Laurence Rocher1,2,3, Parvati Ramchandani4, Jane Belfield5, Michele Bertolotto6, Lorenzo E Derchi7, Jean Michel Correas8, Raymond Oyen9, Athina C Tsili10, Ahmet Tuncay Turgut11, Vikram Dogra12, Karim Fizazi13, Simon Freeman14, Jonathan Richenberg15. 1. Hopitaux Paris Sud, APHP, site Bicêtre, 78 avenue du Général Leclerc, 94270, Le Kremlin Bicêtre, France. laurence.rocher@aphp.fr. 2. Université Parid Sud, Ecole Doctorale Biosigne, ED 419, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France. laurence.rocher@aphp.fr. 3. Institut Langevin, 1 rue Jussieu, 75005, Paris, France. laurence.rocher@aphp.fr. 4. Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA. 5. Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK. 6. Uco di Radiologia Dell 'Universita' di Trieste, Strada di Fiume 447, Trieste, Italy. 7. Universita di Genova, Largo R. Benzi, 8, Genova, Italy. 8. Université Paris Descartes, Hôpital Necker, APHP, Institut Langevin, 149 rue de Sèvres, Paris 15, Paris, France. 9. Radiology, University Hospital Leuven, UZ Herestraat 49, box 7003 54, 3000, Leuven, Belgium. 10. University of Ioannina, Pl. Pargis, 2, Ionnina, 45332, Greece. 11. Radiology, Sokak Huner Sitesi No: 18/30, 25. Cadde 362, Ankara, 6530, Turkey. 12. Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, USA. 13. Université Paris Sud, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France. 14. Plymouth Hospitals NHS Trust, Devon, UK. 15. Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, East Sussex, UK.
Abstract
OBJECTIVES: The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management. METHODS: The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were 'testicular ultrasound', 'contrast-enhanced sonography', 'sonoelastography', 'magnetic resonance imaging', 'testis-sparing surgery', 'testis imaging', 'Leydig cell tumour', 'testicular cyst'. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist. RESULTS: Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80 %, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease. CONCLUSION: Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving. KEY POINTS: • Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.
OBJECTIVES: The increasing detection of small testicular lesions by ultrasound (US) in adults can lead to unnecessary orchiectomies. This article describes their nature, reviews the available literature on this subject and illustrates some classical lesions. We also suggest recommendations to help characterization and management. METHODS: The ESUR scrotal imaging subcommittee searched for original and review articles published before May 2015 using the Pubmed and Medline databases. Key words used were 'testicular ultrasound', 'contrast-enhanced sonography', 'sonoelastography', 'magnetic resonance imaging', 'testis-sparing surgery', 'testis imaging', 'Leydig cell tumour', 'testicular cyst'. Consensus was obtained amongst the members of the subcommittee, urologist and medical oncologist. RESULTS: Simple cysts are frequent and benign, and do not require follow up or surgery. Incidentally discovered small solid testicular lesions detected are benign in up to 80 %, with Leydig cell tumours being the most frequent. However, the presence of microliths, macrocalcifications and hypoechoic areas surrounding the nodule are findings suggestive of malignant disease. CONCLUSION: Asymptomatic small testicular lesions found on ultrasound are mainly benign, but findings such as microliths or hypoechoic regions surrounding the nodules may indicate malignancy. Colour Doppler US remains the basic examination for characterization. The role of newer imaging modalities in characterization is evolving. KEY POINTS: • Characterization of testicular lesions is primarily based on US examination. • The role of MRI, sonoelastography, contrast-enhanced ultrasound is evolving. • Most small non-palpable testicular lesions seen on ultrasound are benign simple cysts. • Leydig cell tumours are the most frequent benign lesions. • Associated findings like microliths or hypoechoic regions may indicate malignancy.
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