Diagnostic Ultrasound - Abdomen and Pelvis

Testicular Lymphoma/Leukemia
Diagnoses: Scrotum
TERMINOLOGY
• Infiltrative neoplasm of testis in which tumor cells surround
and compress seminiferous tubules and normal testicular
vessels
IMAGING
• Bilateral, solid, hypoechoic, hypervascular nodules/masses
• Diffuse hypoechoic testis with hypervascularity
• Striated pattern
• Testicular shape not altered
• Normal testicular vessels with straight course crossing
through lesions
• Comparison of both testes to look for asymmetry in sizes
and echogenicity
PATHOLOGY
• Most commonly secondary lymphomatous involvement of
testis; rarely primary
KEY FACTS
• Lymphoma behaves similar to leukemia with abnormal cells
diffusely infiltrating interstitium with compression of
seminiferous tubules without causing their destruction
• Testis is "sanctuary organ": Blood gonad barrier limits
accumulation of chemotherapeutic agents
CLINICAL ISSUES
• Stages IE and IIE: Orchidectomy
• Stage IIIE and IVE: Systemic chemotherapy using
cyclophosphamide, doxorubicin, vincristine, and
prednisolone
• Radiation in symptomatic and bulky deposits
• Lymphoma accounts for approximately 5% of all testicular
tumors
• Most common bilateral testicular tumor
(Left) Sagittal color Doppler
ultrasound of the right testis
in a 56-year-old man with non-
Hodgkin lymphoma shows a
hypervascular focal mass ſt in
the inferior pole with focal
enlargement of testis. Note
that the shape of the testis is
maintained. Pathology
confirmed lymphoma. (Right)
Sagittal color Doppler
ultrasound of the left testis in
a 65-year-old man shows
multiple hypervascular
hypoechoic masses ſt in the
testis. Pathology confirmed
lymphoma.
(Left) Sagittal grayscale
ultrasound of the testes in a
60-year-old man with non-
Hodgkin lymphoma shows
bilateral hypoechoic masses,
multifocal on the right ſt and
diffuse infiltrative on the left
. (Right) Sagittal color
Doppler ultrasound of the
right testis in a 51-year-old
man with known history of
acute myeloid leukemia shows
a hypervascular focal
hypoechoic mass ſt in the
inferior pole. Pathology
confirmed acute myeloid
leukemia.
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