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Chaudhry H, Siddiqi M, Simpson WL, Rosenberg HK. Pitfalls and Practical Challenges in Imaging of the Pediatric Scrotum. Ultrasound Q 2022; 38:208-221. [PMID: 36054277 DOI: 10.1097/ruq.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Ultrasound is the modality of choice for evaluation of the pediatric scrotum, as it provides excellent image quality without the use of radiation, need for sedation/anesthesia, or use of contrast material and can be used for serial examination. Ultrasound of the scrotum has proven to be useful for assessment of a wide gamut of congenital, infectious, inflammatory, endocrine, neoplastic, and traumatic abnormalities in pediatric patients of all ages from the tiniest premature infant to a fully grown young adult. This review article presents a varied spectrum of conditions that may affect the pediatric scrotum, what the radiologist needs to know to meet the challenge of limiting the differential diagnosis, and how to avoid pitfalls when imaging the scrotum.
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Affiliation(s)
- Humaira Chaudhry
- Department of Radiology, Rutgers-New Jersey Medical School, Newark, NJ
| | - Madheea Siddiqi
- Department of Radiology, Rutgers-New Jersey Medical School, Newark, NJ
| | - William L Simpson
- Department of Diagnostic Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Henrietta Kotlus Rosenberg
- Department of Diagnostic Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
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Falco EC, Daniele L, Metovic J, Bollito E, De Rosa G, Volante M, Papotti M. Adrenal Rests in the Uro-genital Tract of an Adult Population. Endocr Pathol 2021; 32:375-384. [PMID: 34095993 PMCID: PMC8370964 DOI: 10.1007/s12022-021-09685-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 12/02/2022]
Abstract
Ectopic adrenal rests are a rare condition which can be found in various sites, generally in the retroperitoneum or pelvis along the path of gonadal descent. Their real prevalence is unknown. Males are more commonly affected, at least in the pediatric age. Adrenal rests are usually clinically silent and incidentally found in surgical samples, mostly in the pediatric population, and rarely in adults. With the aim of increasing knowledge and estimating the prevalence of ectopic adrenocortical tissue in the adult population, 44 adrenal rests in the urogenital tract of 40 adults are described. These represent approximately 0.07% of the total number of urogenital and gynecological surgeries performed in the 22 considered years. Adrenal rests were identified in the spermatic cord (10 males) and in paraovarian, parasalpingeal, or infundibulopelvic ligament locations (30 females). All but one was incidental findings. One case regarded an adrenocortical carcinoma arisen in adrenal rests. A literature review of adrenal ectopia in the urogenital tract of adults identified 57 reported cases from 53 patients, with similar clinicopathological features as those of our series, with the exception of a lower incidence of parasalpingeal locations. Despite their limited clinical implications, awareness of ectopic adrenal rests is essential also in adults for at least two reasons: (a) to correctly identify sources of adrenocortical hormone production in case of adrenal insufficiency or hormonal imbalance and (b) to avoid misinterpretations in the diagnostic workup of renal cell carcinoma, adrenocortical tumors, and rare gonadal neoplasms, including Sertoli/Leydig cell tumors.
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Affiliation(s)
- Enrico Costantino Falco
- Pathology Unit, Department of Medical Sciences, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | | | - Jasna Metovic
- Pathology Unit, Department of Oncology, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
| | - Enrico Bollito
- Pathology Unit, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Marco Volante
- Pathology Unit, Department of Oncology at San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, Città Della Salute E Della Scienza Hospital, University of Turin, Turin, Italy
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Tresoldi AS, Betella N, Hasenmajer V, Pozza C, Vena W, Fiamengo B, Negri L, Cappa M, Lania AGA, Lenzi A, Isidori AM, Pizzocaro A. Bilateral testicular masses and adrenal insufficiency: is congenital adrenal hyperplasia the only possible diagnosis? First two cases of TARTS described in Addison-only X-linked adrenoleukodystrophy and a brief review of literature. J Endocrinol Invest 2021; 44:391-402. [PMID: 32691371 DOI: 10.1007/s40618-020-01362-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Testicular adrenal rest tumors (TARTs) are benign masses deemed to originate from pluripotent testicular steroidogenic cells that grow under chronic ACTH stimulation. These lesions, occasionally misdiagnosed as Leydig cell tumors (LCTs), are typically described in patients with congenital adrenal hyperplasia (CAH). X-linked adrenoleukodystrophy (X-ALD) is an inherited disorder of beta-oxidation with accumulation of very long chain fatty acids (VLCFAs) in various tissues, and a rare cause of primary adrenal insufficiency (PAI). TARTs have never been associated with X-ALD. CASE 1 DESCRIPTION: A 19-year old male, who had previously undergone bilateral enucleation of presumed LCTs, was referred to our unit. Follow-up scans showed persistent bilateral lesions compatible with TARTs. Biochemical exams revealed PAI but excluded CAH. A serum VLCFAs panel was consistent with X-ALD, with gene testing confirming the diagnosis. Histological revision of the previously resected testicular lesions was compatible with TARTs. Start of glucocorticoid replacement therapy was associated with a reduction of testicular masses. CASE 2 DESCRIPTION: A 26-year old X-ALD male was diagnosed with bilateral testicular lesions compatible with TARTs. These lesions increased after ACTH elevation following switch to modified-release hydrocortisone. Clinical and sonographic findings allowed for a "watchful-waiting" approach, avoiding unnecessary surgery. CONCLUSION These are the first cases reported of TARTs in patients with X-ALD-associated PAI. Testicular lesions in patients with an early onset of ACTH elevation, regardless of the cause, should always be thoughtfully investigated, as they may reveal themselves as TARTs. We suggest that all patients affected from chronic ACTH elevation of a young age of onset should undergo testicular ultrasound in order to evaluate the presence of these lesions. GRT in these patients might also help preserving fertility.
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Affiliation(s)
- A S Tresoldi
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center - IRCCS -, Via Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - N Betella
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center - IRCCS -, Via Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - V Hasenmajer
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - C Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - W Vena
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center - IRCCS -, Via Manzoni, 56, 20089, Rozzano, MI, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - B Fiamengo
- Pathology, Humanitas Clinical and Research Center - IRCCS -, Rozzano, MI, Italy
| | - L Negri
- Division of Gynecology and Reproductive Medicine, Humanitas Fertility Center, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
| | - M Cappa
- Endocrinology Unit, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy
| | - A G A Lania
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center - IRCCS -, Via Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Pizzocaro
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center - IRCCS -, Via Manzoni, 56, 20089, Rozzano, MI, Italy
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Kim MS, Koppin CM, Mohan P, Goodarzian F, Ross HM, Geffner ME, De Filippo R, Kokorowski P. Absence of Testicular Adrenal Rest Tumors in Newborns, Infants, and Toddlers with Classical Congenital Adrenal Hyperplasia. Horm Res Paediatr 2019; 92:157-161. [PMID: 31747670 PMCID: PMC7004842 DOI: 10.1159/000504135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/14/2019] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Testicular adrenal rest tumors (TART) are a known consequence for males with classical congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency. TART are associated with potential infertility in adults. However, little is known about TART in very young males with CAH. OBJECTIVE We assessed the presence of TART in newborn, infant, and toddler males with classical CAH via scrotal ultrasound. METHODS Males with CAH had scrotal ultrasounds during the first 4 years of life, evaluating testes for morphology, blood flow, and presence of TART. Newborn screen 17-hydroxyprogesterone (17-OHP) and serum 17-OHP at the time of ultrasound were recorded. Bone ages were considered very advanced if ≥2 SD above chronological age. RESULTS Thirty-one ultrasounds in 16 males were performed. An initial ultrasound was obtained in four newborns at diagnosis (6.8 ± 2.1 days), six infants (2.2 ± 0.9 months), and six toddlers (2.4 ± 0.9 years). Eleven males had at least one repeat ultrasound. A large proportion (11/16) were in poor hormonal control with an elevated 17-OHP (325 ± 298 nmol/L). One infant was in very poor hormonal control (17-OHP 447 nmol/L) at initial ultrasound, and two toddlers had advanced bone ages (+3.2 and +4.5 SD) representing exposure to postnatal androgens. However, no TART were detected in any subjects. CONCLUSIONS TART were not found by scrotal ultrasound in males up to 4 years of age with classical CAH despite settings with expected high ACTH drive. Further research into the occurrence of TART in CAH may elucidate factors that contribute to the detection and individual predisposition to TART.
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Affiliation(s)
- Mimi S. Kim
- Corresponding Author: Mimi Kim, M.D., M.Sc., Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #61, Los Angeles, CA 90027, , Phone: +1 323-361-1358
| | - Christina M. Koppin
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Pankhuri Mohan
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Fariba Goodarzian
- Children’s Hospital Los Angeles, Los Angeles, California, United States of America,Keck School of Medicine of University of Southern California,Department of Radiology, Children’s Hospital Los Angeles
| | - Heather M. Ross
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, United States of America
| | - Mitchell E. Geffner
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, California, United States of America,Keck School of Medicine of University of Southern California,The Saban Research Institute
| | - Roger De Filippo
- Children’s Hospital Los Angeles, Los Angeles, California, United States of America,Keck School of Medicine of University of Southern California,Division of Pediatric Urology, Children’s Hospital Los Angeles
| | - Paul Kokorowski
- Children’s Hospital Los Angeles, Los Angeles, California, United States of America,Keck School of Medicine of University of Southern California,Division of Pediatric Urology, Children’s Hospital Los Angeles
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Ben-Mordechay D, Ben-Shlush A, Raviv-Zilka L, Jacobson JM, Soudack M. Sonographic Detection of Accessory Adrenal Tissue in Neonates. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:959-963. [PMID: 27072156 DOI: 10.7863/ultra.15.05048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/25/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to describe the incidence and appearance of accessory adrenal tissue in neonates, as diagnosed by high-resolution sonography, and increase the awareness of this entity. METHODS We examined the adrenal glands in 153 neonates referred for renal and urinary tract sonography at our institution between January 2014 and January 2015. All kidneys and adrenal glands, except for ectopic kidneys, were scanned with the neonate prone and a linear array transducer with frequency of 11 or 14 MHz. RESULTS In 9 neonates (5.9%), sonography showed a round, well-defined structure adjacent to the adrenal gland with a hyperechoic center and hypoechoic periphery, similar to the echogenicity of the normal adrenal medulla and cortex, respectively. The largest diameter of the structure measured 2.9 to 4.5 mm. On follow-up studies, which were available for 7 neonates, the structure was not evident, and the suprarenal area was normal. CONCLUSIONS Accessory adrenal tissue can be identified in the suprarenal area in neonates with high-resolution sonography. Radiologists and sonographers caring for neonates should be aware of this finding and not confuse it with disease.
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Affiliation(s)
| | - Aviva Ben-Shlush
- Department of Pediatric Imaging, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Lisa Raviv-Zilka
- Department of Pediatric Imaging, Chaim Sheba Medical Center, Ramat-Gan, IsraelSackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeffrey M Jacobson
- Department of Pediatric Imaging, Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - Michalle Soudack
- Department of Pediatric Imaging, Chaim Sheba Medical Center, Ramat-Gan, IsraelSackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Dobanovacki DS, Maric DM, Maric DL, Vuckovic N, Jokic RR, Slavkovic AR, Miskovic SVS. Ectopic adrenocortical tissue: an incidental finding during inguinal surgery in children. Fetal Pediatr Pathol 2013; 31:32-7. [PMID: 22506927 DOI: 10.3109/15513815.2012.659414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adrenal rests are usually unrecognized during operation, and the incidence of ectopic adrenal cortical tissue in pediatric patients during inguinal surgery procedures is unknown. We performed 3028 groin surgical explorations in 2680 patients aged 1 month to 17 years. Ectopic adrenal tissue was found in 69 inguinal operations (2.2%): 37 during 1.524 orchiopexy (2.4%), 23 during 1.115 herniectomy (2.0%), and 9 during 389 hydrocoela operation (2.3%). Statistically there were no significant differences among those three groups. No adrenal rests were detected in females. Although a few reported cases with hormonal activity of ectopic adrenocortical tissue (EACT), the recommendation is to remove them if found.
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Affiliation(s)
- Dusanka S Dobanovacki
- Institute for Children and Youth Health Care of Vojvodina, Pediatric Surgery Clinic, Novi Sad, Serbia.
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Pierre P, Despert F, Tranquart F, Coutant R, Tardy V, Kerlan V, Sonnet E, Baron S, Lorcy Y, Emy P, Delavierre D, Monceaux F, Morel Y, Lecomte P. Adrenal rest tissue in gonads of patients with classical congenital adrenal hyperplasia: multicenter study of 45 French male patients. ANNALES D'ENDOCRINOLOGIE 2012; 73:515-22. [PMID: 23131470 DOI: 10.1016/j.ando.2012.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 06/10/2012] [Accepted: 09/10/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Several cases of testicular adrenal rest tumours have been reported in men with congenital adrenal hyperplasia (CAH) due to the classical form of 21-hydroxylase deficiency but the prevalence has not been established. The aims of this report were to evaluate the frequency of testicular adrenal rest tissue in this population in a retrospective multicentre study involving eight endocrinology centres, and to determine whether treatment or genetic background had an impact on the occurrence of adrenal rest tissue. MATERIAL AND METHODS Testicular adrenal rest tissue (TART) was sought clinically and with ultrasound examination in forty-five males with CAH due to the classical form of 21-hydroxylase deficiency. When the diagnosis of testicular adrenal rest tumours was sought, good observance of treatment was judged on biological concentrations of 17-hydroxyprogesterone (17OHP), delta4-androstenedione, active renin and testosterone. The results of affected and non-affected subjects were compared. RESULTS TART was detected in none of the 18 subjects aged 1 to 15years but was detected in 14 of the 27 subjects aged more than 15years. Five patients with an abnormal echography result had no clinical signs. Therapeutic control evaluated at diagnosis of TART seemed less effective when diagnosis was made in patients with adrenal rest tissue compared to TART-free subjects. Various genotypes were observed in patients with or without TART. CONCLUSION Due to the high prevalence of TART in classical CAH and the delayed clinical diagnosis, testicular ultrasonography must be performed before puberty and thereafter regularly during adulthood even if the clinical examination is normal.
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Affiliation(s)
- Peggy Pierre
- Adult Endocrinology Unit, University Hospital of Tours, 2, boulevard Tonnelé, 37044 Tours cedex 9, France.
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Papatya Çakır ED, Şentürk Mutlu F, Eren E, Paşa AÖ, Sağlam H, Tarım Ö. Testicular adrenal rest tumors in patients with congenital adrenal hyperplasia. J Clin Res Pediatr Endocrinol 2012; 4:94-100. [PMID: 22672867 PMCID: PMC3386780 DOI: 10.4274/jcrpe.563] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Early diagnosis and treatment of testicular adrenal rest tumors (TART) is important for gonadal functions and fertility protection in boys with congenital adrenal hyperplasia (CAH). In this descriptive study, we investigated the prevalence of TART in boys with 21-hydroxylase deficient (21OHD) CAH followed in our pediatric endocrine clinic. METHODS The study group consisted of 14 male patients with a mean age of 9.6 ± 5.1 (range: 0.8-18.3) years. Six (42.9%) of the 14 patients were diagnosed as having salt-wasting type (SW) and eight (57.1%) patients - as having the simple virilizing (SV) form of 21OHD. Mean age at diagnosis was 2.9 ± 2.7 (range: 0.03-6.3) years. Two different radiologists performed scrotal ultrasonography. Chronological age, bone age, and anthropometric measurements were evaluated. Serum adrenocorticotropic hormone (ACTH), 17-alpha-hydroxyprogesterone (17OHP) and androstenedione levels were also evaluated in all patients during the follow-up period. RESULTS Scrotal ultrasonography revealed bilateral TART in two patients (14.3%) and testicular microlithiasis (TM) in four patients (28.6%). One patient had both TART and TM bilaterally. During the follow-up period, the mean serum adrenocorticotropic hormone, 17OHP and androstenedione levels in the total group of patients were 130.0 ± 179.1 pg/mL (21.7-726.5), 5.8 ± 3.3 ng/mL (0.8-11.4) and 4.3 ± 4.1 (0.2-11.0) ng/mL, respectively. CONCLUSIONS Microlithiasis or TART may be frequently encountered during the follow-up of patients with CAH. In order to prevent late complications including infertility, we suggest that ultrasonographic evaluations be performed yearly in all male CAH patients.
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Affiliation(s)
| | - Fatma Şentürk Mutlu
- Uludağ University Faculty of Medicine, Department of Radiology, Bursa, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Aliye Özlem Paşa
- Uludağ University Faculty of Medicine, Department of Radiology, Bursa, Turkey
| | - Halil Sağlam
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Ömer Tarım
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
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Philips S, Nagar A, Dighe M, Vikram R, Sunnapwar A, Prasad S. Benign non-cystic scrotal tumors and pseudotumors. Acta Radiol 2012; 53:102-11. [PMID: 22025740 DOI: 10.1258/ar.2011.110185] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
There is a wide spectrum of benign, non-cystic scrotal lesions that show characteristic histo-morphology and natural history. While sonography is the preferred modality for the diagnosis of both testicular and extratesticular masses, MRI is used as a problem-solving modality when sonographic findings are inconclusive. This article reviews the cross-sectional imaging features of benign, non-cystic, intra- and extratesticular lesions. Definitive diagnosis of benign scrotal lesions may lead to conservative management including testicular preserving surgery.
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Affiliation(s)
- Shaile Philips
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX
| | - Arpit Nagar
- Department of Radiology, Ohio State University Medical Center, Columbus, OH
| | - Manjiri Dighe
- Department of Radiology, University of Washington Medical Center, Seattle, WA
| | | | - Abhijit Sunnapwar
- Department of Radiology, University of Texas Health Science Center, San Antonio, TX
| | - Srinivasa Prasad
- Department of Radiology, MD Anderson Cancer Center, Houston, TX, USA
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Geraghty MJ, Lee FT, Bernsten SA, Gilchrist K, Pozniak MA, Yandow DJ. Sonography of Testicular Tumors and Tumor-Like Conditions: A Radiologic-Pathologic Correlation. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/10408379891244163] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tazi MF, Ahsaini M, Khalouk A, Fassi MJ, Farih MH. Les tumeurs testiculaires à cellules de Leydig: à propos de quatre cas et revue de la littérature. Basic Clin Androl 2011. [DOI: 10.1007/s12610-010-0114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Résumé
Introduction
Les tumeurs testiculaires à cellules de Leydig (TTCL) sont rares, elles représentent entre 1 et 3 % de l’ensemble des tumeurs testiculaires, ce sont les plus fréquentes des tumeurs des cordons sexuels et du stroma. Ces tumeurs se développent le plus fréquemment (55 %) chez les sujets jeunes de 15 à 35 ans, mais elles peuvent se voir aussi chez les enfants lors de la première décennie (20 %) et chez les hommes après 50 ans (25 %). Le mode de révélation le plus fréquent chez l’adulte est la gynécomastie, par contre chez l’enfant, c’est la pseudopuberté précoce isosexuelle. Elles posent le problème de leur diagnostic biologique devant des formes non palpables et du choix de leur traitement chirurgical en raison de la difficulté diagnostique entre les formes bénignes et malignes.
Matériel et méthodes
Nous rapportons quatre présentations différentes de cette pathologie dont les paramètres étudiés seront l’âge, le mode de révélation, le profil hormonal, le type de traitement et le mode évolutif.
Résultats
L’âge moyen de nos patients était de 37 ans et demi. Le mode de révélation était deux fois sur quatre en rapport avec une grosse bourse unilatérale, une fois pour grosse bourse bilatérale, une fois en rapport avec une gynécomastie. Dans tous les cas, la testostérone était normale ou basse et l’estradiol normal ou élevé. Les quatre patients ont subi une orchidectomie associée à une énucléation controlatérale chez un seul des patients. L’évolution était favorable pour tous nos patients, avec un recul moyen de 15 mois.
Conclusion
Le but de cette revue est de présenter, sur la base de quatre observations cliniques différentes et de l’analyse de la littérature, les différents aspects cliniques, biologiques, radiologiques pathologiques et thérapeutiques des TTCL.
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Banik T, Dey P, Gogoi D. Adrenal rest in testis diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 2010; 39:849-51. [DOI: 10.1002/dc.21569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 09/13/2010] [Indexed: 11/05/2022]
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Unilateral testicular tumour associated to congenital adrenal hyperplasia: Failure of specific tumoral molecular markers to discriminate between adrenal rest and leydigioma. ANNALES D'ENDOCRINOLOGIE 2008; 69:453-8. [PMID: 18620332 DOI: 10.1016/j.ando.2008.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 05/07/2008] [Accepted: 05/28/2008] [Indexed: 11/22/2022]
Abstract
Testicular adrenal rest tumours are frequently associated with congenital adrenal hyperplasia (CAH). These ACTH-dependent tumours cannot be easily distinguished histologically from Leydig-cell tumours. We report the case of a 30-year-old man who was explored for infertility, azoospermia and unilateral testicular tumour. High levels of 17-OH progesterone and ACTH, low cortisol and undetectable gonadotropins levels, associated to bilateral adrenal hyperplasia, led to the diagnosis of CAH by 21-OH deficiency with a composite heterozygoty. The testicular tumour was first considered as adrenal rest. However, histological analysis of this unilateral painful tumour showed a steroid-hormone-secreting cell proliferation with atypical and frequent mitosis. To discriminate between a benign adrenal rest tumour and a possible malignant leydigioma, tumoral expression of specific gene products was analyzed by RT-PCR. No 11-beta-hydroxylase nor ACTH receptor mRNAs could be found in the tumour, which did not behave like usual adrenal rest cells. For this unilateral testicular tumour, the lack of adrenal-specific markers associated with a high rate of mitosis and pleiomorphism supported a leydigian origin with malignant potential. However, lack of tumoral LH-R mRNA expression and a tumour-free 3-year follow-up led us to retain the diagnosis of adrenal rest tumour with loss of adrenal gene expression and progressive autonomous behaviour.
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Martinez-Aguayo A, Rocha A, Rojas N, García C, Parra R, Lagos M, Valdivia L, Poggi H, Cattani A. Testicular adrenal rest tumors and Leydig and Sertoli cell function in boys with classical congenital adrenal hyperplasia. J Clin Endocrinol Metab 2007; 92:4583-9. [PMID: 17895312 DOI: 10.1210/jc.2007-0383] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Infertility observed in adult males with congenital adrenal hyperplasia (CAH) has been associated with testicular adrenal rest tumors (TART) that may originate during childhood. OBJECTIVE Our objective was to describe the prevalence of TART and Sertoli and Leydig cell function in a group of boys aged 2-10 yr with CAH and to compare prevalence with that of a control group. DESIGN From August 2005 to January 2007, 19 patients with classical CAH (CAH group) were referred from seven endocrinology centers. METHODS We studied 19 subjects in the CAH group and, as a control group, 13 boys from the community that did not have testicular diseases. A complete physical exam was performed. High-resolution ultrasound was used to determine TART prevalence. Inhibin B and anti-Müllerian hormone were used as Sertoli cell markers. The ratio between basal testosterone levels and testosterone levels 72 h after beta-human chorionic gonadotropin (5000 U/m2) treatment [(T72- T0)/T0] was used to evaluate Leydig cell response. RESULTS CAH and control groups were comparable in chronological age (5.9 vs. 5.6 yr; P = 0.67) and bone age/chronological age ratio (1.09 vs. 1.03; P = 0.09). TART prevalence was four of 19 (21%) in the CAH group. Lower values for inhibin B (49.2. vs. 65.2 pg/ml; P = 0.018), anti-Müllerian hormone (70.1 vs. 94.2 ng/ml; P = 0.002), and (T72- T0)/T0 (5.6 vs. 13.6; P < 0.01) were observed in the CAH group. CONCLUSION TART in prepubertal males with classic CAH could be found during childhood. We also report differences in markers of gonadal function in a subgroup of patients, especially in those with inadequate control.
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Affiliation(s)
- A Martinez-Aguayo
- Endocrinology Unit, Department of Pediatrics, Pontificia Universidad Católica de Chile, 833-0074, Santiago, Chile.
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Ribagnac M, Brac De La Perrière A, Lyonnet D, Rouvière O. [Testicular adrenal rests: the role of imaging]. ACTA ACUST UNITED AC 2007; 88:631-8. [PMID: 17541355 DOI: 10.1016/s0221-0363(07)89869-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Testicular adrenal rests are encountered in ACTH hypersecretion syndromes, most often in congenital adrenal hyperplasia attributable to a deficit in 21-hydroxylase. They are discovered clinically or on systematic sonography, generally in the young adult. On sonography, they appear as confluent hypoechogenic masses, often bilateral, that have developed in the region of the testicular hilum. At a late stage, they take on a highly suggestive attenuating aspect. In color Doppler, they have a regular vascular architecture. They generally regress or stabilize with replacement glucocorticosteroid treatment. They can sometimes progress, which then poses the problem of the type of lesion. Biopsy or spermatic vein samples are not reliable. MRI contributes very little more than sonography. Diagnosis comes with follow-up or, as a last resort, orchidectomy.
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Affiliation(s)
- M Ribagnac
- Service de Radiologie Urinaire et Vasculaire, Hospices Civils de Lyon, Hôpital Edouard Herriot, 69437 Lyon
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17
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Claahsen-van der Grinten HL, Hulsbergen-van de Kaa CA, Otten BJ. Ovarian adrenal rest tissue in congenital adrenal hyperplasia--a patient report. J Pediatr Endocrinol Metab 2006; 19:177-82. [PMID: 16562593 DOI: 10.1515/jpem.2006.19.2.177] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a young girl who died in an Addisonian crisis due to previously undiagnosed congenital adrenal hyperplasia (CAH), in whom ovarian adrenal rest tissue was detected at postmortem histopathological examination. This is a very rare complication in female patients with CAH with only two previously reported cases.
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18
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Nagamine WH, Mehta SV, Vade A. Testicular adrenal rest tumors in a patient with congenital adrenal hyperplasia: sonographic and magnetic resonance imaging findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1717-20. [PMID: 16301728 DOI: 10.7863/jum.2005.24.12.1717] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- Wayde H Nagamine
- Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153 USA
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19
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Barwick TD, Malhotra A, Webb JAW, Savage MO, Reznek RH. Embryology of the adrenal glands and its relevance to diagnostic imaging. Clin Radiol 2005; 60:953-9. [PMID: 16124976 DOI: 10.1016/j.crad.2005.04.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2004] [Revised: 03/20/2005] [Accepted: 04/06/2005] [Indexed: 01/11/2023]
Abstract
An understanding of the embryology of the adrenal glands is necessary to appreciate the location of adrenal ectopic, or rest, tissue which can occur anywhere along the course of gonadal descent. This tissue usually has no clinical significance, but may become hyperplastic in patients with primary or secondary adrenal pathology. In congenital adrenal hyperplasia, hyperplastic rest tissue may present as a soft-tissue mass, particularly in the gonads and retroperitoneum, and may be mistaken for tumour. The adrenal in the neonate is proportionately much larger than in the adult; in renal ectopy or agenesis the ipsilateral adrenal is normally sited and may be mistaken for a kidney because of its size. This review article illustrates the embryology of the adrenal with particular emphasis on the relevance of embryology to pathology.
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Affiliation(s)
- T D Barwick
- Department of Diagnostic Radiology, St Bartholomew's Hospital, London, UK.
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20
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Houghton R, Rottenberg G. Testicular lumps. IMAGING 2005. [DOI: 10.1259/imaging/77235510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
Ultrasound plays an important role in the diagnostic workup of scrotal diseases. It can differentiate a testicular mass from an extratesticular mass and determine whether the mass is cystic, solid, or complex. Using this information a likely diagnosis can be ascertained. In the acute scrotum, acute epididymitis/epididymo-orchitis can in most cases be distinguished from testicular torsion. Following scrotal trauma, surgery is needed to salvage the testis if there is testicular disruption and ultrasound can help with this diagnostic dilemma. When a large hydrocele is present, ultrasound allows evaluation of the underlying testis and epididymis and it can detect varicoceles, especially in the infertile male. In patients at risk for a testicular tumor (cryptorchid testis, testicular microlithiasis), ultrasound is the best imaging modality for follow-up. CT, MRI, and nuclear medicine scanning may be necessary for further evaluation of scrotal diseases and this will be briefly addressed.
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Affiliation(s)
- Esma A Akin
- Department of Radiology, The George Washington University Hospital, Washington, DC 20037, USA
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Affiliation(s)
- Vikas Kundra
- Department of Radiology and Experimental Diagnostic Imaging, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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23
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Dogra V, Nathan J, Bhatt S. Sonographic appearance of testicular adrenal rest tissue in congenital adrenal hyperplasia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:979-981. [PMID: 15292569 DOI: 10.7863/jum.2004.23.7.979] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Vikram Dogra
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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24
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Weeks DC, Walther MM, Stratakis CA, Hwang JJ, Linehan WM, Phillips JL. Bilateral testicular adrenal rests after bilateral adrenalectomies in a cushingoid patient with von Hippel-Lindau disease. Urology 2004; 63:981-2. [PMID: 15135000 DOI: 10.1016/j.urology.2004.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2003] [Revised: 01/14/2004] [Accepted: 01/14/2004] [Indexed: 11/20/2022]
Abstract
We report a case of bilateral testicular masses in a 25-year-old man with von Hippel-Lindau disease presenting with cushingoid symptoms. His medical history was significant for bilateral adrenalectomies secondary to pheochromocytomas, and he began steroid therapy at that time. After exhaustive endocrinologic, radiographic, and physical examinations, the testicular masses were postulated to be active adrenal rest tissue. Bilateral testicular venous sampling found elevated glucocorticoids that were responsive to dexamethasone suppression, which confirmed the testicular masses as testicular adrenal rests without the need for surgical intervention. Successful conservative management consisted of appropriate steroid manipulation and radiographic evaluation and resulted in the resolution of presenting symptoms, a decrease in size of the bilateral testicular masses, and testicular conservation in this young man.
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Affiliation(s)
- D Champ Weeks
- Urologic Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
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25
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Abstract
PURPOSE We summarize important clinical, pathological and diagnostic features of benign intrascrotal lesions, including paratesticular lesions (adenomatoid tumors, fibrous pseudotumors, cystadenomas, spermatoceles, hydroceles, varicoceles and hernias) and intratesticular lesions (tunica albuginea cysts, testicular simple cysts, epidermoid cysts, cystic ectasia of the rete testis, intratesticular varicocele, adrenal rest tumors and splenogonadal fusion). This review provides the reader with a better understanding of benign lesions that occur in the scrotum. MATERIALS AND METHODS A directed MEDLINE literature review of benign scrotal lesions and of each individual lesion was performed. This information was enhanced with relevant information from select journals and texts. Particular emphasis was placed on clinical, pathological and diagnostic features. RESULTS Intrascrotal lesions continue to provide a diagnostic challenge for physicians. A diagnosis can be made with a thorough history, physical examination and understanding of the pathophysiological processes of the structures contained within the scrotum. Lesions that are suspicious for malignancy should prompt urological consultation and radiological imaging. Ultrasound aids in the diagnosis in instances of uncertainty. Ultimately surgery may be necessary to make a histological diagnosis. CONCLUSIONS Clinical assessment, physical examination and an understanding of benign intrascrotal processes are key to making a diagnosis. Ultrasound has an important role and adds essential information. If surgery is necessary and a benign process is recognized, a testis sparing procedure should be performed.
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Affiliation(s)
- Ronald A Rubenstein
- Department of Urology, Case Western Reserve University, University Hospitals of Cleveland, Cleveland, Ohio, USA
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26
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Calikoglu AS. Adrenocorticotropic hormone, a new player in the control of testicular steroidogenesis. Endocrinology 2003; 144:3277-8. [PMID: 12865301 DOI: 10.1210/en.2003-0618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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27
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Muglia V, Tucci S, Elias J, Trad CS, Bilbey J, Cooperberg PL. Magnetic resonance imaging of scrotal diseases: when it makes the difference. Urology 2002; 59:419-23. [PMID: 11880084 DOI: 10.1016/s0090-4295(01)01579-5] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the utility of magnetic resonance imaging (MRI) after inconclusive sonography in the evaluation of scrotal disease. METHODS From 1993 to 1999, 622 patients underwent ultrasonography (US) with state-of-the-art equipment to evaluate scrotal diseases. Twenty-six patients, two with bilateral and distinct diseases (age range 1--63 years, mean 33), had an inconclusive sonogram and were sent for MRI. The MRI results were compared with previous US reports and with the final diagnosis. RESULTS MRI yielded additional and correct information (compared with US), coincident with the final diagnosis in 23 cases (82.1%). In regard to lesions suspected of malignancy at US (17 cases), MRI had a great concordance with the final diagnosis and was statistically significant (P <0.002, kappa test). CONCLUSIONS The results of our study indicate that MRI could help elucidate scrotal dilemmas found at US, although the small percentage of inconclusive sonograms confirms this technique as the first choice when imaging is required in scrotal diseases.
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Affiliation(s)
- Valdair Muglia
- Department of Radiology, University of São Paulo, Ribeirão Preto, School of Medicine, Ribeirão Preto, São Paulo, Brazil
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Woodward PJ, Sohaey R, O'Donoghue MJ, Green DE. From the archives of the AFIP: tumors and tumorlike lesions of the testis: radiologic-pathologic correlation. Radiographics 2002; 22:189-216. [PMID: 11796908 DOI: 10.1148/radiographics.22.1.g02ja14189] [Citation(s) in RCA: 270] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Testicular carcinoma represents only 1% of all neoplasms in men, but it is the most common malignancy in the 15-34-year-old age group. Germ cell tumors constitute 95% of all testicular tumors. Germ cell tumors are a varied group of neoplasms whose imaging features reflect their underlying histologic characteristics. Seminomas are generally well-defined homogeneous lesions, whereas the nonseminomatous tumors (embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, and mixed germ cell tumor) have a much more varied appearance. Germ cell tumors follow a predictable pattern of spread via the lymphatic drainage to the retroperitoneal nodes. Choriocarcinoma, which has a proclivity for early hematogenous spread, is a notable exception. Testicular tumors may also arise from the sex cords (Sertoli cells) and stroma (Leydig cells). Although 90% of these tumors are benign, there are no reliable imaging criteria to differentiate them from malignant masses. Some benign testicular masses can be recognized, obviating an unwarranted orchiectomy. A dilated rete testis is a normal variant and appears as a series of small tubules near the mediastinum testis. Other benign lesions that can be suspected on the basis of imaging findings and history include intratesticular cysts, epidermoid cysts, congenital adrenal hyperplasia, and sarcoidosis.
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Affiliation(s)
- Paula J Woodward
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St, NW, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA.
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29
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Proto G, Di Donna A, Grimaldi F, Mazzolini A, Purinan A, Bertolissi F. Bilateral testicular adrenal rest tissue in congenital adrenal hyperplasia: US and MR features. J Endocrinol Invest 2001; 24:529-31. [PMID: 11508788 DOI: 10.1007/bf03343887] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe magnetic resonance (MR) and ultrasonography (US) features of bilateral testicular adrenal rest tissue in a 20-yr-old man with congenital adrenal hyperplasia (CAH). Scrotal ultrasonology detected bilateral homogeneous hypoechoic lesions with well-defined margins and without evidence of sound attenuation. MR is useful in defining the size of lesions, because the contrast resolution is better than with sonography and allows an accurate definition of the extent of disease. This case suggests that US evaluation should be included in periodical follow-up of patients with CAH, while MR may be used in the case of rapid increase in the size of the testicular mass.
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Affiliation(s)
- G Proto
- Endocrine Unit, Azienda Ospedaliera S. Maria della Misericordia, Udine, Italy.
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30
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Abstract
Most testicular masses are germ cell malignancies and require radical orchiectomy. There are other causes of testicular masses, however, some of which have characteristic imaging and clinical features. A presumptive diagnosis may be possible for some of these atypical testicular masses. This may result in testis-preserving surgery or nonoperative management.
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Affiliation(s)
- F V Coakley
- Department of Radiology, University of California San Francisco, USA
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31
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Abstract
This article discusses informed consent and emphasizes four critical features of ethically and legally appropriate informed consent. The article also highlights some exceptions to informed consent requirements. The authors outline practical advice for avoiding litigation resulting from consent issues.
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Affiliation(s)
- L M Nora
- Department of Neurology, University of Kentucky College of Medicine, Lexington, Kentucky 40536, USA
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32
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Howlett DC, Jones AJ, Saunders AJ. Case of the month. Painless testicular nodularity in a young man. Br J Radiol 1997; 70:1195-6. [PMID: 9536916 DOI: 10.1259/bjr.70.839.9536916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- D C Howlett
- Department of Radiology, Guy's Hospital, Guy's and St Thomas' NHS Trust, London, UK
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33
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Dieckmann K, Lecomte P, Despert F, Maurage C, Sirinelli D, Rolland JC. [Congenital adrenal hyperplasia and testicular hypertrophy]. Arch Pediatr 1995; 2:1167-72. [PMID: 8547996 DOI: 10.1016/0929-693x(96)89917-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Testicular tumors have been reported in boys and adolescents with congenital adrenal hyperplasia (CAH) inadequately controlled by hormonal therapy. CASE REPORTS Two adolescents were treated for CAH due to 21-hydroxylase deficiency. They developed hyperplastic nodular testes at the age of 16 and 17 years, respectively. CAH in both was inadequately controlled as confirmed by hormonal studies. The tumors regressed after adequate steroid therapy in the first patient but persisted in the second patient despite normalization of 17-OH progesterone and plasma renin activity. CONCLUSION Testicular ultrasonography should be systematic in all male patients with CAH since radiological findings are earlier than clinical manifestations. The ACTH-dependent tumors require intensification of hormonal therapy in order to obtain tumoral regression and to prevent infertility.
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Affiliation(s)
- K Dieckmann
- Service de pédiatrie R, CHU Gatien-de-Clocheville, Tours, France
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34
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Mazza E, Papotti M, Durando R, Robecchi A, Camanni F. Ectopic aldosteronoma associated to another adrenocortical adenoma in the adrenal gland of the same side. J Endocrinol Invest 1995; 18:809-12. [PMID: 8787960 DOI: 10.1007/bf03349816] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The occurrence of tumors originating from aberrant adrenocortical tissue in ectopic site is very rare. Up to now only two cases of ectopic aldosterone-producing adenoma have been described. We have observed another case of ectopic aldosteronoma, located in the retrocaval region, laterally to the body of the 12th thoracic vertebra. This ectopic tumor was associated to another adrenocortical adenoma, in the adrenal gland of the same side. The diagnostic implications of this observation are discussed.
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Affiliation(s)
- E Mazza
- Division of Endocrinology, University of Torino, Italy
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35
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Keely EJ, Matwijiw I, Thliveris JA, Faiman C. Congenital adrenal hyperplasia with testicular tumors, aggression, and gonadal failure. Urology 1993; 41:346-9. [PMID: 8470321 DOI: 10.1016/0090-4295(93)90593-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Bilateral testicular tumors (adrenal rests) may occur in untreated or poorly controlled congenital adrenal hyperplasia. This case report describes two unique associated phenomena: (1) psychologic disturbances similar to those seen with exogenous androgen abuse, which resolved with appropriate glucocorticoid suppression of androgen over-production by this abnormal adrenal/adrenal rest tissue; and (2) testicular failure which showed a partial, delayed recovery with corticosteroid therapy. The need for a careful history and biochemical screening for all patients with bilateral testicular tumors is reinforced.
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Affiliation(s)
- E J Keely
- Department of Medicine, University of Manitoba, Winnipeg, Canada
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36
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O'Connor G, Watlington C, Yeh H, Gabrilove J. Gynecomastia and Bilateral Testicular Masses Secondary to Congenital Adrenal Hyperplasia (21-Hydroxylase Deficiency). ACTA ACUST UNITED AC 1991. [DOI: 10.1515/jpem.1991.4.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Willi U, Atares M, Prader A, Zachmann M. Testicular adrenal-like tissue (TALT) in congenital adrenal hyperplasia: detection by ultrasonography. Pediatr Radiol 1991; 21:284-7. [PMID: 1870928 DOI: 10.1007/bf02018626] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In a consecutive series of 15 male adolescents and young adults with congenital adrenal hyperplasia (CAH), the size, shape, firmness and echostructure of the testes were assessed. The latter was abnormal in 7 patients under long standing treatment with glucocorticoids (group I). In 8, 5 under and 3 off treatment for several years, ultrasonography (US) was normal (group II). On the basis of the US findings the patients were placed in two groups. In group I, the testes had a heterogeneous ultrasonographic pattern; clinically, most felt hard and irregular, although their volume was normal. Sperm count in 3 patients was 5.0 to 14.4 x 10(6)/ml. Five patients have 21-hydroxylase deficiency that was diagnosed in early infancy and had salt-wasting; two have 11-beta-hydroxylase deficiency that was diagnosed late and had no salt-wasting. In group II, testicular volume, shape, firmness and echostructure were normal. All have 21-hydroxylase deficiency, no history of salt-wasting and were diagnosed late. Sperm counts in 3 patients off treatment were 10.5 to 66.0 x 10(6)/ml. In severe cases with a history of salt loss, TALT with deficient spermiogenesis seems likely despite treatment. In mild cases, TALT is absent and spermiogenesis may be normal even without treatment. US is much more accurate in assessing the testes than palpation.
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Affiliation(s)
- U Willi
- University Children's Hospital of Zürich, Switzerland
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Abstract
In this review we will attempt to summarize the use of scrotal sonography in infants and children. The material is gathered from the literature and from our own experience of 197 sonograms performed on 175 pediatric patients. Included will be information on testicular development and descent, normal sonographic anatomy, classification of scrotal disease, and the final diagnoses of the sonograms. Scrotal sonography has proven useful in evaluating undescended testes in the inguinal canal and just inside the inguinal ring. It is of limited value when the testes are in the abdomen. Sonography can often distinguish the various causes of nonpainful scrotal masses such as tumors, hydrocele, and meconium peritonitis. Sonography is highly accurate in distinguishing normal from abnormal scrotal contents and in separating testicular from extratesticular masses. However, sonography does have limitations in distinguishing benign from malignant neoplasms or from some inflammatory lesions. Sonography can be successfully used in the differential diagnosis of the painful scrotum especially with color flow Doppler. Inflammatory diseases that often involve the epididymis can be distinguished from torsion. Torsion of the appendages has been diagnosed. In cases of scrotal trauma, management decisions are often based on the sonographic findings. Conditions that require surgical management such as testicular rupture or large testicular hematomas can be recognized. Information is included on a variety of miscellaneous conditions such as hydrocele, varicocele, and ambiguous genitalia in which sonography has proven valuable.
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Affiliation(s)
- W H McAlister
- Washington University School of Medicine, St. Louis Children's Hospital, Mallinckrodt Institute of Radiology, MO
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Coulter GH, Bailey DR. Effects of ultrasonography on the bovine testis and semen quality. Theriogenology 1988; 30:743-9. [PMID: 16726516 DOI: 10.1016/0093-691x(88)90309-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1987] [Accepted: 08/05/1988] [Indexed: 11/25/2022]
Abstract
Ten yearling beef bulls were assigned to control (n = 5) or ultrasound treatment (n = 5) groups. Treatment consisted of a single 3-min exposure per testis to ultrasonic radiation at a frequency of 5 MHz and at low acoustical intensity (spatial peak temporal averages at 10 and 18 mm, focal points of 0.14 and 0.59 mW/cm(2) and spatial peak pulse averages of 1.1 and 3.4 W/cm(2) at corresponding focal points). Ultrasonic treatment had no effect (P > 0.05) on the percentage of progressively motile spermatozoa, primary sperm defects, secondary sperm defects or normal acrosomes over a 10-wk posttreatment evaluation period. Similarly, scrotal circumference, testicular consistency, paired testes weight, paired epididymal weight, daily sperm production per gram of testicular parenchuma, and epididymal sperm reserves were not affected (P > 0.05) at 69 d following ultrasound treatment. Ultrasonography of bovine scrotal contents did not affect reproductive capacity over the interval studied.
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Affiliation(s)
- G H Coulter
- Research Station, Agriculture Canada Lethbridge, Alberta T1J 4B1 USA
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40
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Abstract
The case of a 6-year-old boy with Peutz-Jeghers syndrome (PJS), gynecomastia, and multifocal and bilateral testicular tumors is described. Females with PJS are known to be at increased risk for developing gonadal tumors. This case and other reports from the literature suggest that males, as well as females, with PJS are at risk for developing gonadal tumors.
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