Abdo: Male Reproductive

Playlist contributed by: Dr Annabelle Skelley

Cystic Testicular Lesions (usually benign) 

  1. Non-seminomatous germ cell tumour (teratoma)
  2. Intratesticular cyst
  3. Tubular ectasia of rete testis 
  4. Tunica albuginea cyst 
  5. Testicular absces
  6. Epidermoid cyst
  7. Haemorrhage/necrosis (in tumour)

Intratesticular Mass (usually malignant) 

Solid, intratesticular mass with vascularity -> usually suggestive of testicular tumour) 

  1. Epididymitis/orchitis -> usually acute history, pain (hyperaemic on US) 
  2. Testicular carcinoma -> painless mass 
  3. Torsion/infarction -> acute scrotal pain 
  4. Haematoma -> history of trauma
  5. Testicular lymphoma -> age >60yrs 
    • Poor prognosis (usually NHL) 
  6. Gonadal stromal tumours - painless (Leydig, Sertoli, Granulosa, Thecoma-fibroma)
    • Uncommon compared GCT
  7. Epidermoid cyst 
    • ONION RING appearance -> concentric layers, no internal vascularity, well-defined (consider as differential as will change management) 
  8. Metastases (uncommon)
    • Bilateral 8-15% 
    • Older > 55yrs
    • Primaries: prostate, lung, kidney & colon 
  9. Syndromic lesions
    1. Congenital adrenal hyperplasia
      • Solid testicular masses -> adrenal rests (bilateral) 
    2. Cowden disease
      • Lipomatosis -> multiple small hyperechoic lesions

Testicular Cancer:

Risk factors:

  • Undescended testis
  • Family history 
  • History of testicular cancer
  • Infertility 

Note: microlithiasis not considered a risk factor although there is possibly some association 

  1. Germ Cell tumours (95%) 
    1. Seminomas (50%) 
      • US: homogeneous, hypoechoic (usually no calcs) 
      • Not very aggressive -> radiation sensitive 
    2. NSGCT
      • ​US: heterogeneous w cystic spaces +/- calcs
        1. Mixed germ cell tumour (33%) 
        2. Embryonal carcinoma (10%) 
        3. Teratoma (4%)
        4. Yolk sac tumour (1%) 
        5. Choriocarcionma (0.3%) = bad prognosis 
  2. Stromal Tumours (5%) 
    • ​​20% in paediatrics
    • 90% are benign
      1. Leydig (most common) 
      2. Sertoli 
      3. Granulosa
      4. Thecoma-fibroma 
  3. Other
    1. Lymphoma
      • US: hypoechoic & hyperaemic (may be diffuse and non-mass like) 

TNM staging

  • S-stage = serum markers (b-HCG, AFP & LDH) 
  • b-HCG & AFP -> useful in NSGCTs (less useful for seminomas) 
  • LDH -> less sensitive/specific for both SGCT & NSGCT 
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Playlist information

rID: 21736
Visibility: public

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