic mass is seen in the kidney what else should be evaluated
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retroperitoneal and renal hilar LAD
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What percent of neoplastic testicular masses are not GCT and are sex chord stromal tumors
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5-10%
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What are 3 examples of sex chord stromal tumors
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sertoli, leydig, gonadoblastomas
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What percent of sex chord stromal tumors are hormonally active
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30-40
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What percent of sex chord stromal tumors are benign
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90-95%
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Can you distinguished benign from malignant sex chord stromal tumor
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no and all are excised
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What is the most common metastic disease to affect the testes
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lymphoma
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What is the mc bilateral testicular tumor
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lymphoma
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What is the typical age group of a pt with lymphoma to the testicles
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greater than 60y
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What pt are most likely to have leukemia to the testicles
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children
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What percent of children with acute leukemia have testicular mets
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65% (this is known as a sancuary site)
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What are the 2 most common non lymphoma mets to the testicle
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prostate and lung
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In addition to people over 60 years old what other group has an increased incidence of lymphoma
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HIV
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What is the mc type of lymphoma to affect the testicle
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large cell non-hodgkins lymphoma
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Is large cell NHL aggresive
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yes, 90% have disemminated disease at the time of presentation
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What is the US of testicular lyphoma
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mass
bilateral mass diffuse heterogeneous infitrative pattern |
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What is the hallmark of a testicular lymphoma
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it is extremely vascular
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What has a similar appearance to lymphoma
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sarcoid (can be bilat, heterogenous infiltrative
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how is sarcoid differentiated from lymphoma
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clinical history and sarcoid will not be as vascular
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When is an adrenal rest seen in a pts testicles
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this is only in the setting of congenital adrenal hyperplasia
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What is the ddx of a testicular infarct
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prior torsion
inflammatino infection sickle cell disease |
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When does a testicular infarct appear similar to a testicular neoplasm
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during its acute phase (no flow will differentiate this from neoplasm)
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What is the tiger stripe appearance of a prior infarct
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a band of hypoechogenicity with concave margins which looks like a tiger stripe
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What is the ddx for cystic intratesticular masses
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cystic teratoma
intratesticular cyst epidermoid cyst tubular ectasia of retes testes |
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During childhood what accounts for 50% of overall GCT
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cystic teratoma
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When a child presents with a cystic teratoma as a child is malignant
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no, almost always benign
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If a cystic teratoma is seen in an adolescent or adult is it malignant or benign
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it is treated as malignant bc some have a component that is malignant
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Where is a intratesticular cyst commonly located
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along the course of the mediastium
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What is the size of an intratesticular cyst
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2-20mm
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What is the US characteristics of an intratesticular cyst
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unilocular and benign
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Do epidermoid cyst appear cyst like
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no, they have a lot of keratin in them
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What are the US characterisits of an epidermoid cyst
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echogenic rim
onion ring target appearance |
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Are epidermoid cyst benign
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yes
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What causes tubular ectasia of retes testes
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ostructed efflux of retes testes
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What is tubular ectasia of a retes testes associated with
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spermatoceles (almost always)
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What does tubular ectasia of retes testes look like
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tiny tubular cystic spaces.
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How do you differentiate TERT with a malignant process
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non mass effect or flow
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What does TERT mimic
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neoplasm
congenital cystic dysplasia of the testes |
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Do patients with congenital cystic dysplasia of the testes have spermatoceles
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no, they often present with infertility also
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What is a burned out GCT AKA
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azzopardi tumor
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What is the ddx of intratesticular masses with calcifications
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burned out GCT
testicular microlithisis granulomatous dz post inflammaroy/traumatic/ischemic |
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What are granulomatous disease that may form a testicular mass with calcification
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TB, fungal, sarcoid
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Is an azzopardi tumor (burned out GCT) aggressive
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yes, present with wide spread LAD
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What are the US findings in a patient with azzopardi tumor
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single or multifocal coarse calcification
parenchymal heterogenity |
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How do you differentiate testicular microlithiasis from an azzopardi tumor
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the calcificaitons are much more coarse
the parenchyma of the teticle is heterogeneous |
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What does granulomatous disease or post-inflammation/trauma/ischemia calcifications look like on US
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coarse calcifications but with normal echotexture
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What is the criteria for diagnosing testicular microlithiasis
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greater than 5 small calcification per cross sectional image
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where is the calcifications located in testicular microlithiasis
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the seminiferous tubules
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What are 3 congenital anomalies that are associated with testicular microlithiasis
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cryptorchidism
klinefelters pseudohermaphroditism |
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What percent of pts diagnosed with testicular microlithiasis were also found to have testicular neoplasm at the time of diagnosis
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40%
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Does testicular microlithiasis lead to testicular neoplasm
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probably not but it is controversal, some do screening up to urologist.
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What is limited testicular microlithiasis
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less than 5 calcifications per cross sectional image
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