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Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee

  • Urogenital
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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.

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Abbreviations

US:

Ultrasound

MRI:

Magnetic resonance imaging :

CEUS:

Contrast-enhanced ultrasound

ESUR:

European Society of Urogenital Radiology

WI:

Weighted image

ADC:

Apparent diffusion coefficient

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Acknowledgments

The scientific guarantor of this publication is Jonathan Richenberg. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. This manuscript is a review but institutional review board approval was obtained to publish radiological data. Written informed consent was waived by the institutional review board. Methodology: review. We thank Vincent Izard, our guest specialized urologist for his contribution. We thank Mustafa Cecil, Pietro Pavlica, Michal Studniarek for their active participation in the group. We thank Valentine Sallerin for her initial English revision.

Author information

Authors and Affiliations

  1. Hopitaux Paris Sud, APHP, site Bicêtre, 78 avenue du Général Leclerc, 94270, Le Kremlin Bicêtre, France

    Laurence Rocher

  2. Université Parid Sud, Ecole Doctorale Biosigne, ED 419, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France

    Laurence Rocher

  3. Institut Langevin, 1 rue Jussieu, 75005, Paris, France

    Laurence Rocher

  4. Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Parvati Ramchandani

  5. Royal Liverpool University Hospital, Prescot Street, Liverpool, L7 8XP, UK

    Jane Belfield

  6. Uco di Radiologia Dell ‘Universita’ di Trieste, Strada di Fiume 447, Trieste, Italy

    Michele Bertolotto

  7. Universita di Genova, Largo R. Benzi, 8, Genova, Italy

    Lorenzo E. Derchi

  8. Université Paris Descartes, Hôpital Necker, APHP, Institut Langevin, 149 rue de Sèvres, Paris 15, Paris, France

    Jean Michel Correas

  9. Radiology, University Hospital Leuven, UZ Herestraat 49, box 7003 54, 3000, Leuven, Belgium

    Raymond Oyen

  10. University of Ioannina, Pl. Pargis, 2, Ionnina, 45332, Greece

    Athina C. Tsili

  11. Radiology, Sokak Huner Sitesi No: 18/30, 25. Cadde 362, Ankara, 6530, Turkey

    Ahmet Tuncay Turgut

  12. Department of Imaging Sciences, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Box 648, Rochester, NY, USA

    Vikram Dogra

  13. Université Paris Sud, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France

    Karim Fizazi

  14. Plymouth Hospitals NHS Trust, Devon, UK

    Simon Freeman

  15. Royal Sussex County Hospital Brighton and Brighton and Sussex Medical School, East Sussex, UK

    Jonathan Richenberg

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  1. Laurence Rocher
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  2. Parvati Ramchandani
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  3. Jane Belfield
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  4. Michele Bertolotto
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  5. Lorenzo E. Derchi
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  8. Athina C. Tsili
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  9. Ahmet Tuncay Turgut
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  10. Vikram Dogra
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  12. Simon Freeman
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  13. Jonathan Richenberg
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Correspondence to Laurence Rocher.

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Rocher, L., Ramchandani, P., Belfield, J. et al. Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol 26, 2268–2278 (2016). https://doi.org/10.1007/s00330-015-4059-7

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  • DOI: https://doi.org/10.1007/s00330-015-4059-7

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