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| Line 533: |
Line 533: |
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| |} | | |} |
| {| class="wikitable"
| |
| ! Disease Name
| |
| ! History and Symptoms
| |
| ! Physical Examination
| |
| ! Lab Findings
| |
| ! Imaging Findings
| |
| ! Gross and Histologic Findings
| |
| ! Genetic Studies / Immunohistochemistry
| |
| |-
| |
| | colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Germ Cell Tumors'''}}
| |
| |-
| |
| | align="center" |
| |
| '''[[Seminoma]]'''
| |
| | valign="top" |
| |
| *Most common
| |
| *30-50 year-old with painless unilateral testicular mass or mild discomfort
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Usually homogeneous enlargement
| |
| | valign="top" |
| |
| *Elevated serum placental ALP (PALP)
| |
| | valign="top" |
| |
| *Hypoechogenic intratesticular well-defined mass on ultrasound with internal blood flow on Doppler ultrasound
| |
| *Cysts and calcificications are uncommon
| |
| *Hypointense lesion with inhomogeneous enhancement on MRI
| |
| *Homogeneous when small and heterogeneous when large
| |
| | valign="top" |
| |
| *Grey-white homogeneous mass with a lobular appearance
| |
| *Fried egg appearance on histopathology (large cells and clear cytoplasm)
| |
| *Prominent lymphocytic infiltration and less commonly, granulomatous formation
| |
| | valign="top" |
| |
| *Stains positively for ALP, c-KIT, CD30, EMA, and glycogen
| |
| |-
| |
| | align="center" |
| |
| '''[[germ cell tumor|Embryonal cell carcinoma]]'''
| |
| | valign="top" |
| |
| *Young adults
| |
| *Painful testicular mass
| |
| *Manifests with early mestastasis (bone, lung, CNS)
| |
| | valign="top" |
| |
| * Often unremarkable (small primary tumor)
| |
| | valign="top" |
| |
| *Elevated serum hCG
| |
| *Elevated serum AFP, when mixed
| |
| | valign="top" |
| |
| *Variable echogenicity (usually hypoechoic on ultrasound)
| |
| *No differentiating features on imaging
| |
| *Commonly invade the surrounding structures (tunica albuginea)
| |
| *Irregular calcifications
| |
| | valign="top" |
| |
| *Pale-grey mass with areas of hemorrhagic and necrosis
| |
| *Often mixed histopathological features (solid, papillary, tubular, pseudoglandular)
| |
| | valign="top" |
| |
| *Stains positively for CD30 and hCG stain
| |
| *May stain positively for AFP, when mixed
| |
| |-
| |
| | align="center" |
| |
| '''[[Yolk sac tumor]]'''
| |
| | valign="top" |
| |
| * Most common testicular cancer in children less than 3 years of age
| |
| *Rapidly growing unilateral mass in an infant or a young child
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Usually heterogeneous enlargement
| |
| | valign="top" |
| |
| *Elevated serum AFP
| |
| | valign="top" |
| |
| *Diffuse enlargement of the testis with a heterogeneous appearance on ultrasound
| |
| *Areas of hemorrhage and necrosis on MRI
| |
| | valign="top" |
| |
| *Yellow, mucinous, non-encapsulated, heterogeneous mass with areas of necrosis and hemorrhage
| |
| *Patterns that resemble embryonal structures (yolk sac, allantois) with reticular, papillary, or elongated forms
| |
| *Schiller-Duval bodies (perivascular structures)
| |
| | valign="top" |
| |
| *Stains positively for AFP, alpha-1-antitrypsin, PAS diastase
| |
| |-
| |
| | align="center" |
| |
| '''[[Teratoma]]'''
| |
| | valign="top" |
| |
| *Bimodal distribution of age (infants and middle aged adults)
| |
| *Painless tumor
| |
| *History of congenital disease (Down syndrome, klinefelter, spina bifida)
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Usually heterogeneous enlargement
| |
| | valign="top" |
| |
| *Elevated serum hCG
| |
| *Elevated serum AFP
| |
| | valign="top" |
| |
| *Heterogeneous, cystic appearance with mucinous or sebaceous depositions
| |
| *Variable echogenicity on ultrasound
| |
| *Calcifications usually irregular
| |
| | valign="top" |
| |
| *Large, heterogeneous appearance with solid, cystic, mucoid, and/or cartilageanous components
| |
| *Presence of at least 2 germ layers
| |
| | valign="top" |
| |
| *Chromosome 12p mutations
| |
| *Stains positively for cytokeratin. hCG, and AFP
| |
| |-
| |
| | align="center" |
| |
| '''[[teratoma|Teratocarcinoma]] '''
| |
| | valign="top" |
| |
| *Middle aged adult with painless testicular mass of mild discomfort
| |
| *May manifest with features of metastasis
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Usually heterogeneous enlargement
| |
| | valign="top" |
| |
| *Elevated serum hCG
| |
| *Elevated serum AFP
| |
| | valign="top" |
| |
| *Variable echogenicity on ultrasound
| |
| | valign="top" |
| |
| *Features of both teratoma and embryonal carcinoma (more common) or both teratoma and choriocarcinoma (less common)
| |
| *Solid and cystic components with mucoid, cartilagenous, sebaceous gland, myxoid stroma components
| |
| *Additional features of underlying embryonal carcinoma or choriocarcinoma
| |
| | valign="top" |
| |
| *Stains positively for cytokeratin. hCG, AFP, and CD30
| |
| |-
| |
| | align="center" |
| |
| '''[[Choriocarcinoma]]'''
| |
| | valign="top" |
| |
| *Adolescent or young adult with extratesticular symptoms
| |
| *Mass is small and locally asymptomatic
| |
| *Manifests with early metastasis and signs of hemorrhage (hemorrhagic stroke, hyperthyroidism, cannon-ball metastasis in lung, liver involvement, neurological deficits)
| |
| | valign="top" |
| |
| *Often unremarkable (small primary tumor)
| |
| | valign="top" |
| |
| *Elevated serum hCG
| |
| | valign="top" |
| |
| *Variable echogenicity
| |
| *No differentiating features on imaging
| |
| *Commonly invade the surrounding structures (tunica albuginea)
| |
| | valign="top" |
| |
| *Prominent areas of hemorrhage and necrosis
| |
| *Nest and sheet pattern that simultaneously includes both cytotrophoblast and syncytiotrophoblast (rarely pure)
| |
| *Paucity of intermediate trophoblasts (unlike placental site trophoblastic tumor)
| |
| | valign="top" |
| |
| *Stains positively for hCG
| |
| |-
| |
| | align="center" |
| |
| '''[[Germ cell tumor|Diffuse embryoma]]'''
| |
| | valign="top" |
| |
| *20-25 yo man with painful testicular mass
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| | valign="top" |
| |
| *Elevated serum hCG
| |
| *Elevated serum AFP
| |
| | valign="top" |
| |
| *Poorly-defined, heterogeneous hyperechoic mass on ultrasound
| |
| | valign="top" |
| |
| *Non-encapsulated mass
| |
| *Intermingled (lace-like) embryonal carcinoma and yolk sac components in equal proportions, but no discrete embyoid bodies
| |
| *Scattered trophoblastic components
| |
| *Necklace-like arrangement of cells
| |
| | valign="top" |
| |
| *Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
| |
| |-
| |
| | align="center" |
| |
| '''[[Polyembryoma]]'''
| |
| | valign="top" |
| |
| *20-25 yo man with painful testicular mass
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| | valign="top" |
| |
| *Elevated serum AFP
| |
| *Elevated serum hCG
| |
| | valign="top" |
| |
| *Poorly-defined, heterogeneous hyperechoic mass on ultrasound
| |
| | valign="top" |
| |
| *Multiple discrete embyoid bodies (combination of both embryonal carcinoma and yolk sac components)
| |
| | valign="top" |
| |
| *Stains positively for cytokeratin, AFP (yolk sac component), and CD30 (embyonal component)
| |
| |-
| |
| | align="center" |
| |
| '''[[Placental site trophoblastic tumor]]'''
| |
| | valign="top" |
| |
| *Infant or young adult
| |
| *Painful small testicular mass
| |
| | valign="top" |
| |
| *Small nontender or minimally painful testicular mass
| |
| | valign="top" |
| |
| *Elevated serum hCG
| |
| | valign="top" |
| |
| *Variable echogenicity
| |
| *No differentiating features on imaging
| |
| *May have vascular flow
| |
| | valign="top" |
| |
| *Solid yellowish mass that resembles uterine tissue
| |
| *Less prominent foci of hemorrhage and ncerosis
| |
| *Predominance of intermediate trophoblast cells (implantation-site type) that invade surrounding blood vessels
| |
| *Paucity of cytotrophoblast and syncytiotrophoblast cells (unlike choriocarcinoma)
| |
| | valign="top" |
| |
| *Stains positively for hPL (diffuse), cytokeratin, AFP, and hCG (patchy)
| |
| *Negative p63 staining
| |
| |-
| |
| | align="center" |
| |
| '''[[Epithelioid trophoblastic tumor]]'''
| |
| | valign="top" |
| |
| *Infant or young adult
| |
| *Painful small testicular mass
| |
| | valign="top" |
| |
| *Small nontender or minimally painful testicular mass
| |
| | valign="top" |
| |
| *Elevated serum hCG
| |
| | valign="top" |
| |
| *Variable echogenicity
| |
| *No differentiating features on imaging
| |
| *May have vascular flow
| |
| | valign="top" |
| |
| *Solid yellowish mass that resembles uterine tissue
| |
| *Less prominent foci of hemorrhage and ncerosis
| |
| *Predominance of intermediate trophoblast cells (implantation-site type) that invade surrounding blood vessels
| |
| *Paucity of cytotrophoblast and syncytiotrophoblast cells (unlike choriocarcinoma)
| |
| | valign="top" |
| |
| *Stains positively for p63 (diffuse), p63, cytokeratin, AFP, and hCG (patchy)
| |
| *Negative hPL staining
| |
| |-
| |
| | align="center" |
| |
| '''[[germ cell tumor|Mixed germ cell tumor]]'''
| |
| | valign="top" |
| |
| *Typical age at diagnosis and other clinical features based on underlying components
| |
| | valign="top" |
| |
| *Physical exam findings based on underlying components
| |
| | valign="top" |
| |
| *Elevated serum hCG, AFP, and/or PALP dependeing on the underlying compoenents
| |
| | valign="top" |
| |
| *Imaging findings based on underlying components
| |
| | valign="top" |
| |
| *Histopathological findings based on underlying components
| |
| *Variable proportion of choriocarcinoma, embryonal cell carcinoma, yolk sac tumor, seminoma, and/or teratoma tissue
| |
| | valign="top" |
| |
| *May stain positively for any of CD30, hCG, AFP, ALP, c-KIT, CD30, EMA, alpha-1-antitrypsin, PAS diastase, and glycogen depending on underlying compoenents
| |
| |-
| |
| | align="center" |
| |
| '''[[Carcinoid|Carcinoid<br>(pure neuroendocrine neoplasm)]]'''
| |
| | valign="top" |
| |
| *Middle-aged and elderly adult
| |
| *Manifests as a minimally painful, rapidly growing mass
| |
| *May manifest as carcinoid syndrome
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| *Hydrocele or cryptorchidism
| |
| | valign="top" |
| |
| *Elevated serum and urine 5-HIAA if carcinoid syndrome present
| |
| | valign="top" |
| |
| *Unilateral, well-circumscribed mass without vascular invasion
| |
| *Solid and cystic appearance
| |
| *Mixed echogenicity on ultrasound
| |
| *Irregular calcifications
| |
| | valign="top" |
| |
| *Well-circumscribed, yellowish solid mass
| |
| *Occasional cystic masses
| |
| *Small acini, cord-forming rosettes, prominent cytoplasmic granularity
| |
| *Salt and pepper chromatic pattern
| |
| *Absent features of atypia
| |
| *Neurosecretory granules on electron microscopy
| |
| | valign="top" |
| |
| *Stains positively for cytokeratin, serotonin, chromogranin, synaptophysin, and CD56
| |
| |-
| |
| | align="center" |
| |
| '''[[PNET|PNET<br>(Ewing's tumor of the testes)]]'''
| |
| | valign="top" |
| |
| *30-50 yo man with rapidly enlarging mass
| |
| *Often metastatic at presentation
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *No differentiating features on imaging
| |
| *Vascular flow on Doppler
| |
| | valign="top" |
| |
| *Greyish necrotic mass of immature neural tissue
| |
| *Sheet-like / rosette distribution of small round blue tumor cells
| |
| *Neurosecretory granules on electron microscopy
| |
| | valign="top" |
| |
| *Stains positively for synaptophysin, NSE, chromogranin, CD99, GFAP, FLI1
| |
| *Split of EWS gene on chromosome 22
| |
| |-
| |
| | colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Sex-cord stromal tumors'''}}
| |
| |-
| |
| | align="center" |
| |
| '''[[Fibroma]]'''
| |
| | valign="top" |
| |
| *Middle-aged adult (range 20-70 years) with slowly-growing, painless testicular mass
| |
| *History of nevoid basal cell carcinoma (Gorlin syndrome)
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Isoechoic mass on ultrasound with prominent acoustic shadowing (fibrous component)
| |
| *May be homogeneous or heterogeneous
| |
| *Margins often blended with the tunica albuginea
| |
| *No vascular flow on Dopper
| |
| | valign="top" |
| |
| *Well-circumscribed, often non-encapsulated solid pale yellow mass
| |
| *No hemorrhage, no necrosis
| |
| *Pure fibromatous features of collagenized plaques and spindle cells that synthesize collagen.
| |
| *Low cellularity
| |
| | valign="top" |
| |
| *Mutation in ''PTCH'' gene
| |
| *Positive staining for calretinin, inhibin, CD56, CD34, actin, vimectin
| |
| *Usually (but not always) negative staining for S-100, keratin, CD99/MIC-2, and desmin
| |
| |-
| |
| | align="center" |
| |
| '''[[Granulosa cell tumor]]'''
| |
| | valign="top" |
| |
| *Young or middle-aged adult (adult-type) or infant/child (juvenile-type) patient with slowly-enlarging painless testicular mass
| |
| *May manifest with symptoms of metastasis or hormonal secretion (e.g. gynecomastia in estrogen-secreting tumors)
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Hypoechoic mass with solid and cystic appearance on ultrasound (swiss-cheese appearance)
| |
| | valign="top" |
| |
| *Well-circumscribed tumor between the seminiferous tubules
| |
| *May be solid, cystic, of lobular
| |
| *Pseudo-capsule
| |
| *No hemorrhage, no necrosis
| |
| *Elongated grooved nuclei (coffee-bean appearance)
| |
| *Call-Exner bodies
| |
| *Variable atypia
| |
| | valign="top" |
| |
| *Stains positively for calretinin, inhibin, vimentin, actin, and MIC2
| |
| |-
| |
| | align="center" |
| |
| '''[[leydig cell tumor|Leydig (interstitial) cell tumor]]'''
| |
| | valign="top" |
| |
| *Bimodal age distribution
| |
| *Slowly enlarging painless unilateral mass
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Signs of excess estradiol (e.g. gynecomastia)
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Well-defined, hypoechoic solid mass on ultrasound
| |
| *May have cystic component
| |
| *Irregular calcifications
| |
| | valign="top" |
| |
| *Well-circumscribed, unencapsulated solid mass
| |
| *Yellowish-brown tumor
| |
| *May have cystic, hemorrhagic, or necrotic areas
| |
| *Often dffuse growth of large polygonal Leydig cells, but may have unique patterns of growth
| |
| *Vacuolated cells with marked atypia
| |
| *Reinke crystals
| |
| *Psammoma bodies
| |
| | valign="top" |
| |
| *Mutation in fumarate hydratase
| |
| *Stains positively for inhibin, cytokeratin, calretinin, synaptophysin, vimentin, Melan-A
| |
| |-
| |
| | align="center" |
| |
| '''[[sertoli cell|Sertoli hyperplasia<br>(Sertoli adenoma, Pick's adenoma)]]'''
| |
| | valign="top" |
| |
| *Child or young adult with history of Peutz-Jegher syndrome, androgen insensitivity syndrome, or McCune Albright syndrome
| |
| *Slowly enlarging painless bilateral masses
| |
| | valign="top" |
| |
| *Palpable, nontender bilateral testicular masses
| |
| *Signs of excess estradiol (e.g. gynecomastia)
| |
| | valign="top" |
| |
| *Elevated serum estradiol
| |
| *Elevated anti-Mullerian hormone and inhibin B
| |
| *Reduced androgen concentration
| |
| | valign="top" |
| |
| *Hyperechogenic nodules on ultrasound
| |
| | valign="top" |
| |
| *Well-demarcated yellowish nodules in the testis
| |
| *Unencapsulated nodules composed of Sertoli cells
| |
| | valign="top" |
| |
| *Stains positively for anti-Mullerian hormone, inhibin A, CK8, and CK18
| |
| *Negative staining for AFP, hCG, and p53
| |
| |-
| |
| | align="center" |
| |
| '''[[sertoli cell|Large cell calcifying Sertoli cell tumor]]'''
| |
| | valign="top" |
| |
| *Young patient with history of Carney syndrome, Peutz-Jeghers syndrome, or tuberous sclerosis
| |
| *Slowly enlarging painless unilateral/bilateral mass(es)
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral or bilateral testicular mass
| |
| *Signs of excess estradiol (e.g. gynecomastia)
| |
| | valign="top" |
| |
| *Elevated serum estradiol
| |
| | valign="top" |
| |
| *Diffuse and regular (smooth, rounded, large) calcifications
| |
| *Variable appearance on ultrasound
| |
| *Often multiple hyperechogenic regions with strong shadowing
| |
| *Possible increased blood flow
| |
| | valign="top" |
| |
| *Multifocal, well-circumscribed yellowish-grey nodules
| |
| *Absent hemorrhage or necrosis
| |
| *Patterrns (sheet or trabeculae) of large cells and formation of solid tubules
| |
| *Psammoma bodies
| |
| *Charcot Bottcher crystals on electron microscopy
| |
| | valign="top" |
| |
| *Stains positively for inhibin, vimentin, calretinin, S100, and cytokeratin
| |
| *Negative staining for laminin, PALP, AFP, and hCG
| |
| |-
| |
| | align="center" |
| |
| '''[[Sertoli-Leydig cell tumor|Sclerosing Sertoli cell tumor]]'''
| |
| | valign="top" |
| |
| *Variable age at presentation (adolescence to elderly)
| |
| *Slowly enlarging painless unilateral mass
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Well-circumscribed hypoechogenic lesion on ultrasound
| |
| | valign="top" |
| |
| *Well-circumscribed, yellowish-grey nodule
| |
| *Absent hemorrhage or necrosis
| |
| *Tubuules and cords of Sertoli cells surrounded by hypocellular collagenous strome (sclerosis)
| |
| | valign="top" |
| |
| *Stains positively for calretinin, inhibin, and vimentin
| |
| *Negative staining for cytokeratin, AFP, and hCG
| |
| |-
| |
| | align="center" |
| |
| '''[[Sertoli-Leydig cell tumor|Sertoli tumor, non-specific]]'''
| |
| | valign="top" |
| |
| *Bimodal age districution: either 40-50 year old man or infants with history of Carney syndrome or Peutz-Jegher syndrome
| |
| *Slowly enlarging testicular mass
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Signs of excess estradiol (e.g. gynecomastia)
| |
| | valign="top" |
| |
| *Often unremarkable
| |
| *Elevated serum estradiol may be present, less common
| |
| | valign="top" |
| |
| *Well-circumscribed mass with variable echogenicity
| |
| | valign="top" |
| |
| *Well-circumscribed, yellowish-grey nodule
| |
| *Hemorrhage and necrosis may be present, but uncommon
| |
| *Features of fetal, prepubertal, and adult Sertoli cells present simultaneously
| |
| *Charcot Bottcher crystals on electron microscopy
| |
| | valign="top" |
| |
| *Stains positively for vimentin, cytokeratin, inhibin, S100, chromogranin, synaptophysin, and CD99
| |
| *Negative staining for hCG, AFP, and PLAP
| |
| |-
| |
| | align="center" |
| |
| '''[[Sertoli-Leydig cell tumor|Sertoli-Leylig cell tumor (SLCT)]]'''
| |
| | valign="top" |
| |
| *Young adult or phenotypic female with history of androgen insensitivity
| |
| *Slowly enlarging painless unilateral mass
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Signs of excess estradiol (e.g. gynecomastia)
| |
| | valign="top" |
| |
| *Often unremarkable
| |
| *Elevated serum estradiol may be present, less common
| |
| *Abrnomally elevated testosterone among pts with androgen insensitivity
| |
| | valign="top" |
| |
| *Well-circumscribed mass with variable echogenicity
| |
| *Solid mass with intratumoral cysts may be present
| |
| | valign="top" |
| |
| *Heterogeneous, lobulated, encapsulated yellowish solid mass
| |
| *Mass contains combination of Sertoli cells and Leydig cells
| |
| *Poorly differentiated cells (immature tubules of Sertoli cells, large Leydig cells)
| |
| | valign="top" |
| |
| *Stains positively for inhibin, melanA, and CD99
| |
| *Negative staining for EMA, PLAP, and S100
| |
| |-
| |
| | align="center" |
| |
| '''[[CAH|Testicular tumor of andrenogenital syndrome<br>(testicular adrenal rest tumor)]]'''
| |
| | valign="top" |
| |
| *Post-pubertal patient with history of congenital adrenal hyperplasia (CAH)
| |
| *Often asymptomatic, detected during screening in patients with CAH
| |
| | valign="top" |
| |
| *Unremarkable testicular exam
| |
| *Other signs of congenital adrenal hyperplasia
| |
| | valign="top" |
| |
| *Elevated 11-beta-hydroxylase activity
| |
| *Reduced concentrations of AFP, LDH, and hCG
| |
| | valign="top" |
| |
| *Uniform hypoechogenicity on ultrasound
| |
| *Usually multifocal and bilateral lesions
| |
| | valign="top" |
| |
| *Hyperplasia, bilateral lesions in testicular hilum
| |
| *Yellowish nodules
| |
| *Cells resemble adrenocortical cells, no mitoses
| |
| *Normal surrounding tissue
| |
| *Absent Reinke crystals
| |
| | valign="top" |
| |
| *Stains positively for CD56, synaptophysin, and inhibin
| |
| *Negative staining for androgen receptor protein
| |
| |-
| |
| | colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Other tumors'''}}
| |
| |-
| |
| | align="center" |
| |
| '''[[Lymphoma]]'''
| |
| | valign="top" |
| |
| *Elderly patient (>60 years) with history of lymphoma (commonly diffuse large B cell lymphoma)
| |
| *Unilateral or bilateral painless testicular mass
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral or bilateral testicular mass
| |
| | valign="top" |
| |
| *Depends on lymphoma subtype
| |
| | valign="top" |
| |
| *Diffuse infiltration
| |
| *Hypoechoic solid masses on ultrasound
| |
| *Hypervascularity on Doppler ultrasound
| |
| | valign="top" |
| |
| *Whitish-tan colored mass
| |
| *Large, pleomorphic malignant cells
| |
| *Seminiferous tubules may be spared or undergo sclerosis
| |
| *Vascular invasion
| |
| | valign="top" |
| |
| *Stains positively for CD45
| |
| *Depends mainly on lymphoma subtype
| |
| *Usually negative staining for PLAP and SALL4
| |
| |-
| |
| | align="center" |
| |
| '''[[Angiosarcoma]]'''
| |
| | valign="top" |
| |
| *Bimodal age distribution
| |
| *Young man with history of teratoma or elderly man with history of radiation or chronic hydrocele
| |
| *Painless/painful testicular mass
| |
| | valign="top" |
| |
| *Tender or non-tender testicular mass
| |
| *Low-grade fever
| |
| *Scrotal swelling
| |
| *Flank pain
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *Often unremarkable
| |
| | valign="top" |
| |
| *Hypervascularity on Doppler ultrasound
| |
| | valign="top" |
| |
| *Solid vascular lesion
| |
| *Classical pattern of proliferating anastomosing blood-filled channels
| |
| *2 patterns: solid (sheet proliferation without lumen) and primitive (small lumina filled withblood)
| |
| | valign="top" |
| |
| *Stains positively for CD31, CD34, lectin, and factor VIII-related antigen
| |
| *Negative staining for pancytokeratin, PLAP, CD45, CD68, CAM5.2, and AE1/AE3
| |
| |-
| |
| | align="center" |
| |
| '''[[Chondrosarcoma]]'''
| |
| | valign="top" |
| |
| *Young or middle-aged adult with history of teratoma
| |
| *Painless testicular mass
| |
| | valign="top" |
| |
| *Palpable, non-tender, heterogeneous mass
| |
| | valign="top" |
| |
| *Often unremarkable
| |
| | valign="top" |
| |
| *Lobulated mass
| |
| | valign="top" |
| |
| *Firm, grey mass with irregular lobulations
| |
| *Cartilaginous (chondroid) matrix surrounded by fibrovascular bands
| |
| *Most have non-cartilagenous components (rarely pure)
| |
| | valign="top" |
| |
| *Stains positively for S100
| |
| |-
| |
| | align="center" |
| |
| '''[[Hemangioma]]'''
| |
| | valign="top" |
| |
| *Painless testicular mass among pts of any age
| |
| | valign="top" |
| |
| *Palpable, non-tender, homogeneous mass
| |
| | valign="top" |
| |
| *Often unremarkable
| |
| | valign="top" |
| |
| *Homogeneous hypoechoic mass
| |
| *Hypervascularity on Doppler ultrasound
| |
| | valign="top" |
| |
| *Well-defined hemorrhagic mass
| |
| *Red blood cells in tubules
| |
| | valign="top" |
| |
| *Stains positively for CD31, CD34, FLI1, and factor VIII-related antigen
| |
| *Negative staining for pancytokeratin, AE, keratin, PLAP, and EMA
| |
| |-
| |
| | align="center" |
| |
| '''[[Mesothelioma]]'''
| |
| | valign="top" |
| |
| *Middle aged man with painless testicular mass and history of hydrocele or exposure to asbestos
| |
| | valign="top" |
| |
| *Palpable, non-tender testicular mass
| |
| *Scrotal swelling
| |
| | valign="top" |
| |
| *Often unremarkable
| |
| | valign="top" |
| |
| *Thickening of tunica vaginais
| |
| *Solid paratesticular mass
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *May be benign or malignant
| |
| *Papillary patterns of uniform epithelioid cells with fibrovacular core
| |
| *Polygonal cells with microvilli on electron microscopy
| |
| *Psammoma bodies
| |
| | valign="top" |
| |
| *Benign: stains positively for p53 (focal) and CEA
| |
| *Malignant: Stains positively for calretinin, WT1, EMA, thrombomodulin, CK5, CK6, CK7 and negative staining for CEA and CK20
| |
| |-
| |
| | align="center" |
| |
| '''[[Plasmacytoma]]'''
| |
| | valign="top" |
| |
| *Adult (of any age) with concurrent or history of plasma cell neoplasia (commonly multiple myeloma)
| |
| *Symptoms of multiple myeloma (e.g. fatigue, back pain)
| |
| | valign="top" |
| |
| *Testicular exam unremarkable
| |
| | valign="top" |
| |
| *Lab findings of plasmacytosis (e.g. anemia, elevated creatinine, hypercalcemia)
| |
| *No specific lab finding for testicular involvement
| |
| | valign="top" |
| |
| *Poorly circumscribed hypoechoic lesions on ultrasound
| |
| *Hypervascularity on Doppler ultrasound
| |
| | valign="top" |
| |
| *Large, tan-yellow mass
| |
| *Areas of hemorrahge
| |
| *Atypical plasma cells
| |
| *Tubule effacement in the center and tubule sparing in the periphery
| |
| | valign="top" |
| |
| *Positive staining for EMA, CD45, CD79am CD138, kappa or lambda light chains, and other plasma cell markers
| |
| |-
| |
| | align="center" |
| |
| '''[[AIDS|AIDS-related testicular cancer]]'''
| |
| | valign="top" |
| |
| *Commonly testicular lymphoma or germ cell tumor
| |
| *Patient with history of AIDS presents with testicular swelling or pain
| |
| *Systemic manifestations of underlying malignancy
| |
| | valign="top" |
| |
| *Palpable testicular mass that may be tender or non-tender
| |
| | valign="top" |
| |
| *Depends on underlying malignancy
| |
| | valign="top" |
| |
| *Depends on underlying malignancy
| |
| | valign="top" |
| |
| *Depends on underlying malignancy
| |
| | valign="top" |
| |
| *Depends on underlying malignancy
| |
| |-
| |
| | colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Non-neoplastic mass'''}}
| |
| |-
| |
| | align="center" |
| |
| '''[[adrenal cortex|Adrenal cortical rest]]'''
| |
| | valign="top" |
| |
| *Usually asymptomatic (incidental finding)
| |
| *Young man with scrotal swelling and dull pain
| |
| *History of congenital adrenal hyperplasia (hydroxylase deficiency)
| |
| | valign="top" |
| |
| *Scrotal swelling
| |
| | valign="top" |
| |
| *May be unremarkable
| |
| *If secretory, elevated concentration of adrenal hormone
| |
| | valign="top" |
| |
| *Heterogeneous, well-circumscribed hypoechoic mass on ultrasound
| |
| *No or minimal vascularity on Doppler
| |
| *No distinguishing features
| |
| | valign="top" |
| |
| *Well-circumscribed, small, round, orange-yellow nodule
| |
| *Adrenal cortical tissue with absence of adrenal medullary tissue
| |
| | valign="top" |
| |
| *Positive staining for markers of cortical adrenal tissue
| |
| |-
| |
| | align="center" |
| |
| '''[[filariasis|Chylocele]]'''
| |
| | valign="top" |
| |
| *Scrotal swelling in a man with history of filariasis / elephantiasis
| |
| | valign="top" |
| |
| *Scrotal swelling
| |
| *Negative trans-illumination test
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Fluid collection surrounding the testes
| |
| | valign="top" |
| |
| *Milky chylous fluid (not waterry) on aspiration
| |
| *Usually no evidence of microfliariae in chylous fluid
| |
| *Abundant leukocytes
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Congenital cystic dysplasia|Cystic dysplasia]]'''
| |
| | valign="top" |
| |
| *Young child with history of renal agenesis / dysplasia
| |
| *May be unilateral or bilateral, painless testicular mass
| |
| | valign="top" |
| |
| *Palpable, non-tender testicular mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Irregular cystic spaces witht varying sizes
| |
| *Absence of solid or vascular components
| |
| | valign="top" |
| |
| *Varying cystic spaces
| |
| *Formation of incomplete connective tissue septa
| |
| *Cells resembling the normal adult rete testes
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Dermoid cyst]]'''
| |
| | valign="top" |
| |
| *Young or middle aged adult with slowly growing painless mass
| |
| *Ruptured cyst may manifest with scrotal swelling, erythema, and pain
| |
| | valign="top" |
| |
| *Palpable, nontender unilateral testicular mass
| |
| *Usually heterogeneous enlargement
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Onioin-skin appearance on ultrasound
| |
| *Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound
| |
| *No vacular flow on Doppler
| |
| | valign="top" |
| |
| *Mature epithelial tissue
| |
| *May have hair (similar to teratoma)
| |
| *Keratin filled cyst
| |
| *Epidermal epithelium surrounded by pilosebaceious units
| |
| *Formation of lipogranulomas and microcalcifications
| |
| *Absence of atypia
| |
| | valign="top" |
| |
| *Absence of any mutation (normal 12p)
| |
| *Stains positively for cytokeratin
| |
|
| |
|
| |-
| |
| | align="center" |
| |
| '''[[Epidermoid cyst|Epidermoid cyst<br>(keratocyst)]]'''
| |
| | valign="top" |
| |
| *10-40 yo
| |
| *Painless slowly growing testicular mass
| |
| *Ruptured cyst may manifest with scrotal swelling, erythema, and pain
| |
| | valign="top" |
| |
| *Palpable, non-tender testicular mass
| |
| *Usually heterogeneous enlargement
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Onioin-skin appearance on ultrasound
| |
| *Target-shape lesions with halo of hypoechonicity and central hyperechogenicity on ultrasound
| |
| *No vacular flow on Doppler
| |
| | valign="top" |
| |
| *Absence of dermal structures, such as hair, sebaceous glands etc. (found in dermoid cyst)
| |
| *Cyst with white keratin debris
| |
| *Lined by squamous epithelium
| |
| *Laminated keratin
| |
| *Granuloma when cyst ruptures
| |
| | valign="top" |
| |
| *Absence of any mutation (normal 12p)
| |
| |-
| |
| | align="center" |
| |
| '''[[orchitis|Granulomatous orchitis]]'''
| |
| | valign="top" |
| |
| *40-60 yo man with sudden-onset testicular tenderness and mass formation
| |
| *History of infection, sarcoidosis, or testicular trauma
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| *Fever
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Solid hypoechoic mass
| |
| | valign="top" |
| |
| *Solid nodule
| |
| *Lymphocytic infiltration and formation of giant cells and macrophages
| |
| *Not true granuloma
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Hematocele]]'''
| |
| | valign="top" |
| |
| *Scrotal mass in patients with history of testicular trauma, torsion, or increased bleeding tendency
| |
| | valign="top" |
| |
| *Scrotal swelling
| |
| *Negative trans-illumination test
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Fluid collection surrounding the testes
| |
| | valign="top" |
| |
| *Bloody fluid on aspiration
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Hydrocele]]'''
| |
| | valign="top" |
| |
| *Scrotal mass in patients with history of testicular trauma or epidymitis
| |
| | valign="top" |
| |
| *Scrotal swelling
| |
| *'''Positive''' trans-illumination test
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Fluid collection surrounding the testes
| |
| | valign="top" |
| |
| *Clear fluid on aspiration
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Macroorchidism]]'''
| |
| | valign="top" |
| |
| *History of fragile X syndrome, FSH secreting adenoma
| |
| | valign="top" |
| |
| *Large testicle (the testicle itself is large)
| |
| *Signs of underlying disease
| |
| | valign="top" |
| |
| *May have elevated hormone concentration (e.g. FSH) if secretory adenoma
| |
| | valign="top" |
| |
| *Large testicle, but normal architecture
| |
| | valign="top" |
| |
| *Normal testicular findings
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Malakoplakia]]'''
| |
| | valign="top" |
| |
| *Young man with long-standing symptoms of orchi-epididymitis (pain, scrotal swelling)
| |
| *History of immunosuppression
| |
| | valign="top" |
| |
| *Palpable, tender testicular mass
| |
| *Scrotal swelling
| |
| *Erythema
| |
| | valign="top" |
| |
| *Positive culture results for bacterial infection (chronic inflammation)
| |
| | valign="top" |
| |
| *Hypoechogenic mass on ultrasound
| |
| *Increased vascularity on Doppler
| |
| | valign="top" |
| |
| *Soft yellow friable plaques (malakos=soft | plakos=plaques)
| |
| *Von Hansemann cells (large cells with abundant eosinophilic cytoplasm) and Michaelis-Gutmann bodies (intracytoplasmic inclusion bodies with owl eyes appearance)
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[vasculitis|Testicular vasculitits]]'''
| |
| | valign="top" |
| |
| *Middle aged man with history of polyarteritis nodosa (less commonly granulomatosis with polyangiomatosis, Henoch-Schonlein purpura, or giant cell arteritis)
| |
| *History of HBV or HIV
| |
| Painful testicular mass with intra-testicular hemorrhage
| |
| *Symptoms of underlying vasculitis
| |
| | valign="top" |
| |
| *Signs of underlying vasculitis
| |
| *Palpable, tender testicular mass
| |
| *Scrotal swelling if vasculitis includes extratesticular structures
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Heterogeneous, hypoechogenic lesion on ultrasound
| |
| *Inreased intralesional vascularity on Doppler
| |
| | valign="top" |
| |
| *Soft, dark red lesion with areas of hemorrhage
| |
| *Fibrinoid necrosis
| |
| *Vascular wall fibrosis
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Fibrous connective tissue|Fibrous proliferation<br>(paratesticular fibrous pseudotumor)]]'''
| |
| | valign="top" |
| |
| *Patients of all ages (peak during young adulthood)
| |
| *Slowly growing painless unilateral scrotal masss
| |
| *History of genitourinary infection or trauma
| |
| | valign="top" |
| |
| *Palpable, non-tender scrotal mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Paratesticular mass between tunica layers
| |
| *Hypoechogenic solid mass on ultrasound
| |
| *No vascularity on Doppler
| |
| | valign="top" |
| |
| *Whitish mass with multinoduular thickening
| |
| *Collagen-rich fibrous tissue with increased fibroblasts
| |
| *Dystrophic calcifications
| |
| *No hemorrhage or necrosis
| |
| | valign="top" |
| |
| *Stains positiively for actin and keratin
| |
| *Negative staining for ALK-1, beta-catenin
| |
| |-
| |
| | align="center" |
| |
| '''[[testis|Polyorchism<br>(supranumerary testes)]]'''
| |
| | valign="top" |
| |
| *Often asymptomatic (incidental finding)
| |
| *Young patient with scrotal pain, swelling, hydrocele, varicocele
| |
| *Patients may present with testicular torsion
| |
| | valign="top" |
| |
| *Palpable, non-tender scrotal mass
| |
| *Scrotal swelling
| |
| *Testicular torsion manifests with excruciating testicular or pelvic pain, erythema, and swelling
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Isoechogenic scrotal mass
| |
| | valign="top" |
| |
| *Normal testicular tissue
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Spermatocele]]'''
| |
| | valign="top" |
| |
| *Young or middle aged adult with painless testicular or scrotal mass
| |
| | valign="top" |
| |
| *Homogeneous palpable non-tender testicular or scrotal mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Well-defined, homogeneous,, hypoechoic mass on ultrasound
| |
| *Increased vascular flow on Doppler
| |
| | valign="top" |
| |
| *Splenic tissue (red with clear boundaries)
| |
| *Occasional calcification, thrombi, or fibrosis
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[spleen|Splenogodal fusion syndrome<br>(ectopic scrotal spleen)]]'''
| |
| | valign="top" |
| |
| *Child or adolescent with painless, left scrotal mass (not right) and history of perimelia (continuous subtype) or cardiac defect (discontinuous subtype)
| |
| | valign="top" |
| |
| *Homogeneous palpable non-tender scrotal mass
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Well-defined, homogeneous,, hypoechoic mass on ultrasound
| |
| *Increased vascular flow on Doppler
| |
| | valign="top" |
| |
| *Splenic tissue (red with clear boundaries)
| |
| *Occasional calcification, thrombi, or fibrosis
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Varicocele]]'''
| |
| | valign="top" |
| |
| *Often asymptomatic
| |
| *Dull or sharp testicular pain that increases with standing or physical activity and improves when lying down
| |
| *History of infertility
| |
| | valign="top" |
| |
| *Scrotal mass and swelling
| |
| *Often left-sided
| |
| *Dilated, tortuous veins
| |
| *"Bag of worms" sensation upon palpation
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *On ultrasound, CT/MRI, and venography, apperance of dilated pampiniform plexus veins with serpentine appearance is diagnostic
| |
| *Flow reversal (reflux) with Valsalva maneuver on Doppler
| |
| *Enhancement following administration of gadolinium on MRI
| |
| | valign="top" |
| |
| *Testicular atrophy in advanced cases
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Testicular torsion]]'''
| |
| | valign="top" |
| |
| *Excruciating, acute, sharp testicular pain that radiates to the pelvis and abdomen
| |
| *Testicular swelling and pain
| |
| | valign="top" |
| |
| *Scrotal swelling and tenderness
| |
| | valign="top" |
| |
| *Unremarkable
| |
| | valign="top" |
| |
| *Focal/diffuse hypoechogenicity on ultrasound
| |
| *No blood flow on Doppler (vs. increased flow in infections)
| |
| *Scrotal wall thickening
| |
| | align="center" | ---
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | colspan="7" style="background: #4479BA; width: 50px;" |{{fontcolor|#FFF|'''Scrotal'''}}
| |
| |-
| |
| | align="center" |
| |
| '''[[Brucellosis]]'''
| |
| | valign="top" |
| |
| *Patient with history of exposure to cattle/sheep/goat/swine or animal products (milk, meat, cheese) presents with acute scrotal pain and swelling
| |
| *Undulant fever and night sweats (characteristic wet hay odor)
| |
| *Relapses common with similar symptoms
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| *Fever
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *Elevated WBC count
| |
| *Positive serum STA test for brucellosis
| |
| *Elevated Brucella IgM and IgG antibodies
| |
| *Urine PCR positive for Brucella
| |
| | valign="top" |
| |
| *Focal/diffuse hypoechogenicity on ultrasound
| |
| *Focal/diffusre increased blood flow on Doppler
| |
| *Scrotal wall thickening
| |
| | valign="top" |
| |
| *Granulomatous inflammation with lymphocytic infiltration
| |
| | valign="top" |
| |
| *Urethral Gram stain demonstrates Gram-negative diplococci
| |
| |-
| |
| | align="center" |
| |
| '''[[Brucellosis]]'''
| |
| | valign="top" |
| |
| *Patient with history of exposure to cattle/sheep/goat/swine or animal products (milk, meat, cheese) presents with acute scrotal pain and swelling
| |
| Undulant fever and night sweats (characteristic wet hay odor)
| |
| *Relapses common with similar symptoms
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| *Fever
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *Elevated WBC count
| |
| *Positive serum STA test for brucellosis
| |
| *Elevated Brucella IgM and IgG antibodies
| |
| *Urine PCR positive for Brucella spp.
| |
| | valign="top" |
| |
| *Focal/diffuse heterogeneous, hypoechoic intratesticular mass on ultrasound
| |
| *Focal/diffuse increased blood flow on Doppler
| |
| *Scrotal wall thickening
| |
| | valign="top" |
| |
| *Abscess formation at diagnosis is common
| |
| *Grey-white mass suggestive of testicular atrophy
| |
| *Granulomatous inflammation with lymphocytic infiltration
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Gonorrhea|Gonorrhea infection]]'''
| |
| | valign="top" |
| |
| *Patient with history of unprotected sexual intercourse presents with unilaterla testicular pain, swelling, and fever
| |
| *May be either acute or chronic
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| *Fever
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *Elevated WBC count
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| *Gram-negative diplococci on urethral Gram stain
| |
| *Urine PCR positive for Gonorrhea
| |
| | valign="top" |
| |
| *Focal/diffuse hypoechogenicity on ultrasound
| |
| *Focal/diffusre increased blood flow on Doppler
| |
| *Scrotal wall thickening
| |
| | valign="top" |
| |
| *Granulomatous inflammation with lymphocytic infiltration
| |
| | valign="top" |
| |
| *Urethral Gram stain demonstrates Gram-negative diplococci
| |
| |-
| |
| | align="center" |
| |
| '''[[Histoplasmosis|Histoplasma infection]]'''
| |
| | valign="top" |
| |
| *Chronic testicular enlargement
| |
| *Patients may have systemic manifestations of histoplasmosis
| |
| | valign="top" |
| |
| *Tender/non-tender testicular mass
| |
| | valign="top" |
| |
| *Elevated WBC count and eosinophilia may be present (may be normal in chronic cases)
| |
| | valign="top" |
| |
| *Focal/diffuse hypoechogenicity on ultrasound
| |
| *Focal/diffusre increased blood flow on Doppler
| |
| *Scrotal wall thickening
| |
| | valign="top" |
| |
| *Caseating granuloma with giant cells
| |
| | valign="top" |
| |
| *Yeast observed on silver stain
| |
| |-
| |
| | align="center" |
| |
| '''[[Mumps]]'''
| |
| | valign="top" |
| |
| *Post-pubertal man with recent manifestations of mumps (e.g. parotiditis, pancreatitis, arthritis, myocarditis, meningoencephalitis) presents with acute, unilateral painful testicular mass
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| *Hydrocele
| |
| *Fever
| |
| *Parotiditis
| |
| *Rash
| |
| | valign="top" |
| |
| *Elevated WBC
| |
| *Elevated paramyxovirus IgM and IgG
| |
| *Urine PCR positive for paramyxovirus
| |
| | valign="top" |
| |
| *Focal/diffuse hypoechogenicity on ultrasound
| |
| *Focal/diffusre increased blood flow on Doppler
| |
| *Scrotal wall thickening
| |
| | valign="top" |
| |
| *Non-specific interstitial edema, degenerative changes, vascular dilation
| |
| *Lymphocytic infiltration
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[epididymo-orchitis|Pyogenic epididymo-orchitis]]'''
| |
| | valign="top" |
| |
| *Patient with history of unprotected sexual intercourse presents with acute scrotal swelling and pain
| |
| | valign="top" |
| |
| *Tender testicular mass
| |
| *Fever
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *Elevated WBC
| |
| *Bacterial growth on urethral swab specimin (usually E. coli)
| |
| *Urine PCR positive for offending bacterial agent
| |
| | valign="top" |
| |
| *Focal/diffuse hypoechogenicity on ultrasound
| |
| *Focal/diffusre increased blood flow on Doppler
| |
| *Scrotal wall thickening
| |
| | valign="top" |
| |
| *Abscess formation in advanced cases
| |
| *Non-specific interstitial edema, degenerative changes, vascular dilation
| |
| *Lymphocytic infiltration
| |
| *Grey-white mass suggestive of testicular atrophy
| |
| | valign="top" |
| |
| *N/A
| |
| |-
| |
| | align="center" |
| |
| '''[[Syphilis]]'''
| |
| | valign="top" |
| |
| *Patient with long history of unprotected sexual intercourse presents with painful testicular swelling (tertiary syphilis)
| |
| *Often manifests as epidimo-orchitis that is resistant to conventional antibiotic therapy
| |
| *May have other systemic symptoms of tertiary syphilis
| |
| | valign="top" |
| |
| *Irregular tender testicular mass
| |
| *Thickened epididymis
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *Positive syphilis serology (suggest latent syphilis)
| |
| *VDRL may be either positiive or negative
| |
| *Positive dark field microscopy from lesion content
| |
| | valign="top" |
| |
| *Heterogeneous hypoechogenicity on ultrasound
| |
| *Solid and cystic appearance with areas of necrosis
| |
| *May have increased blood flow on Doppler
| |
| | valign="top" |
| |
| *Discrete gummas on gross pathology
| |
| *Microscopic features of gumma (interstitial inflammation, lymphocytic and plasma cell infiltration, obliterative endorteritis (endoarteritis obliterans), perivascular cuffing)
| |
| *Spirochetes may occasionally be observed
| |
| | valign="top" |
| |
| *May stain positively for silver-based methods (Warthin-Starry stain, Wright stain, Levaditi stain)
| |
| |-
| |
| | align="center" |
| |
| '''[[Tuberculosis]]'''
| |
| | valign="top" |
| |
| *Patient with history of tuberculosis presents with painless mass or chronically dull testicular discomfort
| |
| *Positive constitutional symptoms (weight loss, malaise)
| |
| *May be isolated or may be associated with other systemic symptoms of tuberculosis (e.g. lymphadenopathy, pulmonary lesions, renal involvement)
| |
| *May have concomitant involvement of other GU organs (e.g. prostate, seminal vesicles)
| |
| | valign="top" |
| |
| *Irregular testicular mass
| |
| *May be tender or non-tender
| |
| *Thickened scrotal skin
| |
| *Hydrocele
| |
| | valign="top" |
| |
| *Ejaculum may demonstrate positive acid fast bacilli (AFB) staining
| |
| | valign="top" |
| |
| *Heterogeneous hypoechogenicity on ultrasound
| |
| *No/minimal blood flow on Doppler
| |
| *Hypointense lesion on T1WI MRI and hyperintense on T2WI MRI
| |
| | valign="top" |
| |
| *Possible abscess formation
| |
| *Caseating necrosis
| |
| *Epithelioid cells and lymphocytic infiltration with presence of multinucleated giant cells
| |
| | valign="top" |
| |
| |}
| |
|
| |
|
| [[Category:Disease]] | | [[Category:Disease]] |