Adenomatoid tumors of the scrotum
Adenomatoid tumors of the scrotum are benign, solid extratesticular lesions that can originate from the epididymis, tunica vaginalis, or spermatic cord (90% derived from the funiculus).
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Epidemiology
They are the most common extratesticular neoplasm, and most common tumor of the epididymis, and occur more often in the lower pole than in the upper pole by a ratio of 4:1.
Clinical presentation
Usually an incidental finding, adenomatoid tumors manifest as a small (usually under 2 cm), painless scrotal mass, with the majority diagnosed in patients aged 20-50 years. They are typically unilateral and occur more frequently on the left side.
When they grow non-invasively into the testicular parenchyma, they can simulate intratesticular disease.
Radiographic features
Ultrasound
- well-defined, usually oval extratesticular mass with variable echogenicity although most are isoechoic to the epididymis 6
- usually solid although can be completely cystic 6
- range in size from a few millimeters to a few centimeters
MRI
MR imaging can aid in determining the paratesticular origin of the lesion.
Signal characteristics
- T2: low signal intensity relative to the testicular parenchyma
- T1 C+ (Gd): show enhancement
Treatment and prognosis
They are benign with no reports of recurrence or metastatic disease after excision 5,6.
Differential diagnosis
General imaging differential considerations include:
- peritesticular lipoma
- peritesticular rhabdomyosarcoma
- peritesticular liposarcoma
- supernumerary testes: a rare condition in which more than two testes are present
- epididymitis
- scrotal tuberculosis
See also
Related Radiopaedia articles
Ultrasound - testicular and scrotal
- ultrasound (introduction)
-
testicular and scrotal ultrasound
-
unilateral testicular lesion
- testicular torsion
- orchitis
- testicular rupture
-
germ cell tumors of the testis
- testicular seminoma
-
non seminomatous germ cell tumors
- mixed germ cell tumor
- yolk sac tumor (endodermal sinus tumor)
- embryonal cell carcinoma
- choriocarcinoma
- testicular teratoma
- testicular epidermoid (teratoma with ectodermal elements only)
- burned out testis tumor
- sex cord / stromal tumors of the testis
- testicular cyst
- testicular lymphoma
- bilateral testicular lesion
- paratesticular lesions
- epididymis
- other
- polyorchidism
- cryptorchidism
- tubular ectasia of the rete testis
- cystadenoma of the rete testis
- testicular sarcoidosis
- testicular tuberculosis
- spermatic cord
- fibrous pseudotumor of the scrotum
- scrotal leiomyosarcoma
- testicular adrenal rest tumors (TARTs)
- tunica vaginalis testis mesothelioma
- splenogonadal fusion
- testicular vasculitis
- abnormal testicular Doppler flow (differential)
-
unilateral testicular lesion