Diagnostic Ultrasound - Abdomen and Pelvis

Testicular Germ Cell Tumors
Diagnoses: Scrotum
IMAGING
• Most common neoplasm in males between ages 15-34
years
• Mostly unilateral; contralateral tumor develops eventually
in 8%
• Seminoma is most common pure germ cell tumor of testis
• On ultrasound, seminomas are usually well-defined,
hypoechoic, solid without calcification or tunica invasion
• Tumor < 1.5 cm is commonly hypovascular, and tumors >
1.6 cm are more often hypervascular
• Embryonal cell carcinoma are aggressive tumors, may
invade tunica albuginea and distort testicular contour
• US is used to identify and characterize scrotal mass; CT or
MR for metastatic staging; PET to evaluate post-treatment
residual masses
• Lymph nodes < 1 cm are suspicious if located in typical
drainage areas; left renal hilus and right retrocaval in
location
KEY FACTS
PATHOLOGY
• Associated with cryptorchidism, previous contralateral
cancer; possible association with mumps orchitis,
microlithiasis, and family history of tumor
CLINICAL ISSUES
• Beta hCG is elevated inpure or mixed embryonal carcinoma
or choriocarcinoma; also in15-20% of those with advanced
seminoma
• Elevated α-fetoprotein (AFP) levels above 10,000 microg/L
are found almost exclusively in patients with NSGCTs (not
seen with pure seminomas) and hepatocellular carcinoma
• Lactate dehydrogenase (LDH) has independent prognostic
significance: Increased levels reflect tumor burden, growth
rate, and cellular proliferation
(Left) Graphic shows a
multilobulated testicular mass
st. Note the compressed and
near-complete replacement of
normal testicular parenchyma
ſt. (Right) Longitudinal color
Doppler ultrasound of the
right testis demonstrates a
well-defined hypoechoic solid
mass ſt with mild internal
vascularity. Imaging features
are classic for a seminoma. A
few scattered microliths
are also seen in the
noninvolved portion of the
testicle.
(Left) Sagittal color Doppler
ultrasound of the right testicle
demonstrates a predominantly
solid, heterogeneous mass
with internal arterial
vascularity st. Pathology
revealed a mixed germ cell
tumor with 95% embryonal
component and 5% teratoma.
(Right) Sagittal grayscale US
of the left testicle
demonstrates multifocal
masses with 3 different
sonographic patterns including
solid , multiple cystic foci
, and solid and cystic foci
. Pathology revealed MGCT
with 55% embryonal, 35%
teratoma, and 10% yolk sac.
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