1. Dr lokesh kumar meena
Dept of Radiodignosis MGIMS ,
Sevagram wardha

2. Incidence
 Testicular tumors are rare.
 1 – 2 % of all malignant tumors.
 Most common malignancy in men in the 15 to 35 year
age group.
 Benign lesions represent a greater percentage of cases
in children than in adults.

3. CLASSIFICATION
 I. Primary Neoplasms of Testis.
 A. Germ Cell Tumor.
 B. Non-Germ Cell Tumor .
 II. Secondary Neoplasms.
 III. Paratesticular Tumors.

4. Germ cell tumors
 1. Seminomas - 40%
 (a) Classic Typical Seminoma
 (b) Anaplastic Seminoma
 (c) Spermatocytic Seminoma
 2. Embryonal Carcinoma - 20 - 25%
 3. Teratoma - 25 - 35%
 (a) Mature
 (b) Immature
 4. Choriocarcinoma - 1%
 5. Yolk Sac Tumour

5. Sex cord/ gonadal stromal tumors (5 to 10% )
1. Specialized gonadal stromal tumor
(a) Leydig cell tumor
(b) sertoli cell tumor
2. Gonadoblastoma
3. Miscellaneous Neoplasms
(a) Carcinoid tumor
(b) Tumors of ovarian epithelial sub
types

6. II. SECONDARY NEOPLASMS OF TESTIS
 A. Reticuloendothelial Neoplasms
 B. Metastases
III.PARATESTICULAR NEOPLASMS
 A. Adenomatoid
 B. Cystadenoma of Epididymis
 C. Desmoplastic small round cell tumor
 D. Mesothelioma
 E. Melanotic neuroectodermal

7. Classic Seminoma
 82-85% of seminomas
 Mostly men in 30’s
 Rarely occurs in adolescents or infants
 Clear cytoplasm, dense nucleus
 Synctiotrophoblasts in 10-15%
 Elevated B-HCG in 10%
 hCG up to 500 ng/ml
 Lymphocytes in 20%

8. Seminoma imaging….
 microcalcification
 A large mass in the testes. Mass is markedly
hypoechoic and inhomogenous with irregular, poorly
defined margins.
 On color doppler imaging, the mass shows increased
vascularity and feeding vessels.
 These ultrasound images suggest a diagnosis of Germ
cell tumour of the testes, probably a seminoma.

9. Seminoma.
Focal increase in vascular signal with irregular
branching.

10. Seminoma. (a) right testis demonstrates a hydrocele(arrow), diffuse
microlithiasis (arrowheads), and a homogeneous mass with no definite
normal testicular parenchyma.
(b) Doppler US image shows a generalized increase in testicular vascular
flow

11. This is another seminoma. On sonograms, a
seminoma is often more homogeneous than
nonseminomatous cancers

12. This is a seminoma. Sometimes epididymal
invasion can be noted on sonograms.

13. Non-seminomatous germ cell tumor.
USG shows a focal lesion having a heterogenous
echotexture with solid and cystic components (asterix)

14. heterogeneous echogenicity, and small cystic areas

15. Mixed germ cell tumor
 composed of two or more types of germ cell tumour.
They are considered to be part of non-seminomatous
germ cell tumours.
 Overall they account for over 10% of all testicular
cancers

16. Mixed germ cell tumor
Partly solid and
partly cystic
testicular mass
that proved to
be a mixed
germ cell
tumor

17. Mixed germ cell tumor
Heterogeneous,predominantly hypoechoic mass, with scattered areas of
hypoechogenicity (arrowheads). Normal testicular parenchyma is
compressed peripherally by the tumor and contains diffuse microlithiasis
(arrow).
(b) Doppler US image shows normal peripheral vascularity with absence of
central flow.

19. This is a mixed germ cell tumor. Testicular cancers
can be ill-defined and subtle.

20. Malignant teratoma. A well defined hypoechoic
mass (open arrows) with a peripheral focus of
calcification (curved arrow).

21. Embryonal Carcinoma
Embryonal cell carcinoma with a vascularized tumor
with calcifications

22. Testicular choriocarcinoma
Choriocarcinoma in a 16-
year-old boy who presented
with enlarged inguinal
lymph nodes.
US image demonstrates a
mixed solid and cystic mass
in the left testis
(arrowheads).

23. “Testicular choriocarcinoma with cannon-ball
metastases in lung.”

24. Dilated rete testes can mimic a cystic neoplasm, but
they are usually elongated on orthogonal views and
clearly located in the testicular mediastinum.

25. Testicular sarcoid can mimic seminoma when it
presents as a solid-appearing testicular mas

26. Leydig Cell Tumors of the Testis
a 27-year-old man with testicular discomfort. A, Sonogram showing
a homogeneously hypoechoic tumor in the anterior aspect of the
testis.
B, Power Doppler image showing circumferential blood flow around
the tumor.

27. Lymphoma and leukaemia
 most common metastatic testicular tumours.
 Primary testicular leukaemia is rare, but leukaemic
infiltration is not uncommon in children. The testis
may be a site for leukaemic cells during chemotherapy.
 The most frequent sonographic appearance is diffuse
enlargement with hypoechogenicity. Hypervascularity
is typical.
 Focal well-marginated masses have been described in
chronic lymphocytic leukaemia.

28. left testis is large and hypoechoic compared to
the normal right testis.

29. Epididymitis.
Image of the testis demonstrates
enlarged, thickened, and heterogeneous epididymis.
Doppler shows an increase in vascular flow.

30. Testicular torsion

31.  (a) Longitudinal
 US scan of the right hemiscrotum shows a round
supratesticular mass (M), which represents an edematous
spermatic cord. There are several anechoic structures
(arrowheads) within the mass, which probably represent
obstructed and dilated lymphatic vessels.
 (b) Bilateral transverse color Doppler images show no
color flow signals in the right testis, which is enlarged
and has heterogeneous echogenicity. Reactive hydrocele
(h) and thickening of the scrotal wall.

32. Varicocele.
 Multiple sepiginous ,tubular hypoechic structure of
diameter more then 2mm.
 Generally seen posterior or lateral to the testis.
 More common on left side b/c of longer course of left
testicular vein.
 Grading on USG (on valsalva)
 Grade 1 : 2-2.5 mm ,grade 2 : 2.5-3mm, grade 3 : 3mm

33. Varicocele.
Color Doppler demonstrates multiple serpentine
vascular channels within the scrotum, which
become more prominent after Valsalva maneuver.

34. Orchitis.
Color Doppler of the scrotum reveals
-hypoechoic testis with
-markedly increased vascularity,
compared with normal echogenic testis showing
normal vascularity.

36. Hematocele.
 One week following a direct blow to the scrotum, US
reveals complex fluid with septation and debris indicative
of hematocele in the cavity of the tunica vaginalis.
 The scrotal wall is thickened.
 Septations and loculations are common
 Pyocele has a similar appearance.
 Anechoic fluid without septations is characteristic of
hydrocele .
 Bloody fluid contains low-intensity echoes that often layer.

38. Testicular
Abscess
testis is swollen and has markedly heterogeneous
echogenicity.
A central complex fluid collection (arrow) was proven to
be an abscess

39. Spermatocele
 - Found only at the superior pole of the testis adjacent
to the mediastinum.
 - Oval/round cystic mass with echogenic, often
layering, fluid.
 - May appear solid if completely filled with echogenic
fluid.
 - Septations are common.
 - Solitary, with size up to 2-3-cm diameter.

40. Large cystic extratesticular mass (S) with septations and
debris above the upper pole of the testis (T) is
characteristic for spermatocel