Advertisement

Pediatric Radiology

, Volume 45, Issue 9, pp 1382–1391 | Cite as

Extratesticular masses in children: taking ultrasound beyond paratesticular rhabdomyosarcoma

  • Aparna Annam
  • Marthe M. Munden
  • Amy R. Mehollin-Ray
  • Deborah Schady
  • Lorna P. BrowneEmail author
Pictorial Essay

Abstract

Extratesticular cystic and solid scrotal masses are commonly encountered in pediatrics. The most common extratesticular malignancy is paratesticular rhabdomyosarcoma. The remainder of the common pathologies encountered -- appendage torsion, epididymitis and varicoceles -- are mostly benign. These frequently encountered benign lesions are confidently differentiated from paratesticular rhadbomyosarcoma using high-frequency scrotal sonography in combination with clinical features. Less commonly encountered extratesticular masses may not be as easily classified; however, these also have distinguishing features that can enable differentiation from malignancy. This review discusses the sonographic findings, and relevant clinical and pathological manifestations of the more unusual extratesticular masses encountered in two tertiary pediatric institutions during a 10-year period. While these extratesticular pathologies are encountered relatively infrequently, recognition of their manifestations enables appropriate management.

Keywords

Adolescents Children Epididymis Rhabdomyosarcoma Scrotum Testicle Ultrasound 

Notes

Conflicts of interest

None

References

  1. 1.
    Akbar SA, Sayyed TA, Jafri SZ et al (2003) Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics 23:1461–1476PubMedCrossRefGoogle Scholar
  2. 2.
    Mak CW, Chou CK, Su CC et al (2004) Ultrasound diagnosis of paratesticular rhabdomyosarcoma. Br J Radiol 77:250–252PubMedCrossRefGoogle Scholar
  3. 3.
    Sung T, Riedlinger WF, Diamond DA et al (2006) Solid extratesticular masses in children: radiographic and pathologic correlation. AJR Am J Roentgenol 186:483–490PubMedCrossRefGoogle Scholar
  4. 4.
    Liu W, Wu RD, Yu QH (2011) Adenomatoid tumor of the testis in a child. J Pediatr Surg 46:E15–E17PubMedCrossRefGoogle Scholar
  5. 5.
    Amin W, Parwani AV (2009) Adenomatoic tumor of testis. Clin Med Pathol 2:17–22PubMedCentralPubMedGoogle Scholar
  6. 6.
    Lilly MC, Arregui ME (2002) Lipomas of the cord and round ligament. Ann Surg 235:586–590PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Germaine P, Simerman LP (2007) Fibrous pseudotumor of the scrotum. J Ultrasound Med 26:133–138PubMedGoogle Scholar
  8. 8.
    Cassidy FH, Ishioka KM, McMahon CJ et al (2010) MR imaging of scrotal tumors and pseudotumors. Radiographics 30:665–683PubMedCrossRefGoogle Scholar
  9. 9.
    Odrzywolski KJ, Mukhopadhyay S (2010) Papillary cystadenoma of the epididymis. Arch Pathol Lab Med 13:630–633Google Scholar
  10. 10.
    Claahsen-van der Grinten HL, Hermus AR, Otten BJ (2009) Testicular adrenal rest tumours in congenital adrenal hyperplasia. Int J Pediatr Endocrinol 624823Google Scholar
  11. 11.
    Kim HK, Crotty E (2010) Bilateral testicular adrenal rests in a boy with congenital adrenal hyperplasia. Pediatr Radiol 40:S25PubMedCrossRefGoogle Scholar
  12. 12.
    Bonneau D, Roume J, Gonzalez M et al (1999) Splenogonadal fusion limb defect syndrome: report of five new cases and review. Am J Med Genet 86:347–358PubMedCrossRefGoogle Scholar
  13. 13.
    Lin C, Lazarowicz JL, Allan RW et al (2010) Splenogonadal fusion. J Urol 184:332–333PubMedCrossRefGoogle Scholar
  14. 14.
    Stewart VR, Sellars ME, Somers S et al (2004) Splenogonadal fusion:B-mode and color Doppler sonographic appearances. J Ultrasound Med 23:1087–1090PubMedGoogle Scholar
  15. 15.
    Wolf B, Youngson GG (1998) Polyorchidism. Pediatr Surg Int 13:65–66PubMedCrossRefGoogle Scholar
  16. 16.
    Oh C, Nisenbaum HL, Langer J et al (2000) Sonographic demonstration, including color Doppler imaging, of recurrent sperm granuloma. J Ultrasound Med 19:333–335PubMedCrossRefGoogle Scholar
  17. 17.
    Goodson JM, Fruchtman B (1975) Spermatic granulomas of epididymis. Urology 5:278–280PubMedCrossRefGoogle Scholar
  18. 18.
    Munden MM, Williams JL, Zhang W et al (2013) Intermittent testicular torsion in the pediatric patient: sonographic indicators of a difficult diagnosis. AJR Am J Roentgenol 201:912–918PubMedCrossRefGoogle Scholar
  19. 19.
    Sista AK, Filly RA (2008) Color Doppler sonography in evaluation of spermatoceles: the “falling snow” sign. J Ultrasound Med 27:141–143PubMedGoogle Scholar
  20. 20.
    Yang WT, Whitman GJ, Tse GM (2004) Extratesticular epidermal cyst of the scrotum. AJR Am J Roentgenol 183:1084PubMedCrossRefGoogle Scholar
  21. 21.
    Ye H, Ulbright TM (2012) Difficult differential diagnoses in testicular pathology. Arch Pathol Lab Med 136:435–446PubMedCrossRefGoogle Scholar
  22. 22.
    Nistal M, González-Peramato P, Sousa G et al (2010) Cystic dysplasia of the epididymis: a disorder of mesonephric differentiation associated with renal maldevelopment. Virchows Arch 456:695–702PubMedCrossRefGoogle Scholar
  23. 23.
    Frank RG, Friedman SC, Krieger A et al (1991) Antenatal sonographic evidence of a paratesticular mass representing healed meconium peritonitis. J Diagn Med Sonogr 7:348–351CrossRefGoogle Scholar
  24. 24.
    Regev RH, Markovich O, Arnon S et al (2009) Meconium periorchitis: intrauterine diagnosis and neonatal outcome: case reports and review of the literature. J Perinatol 29:585–587PubMedCrossRefGoogle Scholar
  25. 25.
    Lao OB, Fitzgibbons RJ, Cusick RA (2012) Pediatric inguinal hernias, hydroceles, and undescended testicles. Surg Clin N Am 92:487–504PubMedCrossRefGoogle Scholar
  26. 26.
    Ballas K, Kontoulis T, Skouras C et al (2009) Unusual findings in inguinal hernia surgery: report of 6 rare cases. Hippokratia 13:169–171PubMedCentralPubMedGoogle Scholar
  27. 27.
    Bunting D, Harshen R, Ravichandra M et al (2006) Unusual diagnoses presenting as incarcerated inguinal hernia: a case report and review of the literature. Int J Clin Pract 60:1681–1682PubMedCrossRefGoogle Scholar
  28. 28.
    Hurwitz RS, Shapiro E, Hulbert WC et al (1997) Scrotal cystic lymphangioma: the misdiagnosed scrotal mass. J Urol 158:1182–1185PubMedCrossRefGoogle Scholar
  29. 29.
    Coley BD (2007) Sonography of pediatric scrotal swelling. Semin Ultrasound CT MR 28:297–306PubMedCrossRefGoogle Scholar
  30. 30.
    Loberant N, Chernihovski A, Goldfeld M et al (2002) Role of Doppler sonography in the diagnosis of cystic lymphangioma of the scrotum. J Clin Ultrasound 30:384–387PubMedCrossRefGoogle Scholar
  31. 31.
    Paltiel HJ, Burrows PE, Kozakewich HP et al (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754PubMedCrossRefGoogle Scholar
  32. 32.
    Yilmaz C, Arslan M, Arslan M (2009) Intrascrotal arteriovenous malformation simulating varicocele. AJR Am J Roentgenol 192:W351PubMedCrossRefGoogle Scholar
  33. 33.
    McCracken JM, MacNeily AE, Mueller D et al (2005) Ultrasound features of a paratesticular arteriovenous malformation: a case report of an 11-year-old boy. Pediatr Radiol 35:532–534PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Aparna Annam
    • 1
  • Marthe M. Munden
    • 2
  • Amy R. Mehollin-Ray
    • 2
  • Deborah Schady
    • 2
  • Lorna P. Browne
    • 1
    Email author
  1. 1.Department of Pediatric RadiologyChildren’s Hospital ColoradoAuroraUSA
  2. 2.Department of Pediatric RadiologyTexas Children’s HospitalHoustonUSA

Personalised recommendations