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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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Revels JW, Wang SS, Gangadhar K, Ali A, Ali AA, Lee JH. Multimodality Radiological Pictorial Review of Testicular Carcinoma: From Initial Staging to Restaging. Res Rep Urol 2020; 12:599-613. [PMID: 33294422 PMCID: PMC7718994 DOI: 10.2147/rru.s257243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/27/2020] [Indexed: 11/23/2022] Open
Abstract
With an overall 5-year survival rate >95%, patients with testicular cancer have a great prognosis. Although initial diagnosis is based on clinical examination, imaging does play a significant role in the diagnosis and prognosis of testicular cancer, which are dependent on tumor burden and staging. Successful treatment requires appropriate disease assessment throughout a patient’s treatment: evaluating treatment response, restaging, and monitoring for disease recurrence after treatment completion. Ultrasound is usually the initial screening modality for painless testicular masses, and computedtomography (CT) the most commonly used for staging and restaging. However, with regard to seminomas, positron-emission tomography (PET) combined with CT is slowly taking priority. With regard to nonseminomatous germ-cell tumors, PET-CT has not proven to be completely effective, due to a high number of false-negative results. The purpose of this paper is to provide radiologists with a pictorial review of testicular carcinoma from initial staging through posttreatment follow-up.
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Affiliation(s)
- Jonathan W Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake, UT, USA
| | - Kiran Gangadhar
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Arafat Ali
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Al-Amin Ali
- Department of Literature, Science, and Arts, University of Michigan, Ann Arbor, MI, USA
| | - Jean H Lee
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
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Li XX, Chen F, Li SL, Huang YC, Lv YQ, Chen Y, Sun HZ, Xie H. Sequential testis sparing surgery of simultaneous bilateral testicular tumors with different cell types in a Chinese infant: an uncommon presentation. Asian J Androl 2020; 21:419-420. [PMID: 30618414 PMCID: PMC6628740 DOI: 10.4103/aja.aja_104_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Xiao-Xi Li
- Department of Urology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Fang Chen
- Department of Urology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Shou-Lin Li
- Department of Urology, Children's Hospital of Shenzhen, Shenzhen 518026, China
| | - Yi-Chen Huang
- Department of Urology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Yi-Qing Lv
- Department of Urology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Yan Chen
- Department of Urology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hui-Zhen Sun
- Department of Urology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
| | - Hua Xie
- Department of Urology, Children's Hospital of Shanghai, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
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Chung JM, Lee SD. Overview of pediatric testicular tumors in Korea. Korean J Urol 2014; 55:789-96. [PMID: 25512812 PMCID: PMC4265712 DOI: 10.4111/kju.2014.55.12.789] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/28/2014] [Indexed: 11/24/2022] Open
Abstract
Prepubertal testicular tumors are rare compared with postpubertal testicular tumors. The incidence of prepubertal testicular tumors peaks at 2 years of age, tapers off after 4 years of age, and then begins to rise again at puberty. Prepubertal and postpubertal testicular tumors show many differences, including the typical tumor histology, molecular biological differences, and the malignant potential of tumors at different ages. Pediatric testicular tumors are classified as benign or malignant on the basis of their clinical behavior and histologically are divided into germ cell and gonadal stromal (nongerm cell) tumors. Many histological and biological studies have further confirmed the distinct nature of prepubertal and postpubertal testicular tumors. These differences have led to various management strategies for prepubertal and postpubertal tumors. Because overall about 75% of prepubertal testicular tumors are benign, a testis-sparing approach is becoming more common in children. Orchiectomy and observation with very selective use of chemotherapy has become the standard approach when a malignant tumor is identified. Retroperitoneal lymph node dissection and radiation therapy play very limited roles.
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Affiliation(s)
- Jae Min Chung
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Don Lee
- Department of Urology, Pusan National University School of Medicine, Yangsan, Korea
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Hoag NA, Afshar K, Youssef D, Masterson JST, Murphy J, Macneily AE. Cystic intratesticular lesions in pediatric patients. J Pediatr Surg 2013; 48:1773-7. [PMID: 23932621 DOI: 10.1016/j.jpedsurg.2012.10.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 09/26/2012] [Accepted: 10/22/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE Intratesticular cysts are a rare clinical entity in the pediatric population. Recently, testes sparing surgery has been recommended. We share our experience with the management of pediatric testicular cysts. METHODS A retrospective review of all pediatric patients referred for intratesticular cysts was conducted at a single pediatric institution from 2002 to 2010. Charts were evaluated for patient demographics, diagnosis, and management. RESULTS Seven patients were identified and included in this series. After partial orchiectomy, the final diagnosis in three patients was epidermoid cyst. Three further patients were diagnosed as mature cystic teratoma, with two of these demonstrating adjacent intra-tubular germ cell neoplasia (ITGCN). One cyst in the series underwent spontaneous resolution after eight months. CONCLUSION All of the cystic lesions in our case series were benign with one undergoing complete resolution. The remainder became smaller and developed a solid component prompting surgery. The pre-pubertal findings of ITGCN in two patients raise a dilemma regarding the optimal long-term management for these patients. Initial conservative observation is an option for the majority of pre-pubertal cystic testicular lesions until such time that testis sparing surgery is deemed technically feasible. Testes sparing surgery should be advocated in those patients undergoing surgical management.
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Affiliation(s)
- Nathan A Hoag
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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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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Makari JH, Ramachandra P, Ferrer FA. Pediatric urologic oncology: organ-sparing surgery in kidney and testis. Urol Clin North Am 2010; 37:287-98. [PMID: 20569806 DOI: 10.1016/j.ucl.2010.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technological advances in imaging as well as increased knowledge of tumor-specific biology have promoted the role of organ-sparing approaches to pediatric renal and testicular tumors. Application of these techniques continues to evolve as data on long-term follow-up become available and as protocol-guided investigation provides answers to therapeutic outcomes of these approaches. Optimally, organ-sparing surgery will continue to provide increased potential for preservation of both renal function and fertility.
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Affiliation(s)
- John H Makari
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT 06030, USA
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Abstract
Similar to the experience of finding a lump upon physical examination of the breast, the detection of an intrascrotal mass is often a frightening experience for both the patient and his physician. Ultrasound is a nearly ideal modality for evaluation of the scrotum. This manuscript will review the sonographic assessment of the common pathologic and normal conditions that may present as a mass within the scrotum, including discussion of intratesticular and extratesticular etiologies.
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Carkaci S, Ozkan E, Lane D, Yang WT. Scrotal sonography revisited. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:21-37. [PMID: 19802889 DOI: 10.1002/jcu.20642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Sonography is the imaging modality of choice for the scrotum because it is simple, relatively inexpensive, and quick. Recent technological advances and transducer improvements have led to exquisite high-resolution detail in gray-scale as well as Doppler imaging. The purposes of this pictorial essay are to review the anatomy and embryology of the scrotal contents and to review the various scrotal and extrascrotal pathologic conditions, including acute scrotum, pediatric and adult testicular and extratesticular scrotal neoplasms, traumatic lesions, and miscellaneous other scrotal lesions.
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Affiliation(s)
- Selin Carkaci
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Ultrasound is a vital adjunct to clinical examination in diagnosing scrotal disease, as a number of different processes may present similarly. Potential applications range from the acute emergency to long-term screening as well as cases in which a distinct scrotal abnormality may or may not be palpable. Differentiating acute epididymitis/epididymoorchitis from testicular torsion is possible sonographically, thereby guiding appropriate medical or surgical management. Distinguishing between cystic, solid, or complex scrotal masses is readily performed with this modality. It clearly depicts simple versus complex hydroceles and determines the presence of underlying testicular or epididymal disease. Not only is ultrasound the best imaging modality for longitudinal screening in patients (testicular microlithiasis, cryptorchidism) at risk for testicular tumors, it also provides valuable information in the infertile male by documenting the presence or absence of a varicocele.
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Affiliation(s)
- Monica Smith Pearl
- Department of Radiology, The George Washington University Hospital, Washington, DC 20037, USA
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Abstract
Sonography is the preferred imaging method for the evaluation of pediatric scrotal swelling. By identifying the site of origin and whether a mass is solid or cystic, the diagnosis is usually readily made, making ultrasound especially valuable in patient management. Scrotal pathology differs in pediatric patients, especially prior to puberty, making understanding of pediatric conditions essential. This article reviews the common intra- and extratesticular causes of pediatric scrotal swelling and their sonographic appearances.
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Affiliation(s)
- Brian D Coley
- Section of Ultrasound, Department of Radiology, Columbus Children's Hos pital, Ohio 43205, USA.
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Xu HX, Yi XP. Sonographic appearance of a testicular yolk sac tumor in a 2-year-old boy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:55-7. [PMID: 16960883 DOI: 10.1002/jcu.20249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Yolk sac tumor (YST) of testis is the most common of all childhood testicular malignancies. We report a case of testicular YST in a 2-year-old boy. The tumor appeared sonographically as an ovoid, homogeneous, well-circumscribed, isoechoic, solid testicular mass with good sound-through transmission and increased internal vascularity on color Doppler imaging. The serum alpha-fetoprotein level was 4,396 ng/ml. Pathological examination confirmed YST at at stage I. Although the sonographic appearance of YST of the testis is nonspecific, the diagnosis is achievable in clinical practice on the combination of elevated serum alpha-fetoprotein level and sonograms depicting a solid testicular hypervascular mass.
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Affiliation(s)
- Hui-Xiong Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
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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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Abstract
This is a case of a newborn with a rare testicular tumor-a juvenile granulosal cell tumor. This is a tumor of stromal origin, which is similar histologically to granulosal cell tumors of the ovaries. The authors present the imaging characteristics and differential diagnoses in this patient.
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Affiliation(s)
- William Moore
- Department of Radiology, Health Sciences Center, State University of New York at Stony Brook, New York, USA.
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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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Ramsden WH. Imaging in the diagnosis and staging of paediatric abdominal tumours. IMAGING 2001. [DOI: 10.1259/img.13.4.130262] [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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Affiliation(s)
- J.S. VALLA
- From the Foundation Lenval, Hôpital pour Enfants, Nice, France
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Abstract
PURPOSE In this retrospective survey we identify preoperative and intraoperative criteria of nonmalignancy and analyze the result of conservative treatment of a testicular mass. MATERIALS AND METHODS A total of 22 surgeons responded to a questionnaire concerning lesions treated during the last 15 years in children between 0 and 15 years old. By definition alpha fetoprotein and beta human chorionic gonadotropin are within the normal limits at this age. The results were evaluated regarding evolution, growth of the preserved testis and local or distant recurrences. RESULTS Benign tumor of the testis (83 cases) represented 48% of all cases. Orchiectomy was performed in 27 cases and conservative treatment in 56. The final histopathological diagnosis was benign germinal tumor in 48 cases, cysts in 18, gonadal stromal tumor in 13 and rare lesions (lipoma, hemangioma) in 4. No definitive clinical criteria of nonmalignancy were identified but some symptoms were suggestive of nonmalignancy. Ultrasound results were more conclusive and provided the diagnosis of teratoma, epidermoid cyst and particularly simple cyst. The conservative treatment performed 56 times was a simple biopsy in 2 children with bilateral lesions and enucleation in 52. Enucleation was performed in 43% of cases using a pedicle clamp and in 50% with frozen section. The frozen section was changed in 12 cases due to therapeutic decision for preservation (10) and orchiectomy (2). There were no contradictions between the definitive histopathological examination and frozen section. Secondary orchiectomy was performed for neonatal granular tumor. Average followup in 56 cases of conservative treatment was 4.8 years (range 6 months to 15 years). Neither secondary testicular atrophy nor any local or distant recurrence was recorded. CONCLUSIONS A testicular tumor in children has a 50% chance of being benign. Treatment selection according to some clinical, biological, radiological and frozen section findings should allow us to decide on testis-sparing surgery without additional oncological risk, and with an aesthetic, psychological and functional benefit.
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Fernández GC, Tardáguila FM, Rivas C, Meijide F, Miguel PS, Fuente ADL. Papel de la resonancia magnética en la patología testicular y paratesticular. RADIOLOGIA 2001. [DOI: 10.1016/s0033-8338(01)76985-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Scrotal pathology in pediatrics ranges from the more benign hydrocele and varicocele to acute testicular torsion requiring emergent surgery. Malignant testicular tumors can be insidious in onset or may present acutely when trauma brings a swollen scrotum to the patient's or physician's attention. Three common conditions can present as an acute scrotum, all of which can suggest testicular torsion clinically. Epididymitis often has a less acute onset than testicular torsion, although it does not always present with a straightforward diagnosis. Although it is generally an inflammatory process affecting males from 9 to 14 years of age, it can be seen in younger males with Henoch-Schonlein purpura and Kawasaki disease. Torsion of the appendix of the testis and epididymis can present acutely and mimic acute testicular torsion and generally occurs from 6 to 12 years of age. Testicular torsion itself usually occurs from 12 to 18 years of age and usually results from the anatomical "bell-and-clapper" deformity. Infarction of the testis can occur within as early as 4 to 6 hours after torsion, depending on the duration of symptoms and degree of twist of the spermatic cord. Advances in ultrasound technology in recent years have made ultrasound the examination of choice for imaging scrotal pathology, whether acute or chronic in nature. Doppler technology has tremendously increased the radiologist's ability to assess flow within the prepubertal testicle, which allows assessment of viability in the undescended testis as well as in neonatal torsion. The ability of ultrasound to diagnose the pathogenesis of the acute scrotum is unsurpassed by any other imaging modality. Ultrasound is a readily available, noninvasive examination without radiation that provides excellent anatomic detail and serves as an important and tremendously helpful imaging modality in all types of pediatric scrotal pathology.
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Affiliation(s)
- M M Munden
- Baylor College of Medicine, Texas Children's Hospital, Houston, USA
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Abstract
Over the last 3 decades, the management of pediatric yolk sac tumors of the testis has changed significantly. These changes reflect improvement in the treatment of testicular tumors in adults and children, such as the advent of platinum-based chemotherapy regimens. They also reflect increased understanding of the biology and natural history of prepubertal yolk sac tumors of the testis as a unique disease entity.
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Affiliation(s)
- R W Grady
- Section of Pediatric Urology, Children's Hospital & Regional Medical Center, University of Washington Medical Center, Seattle, USA
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Abstract
The primary role of Doppler ultrasound of the acute testicle and scrotum is for the diagnosis of spermatic cord torsion or epididymitis. The utility of Doppler in other conditions such as testicular neoplasm is limited, and in general does not increase diagnostic specificity. The application of color Doppler imaging and power Doppler imaging increases sensitivity for the detection of orchitis and testicular neoplasms in which the gray scale findings may be subtle. Power Doppler imaging is more sensitive for the identification of slowly flowing blood than color Doppler imaging. As a result, power Doppler imaging may be particularly helpful for the diagnosis or exclusion of spermatic cord torsion as a cause of acute scrotal pain in the prepubescent male.
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Affiliation(s)
- J B Feole
- Department of Radiology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792-3252, USA
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Siegel MJ. PELVIC TUMORS IN CHILDHOOD. Radiol Clin North Am 1997. [DOI: 10.1016/s0033-8389(22)00734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Abstract
Pediatric patients presenting with painless scrotal masses can be perplexing because of the long differential diagnosis. A careful plan based on the physical examination and sonogram findings localizes the mass to the testis or an extratesticular location. Sonography distinguishes solid from cystic lesions. Subsequent management is based on the location and nature of the mass. Intratesticular masses are assumed to be malignant, but testis-sparing surgery is possible in pediatric patients. Extratesticular cystic lesions are likely benign and are managed according to the specific diagnosis. Solid extratesticular lesions require exploration to establish the correct diagnosis.
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Affiliation(s)
- S J Skoog
- Oregon Health Sciences University, Portland, USA
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Abstract
Color Doppler imaging (CDI) has become the study of choice in evaluation of the scrotum due to technological advances resulting in superior resolution and sensitive Doppler systems. CDI has become particularly helpful in evaluating the scrotum in the setting of acute disorders, such as torsion of the spermatic cord, epididymal and testicular inflammation, and scrotal trauma. CDI should be the study of choice to evaluate for torsion of the spermatic cord and demonstrates a high degree of accuracy. CDI in such a setting, however, does require operator experience, sensitive Doppler ultrasound equipment, and operator knowledge of the limitations of CDI. With epididymitis or epididymo-orchitis, CDI has proven to be quite helpful in evaluating the scrotal contents for the presence of inflammation and associated complications. In scrotal trauma, CDI's utility remains somewhat controversial, but with further investigation its appropriate application in this situation may become clear.
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Affiliation(s)
- T E Herbener
- Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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