Diagnostic Ultrasound - Abdomen and Pelvis

Gonadal Stromal Tumors, Testis
Diagnoses: Scrotum
TERMINOLOGY
• Gonadal stromal tumors arise from nongerm cell elements
IMAGING
• May be indistinguishable from germ cell tumors on
grayscale ultrasound
○ Leydig cell tumors
– Small, solid, hypoechoic intratesticular mass
○ Sertoli cell tumors
– Small, hypoechoic mass with occasional hemorrhage,
which may lead to heterogeneity and cystic
components
○ Gonadoblastoma
– Stromal tumor in conjunction with germ cell tumor,
usually mixed sonographic features
• High-resolution US (≥ 7.5 MHz) is best imaging tool for
detection of gonadal stromal neoplasms
KEY FACTS
CLINICAL ISSUES
• 30% of patients with gonadal stromal tumors have
endocrinopathy secondary to testosterone or estrogen
production by tumor presenting with
○ Precocious virilization in children
○ Gynecomastia, impotence, ↓ libido in adults
• Majority of these tumors are benign
• Orchidectomy is preferred treatment
DIAGNOSTIC CHECKLIST
• Consider stromal tumor in any patient with endocrinopathy
and testicular mass
(Left) Sagittal grayscale
ultrasound of the right testis
in a 16-year-old male
demonstrates a well-defined,
hypoechoic mass with
some posterior acoustic
shadowing . Pathology
after orchiectomy confirmed it
to be a benign sex cord
stromal tumor (unclassified
type). (Right) Sagittal
grayscale ultrasound in a 16-
year-old male demonstrates a
well-defined, predominantly
solid mass with some
interspersed cystic areas ſt.
Pathology confirmed it to be a
granulosa cell tumor (adult
type).
(Left) Sagittal color Doppler
ultrasound of the right testis
in a 33-year-old man
demonstrates a well-defined,
hypoechoic, solid mass with
marked internal vascularity
. Pathology confirmed it to
be a Leydig cell tumor. (Right)
Sagittal color Doppler
ultrasound shows the right
testis with a partially calcified
mass and minimal to no
internal vascularity. Pathology
confirmed a Sertoli cell tumor.
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