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Testis

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Multimodality Imaging and Intervention in Oncology

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Abstract

Testicular cancer is uncommon in the general male population, accounting for 1–2% of all neoplasms and for 5% of urological tumours. It is, however, the most common malignancy in young adult men aged 15–40 years. Although malignancy is prevailing in testicular lesions, and extratesticular masses are most likely benign, in the latter malignancy is encountered in about 3% of cases.

Multiparametric US is the modality of choice for detection and location of scrotal lesions. US identifies lesions in virtually all cases and is able to distinguish intratesticular from extratesticular lesions. Differential diagnosis, however, is often difficult due to overlap of the imaging findings between tumours, either benign or malignant, and a variety of non-neoplastic lesions.

Compared to US, MRI is more panoramic and helps characterization due to its capability to differentiate among tissue components. Although in many cases a precise diagnosis is not obtained based on imaging alone, a correct framing of the patient is often possible when epidemiological, clinical, laboratory, and imaging findings are considered together.

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References

  1. Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology. 2003;227:18–36.

    Article  PubMed  Google Scholar 

  2. Zawaideh JP, Bertolotto M, Olivero A, Trambaiolo Antonelli C, Derchi LE. The added value of simultaneous palpation during scrotal ultrasound. J Clin Ultrasound. 2019;47(4):220–1.

    Article  PubMed  Google Scholar 

  3. Bertolotto M, Grenier N, Hamm B, Stocca T, Sarocchi F, Derchi LE. Imaging of bilateral synchronous testicular tumors of different histologic types and implications for surgical management. J Ultrasound Med. 2016;35:2511–6.

    Article  PubMed  Google Scholar 

  4. Bertolotto M, Derchi LE, Secil M, et al. Grayscale and color Doppler features of testicular lymphoma. J Ultrasound Med. 2015;34:1139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Laguna MP, Albers P, Algaba F, et al. EAU guidelines on testicular cancer 2020. In: Presented at the EAU annual congress Amsterdam 2020. Arnhem: European Association of Urology Guidelines Office; 2020.

    Google Scholar 

  6. Horstman WG, Melson GL, Middleton WD, Andriole GL. Testicular tumors: findings with color Doppler US. Radiology. 1992;185:733–7.

    Article  CAS  PubMed  Google Scholar 

  7. Cantisani V, Bertolotto M, Weskott HP, et al. Growing indications for CEUS: the kidney, testis, lymph nodes, thyroid, prostate, and small bowel. Eur J Radiol. 2015;84:1675–84.

    Article  CAS  PubMed  Google Scholar 

  8. Reginelli A, D’Andrea A, Clemente A, et al. Does multiparametric US improve diagnostic accuracy in the characterization of small testicular masses. Gland Surg. 2019;8:S136–41.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Konstantatou E, Fang C, Romanos O, et al. Evaluation of intratesticular lesions with strain elastography using strain ratio and color map visual grading: differentiation of neoplastic and nonneoplastic lesions. J Ultrasound Med. 2019;38:223–32.

    Article  PubMed  Google Scholar 

  10. Secil M, Altay C, Basara I. State of the art in germ cell tumor imaging. Urol Oncol. 2016;34:156–64.

    Article  PubMed  Google Scholar 

  11. Pierorazio PM, Cheaib JG, Tema G, et al. Performance characteristics of clinical staging modalities for early stage testicular germ cell tumors: a systematic review. J Urol. 2019;203(5):894–901. https://doi.org/10.1097/JU.0000000000000594.

    Article  Google Scholar 

  12. Feldman DR, Lorch A, Kramar A, et al. Brain metastases in patients with germ cell tumors: prognostic factors and treatment options–an analysis from the Global Germ Cell Cancer Group. J Clin Oncol. 2016;34:345–51.

    Article  PubMed  Google Scholar 

  13. Tsili AC, Bertolotto M, Turgut AT, et al. MRI of the scrotum: recommendations of the ESUR Scrotal and Penile Imaging Working Group. Eur Radiol. 2018;28:31–43.

    Article  PubMed  Google Scholar 

  14. Tsili AC, Sofikitis N, Stiliara E, Argyropoulou MI. MRI of testicular malignancies. Abdom Radiol. 2019;44:1070–82.

    Article  Google Scholar 

  15. Parenti GC, Feletti F, Carnevale A, Uccelli L, Giganti M. Imaging of the scrotum: beyond sonography. Insights Imaging. 2018;9:137–48.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Tsili AC, Argyropoulou MI, Giannakis D, Sofikitis N, Tsampoulas K. MRI in the characterization and local staging of testicular neoplasms. AJR Am J Roentgenol. 2010;194:682–9.

    Article  PubMed  Google Scholar 

  17. Mathur M, Spektor M. MR imaging of the testicular and extratesticular tumors: when do we need. Magn Reson Imaging Clin N Am. 2019;27:151–71.

    Article  PubMed  Google Scholar 

  18. Tsili AC, Bertolotto M, Rocher L, et al. Sonographically indeterminate scrotal masses: how MRI helps in characterization. Diagn Interv Radiol. 2018;24:225–36.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Piscaglia F, Nolsøe C, Dietrich CF, et al. The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med. 2012;33:33–59.

    Article  CAS  PubMed  Google Scholar 

  20. Sidhu PS, Cantisani V, Dietrich CF, et al. The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (long version). Ultraschall Med. 2018;39:e2–e44.

    Article  PubMed  Google Scholar 

  21. Sidhu PS, Cantisani V, Dietrich CF, et al. The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (short version). Ultraschall Med. 2018;39:154–80.

    Article  PubMed  Google Scholar 

  22. Sohaib SA, Koh DM, Barbachano Y, et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol. 2009;64:362–7.

    Article  CAS  PubMed  Google Scholar 

  23. Joffe JK, Cafferty FH, Murphy L, et al. Imaging modality and frequency in surveillance of Stage I seminoma testicular cancer: results from a randomized, phase III, Noninferiority Trial (TRISST). J Clin Oncol. 2022; 40:2468–78.

    Google Scholar 

  24. Park JS, Kim J, Elghiaty A, Ham WS. Recent global trends in testicular cancer incidence and mortality. Medicine. 2018;97:e12390.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Marshall C, Enzerra M, Rahnemai-Azar AA, Ramaiya NH. Serum tumor markers and testicular germ cell tumors: a primer for radiologists. Abdom Radiol. 2019;44:1083–90.

    Article  Google Scholar 

  26. McDonald MW, Reed AB, Tran PT, Evans LA. Testicular tumor ultrasound characteristics and association with histopathology. Urol Int. 2012;89:196–202.

    Article  PubMed  Google Scholar 

  27. Tsili AC, Sylakos A, Ntorkou A, et al. Apparent diffusion coefficient values and dynamic contrast enhancement patterns in differentiating seminomas from nonseminomatous testicular neoplasms. Eur J Radiol. 2015;84:1219–26.

    Article  PubMed  Google Scholar 

  28. Patel HD, Ramos M, Gupta M, et al. Magnetic resonance imaging to differentiate the histology of testicular masses: a systematic review of studies with pathologic confirmation. Urology. 2020;135:4–10.

    Article  PubMed  Google Scholar 

  29. Sharbidre KG, Lockhart ME. Imaging of scrotal masses. Abdom Radiol. 2020;45(7):2087–108.

    Article  Google Scholar 

  30. Tsili AC, Tsampoulas C, Giannakopoulos X, et al. MRI in the histologic characterization of testicular neoplasms. AJR Am J Roentgenol. 2007;189:W331–7.

    Article  PubMed  Google Scholar 

  31. Maxwell F, Izard V, Ferlicot S, et al. Colour Doppler and ultrasound characteristics of testicular Leydig cell tumours. Br J Radiol. 2016;89:20160089.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pozza C, Pofi R, Tenuta M, et al. Clinical presentation, management and follow-up of 83 patients with Leydig cell tumors of the testis: a prospective case-cohort study. Hum Reprod. 2019;34:1389–403.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Isidori AM, Pozza C, Gianfrilli D, et al. Differential diagnosis of nonpalpable testicular lesions: qualitative and quantitative contrast-enhanced US of benign and malignant testicular tumors. Radiology. 2014;273:606–18.

    Article  PubMed  Google Scholar 

  34. Drudi FM, Valentino M, Bertolotto M, et al. CEUS time intensity curves in the differentiation between leydig cell carcinoma and seminoma: a multicenter study. Ultraschall Med. 2016;37:201–5.

    CAS  PubMed  Google Scholar 

  35. Kachramanoglou C, Rafailidis V, Philippidou M, et al. Multiparametric sonography of hematologic malignancies of the testis: grayscale, color doppler, and contrast-enhanced ultrasound and strain elastographic appearances with histologic correlation. J Ultrasound Med. 2017;36:409–20.

    Article  PubMed  Google Scholar 

  36. Mathur M, Mills I, Spektor M. Magnetic resonance imaging of the scrotum: pictorial review with ultrasound correlation. Abdom Radiol. 2017;42:1929–55.

    Article  Google Scholar 

  37. Mittal PK, Abdalla AS, Chatterjee A, et al. Spectrum of extratesticular and testicular pathologic conditions at scrotal MR imaging. Radiographics. 2018;38:806–30.

    Article  PubMed  Google Scholar 

  38. Bertolotto M, Cantisani V, Valentino M, Pavlica P, Derchi LE. Pitfalls in imaging for acute scrotal pathology. Semin Roentgenol. 2016;51:60–9.

    Article  PubMed  Google Scholar 

  39. Mazzu D, Jeffrey RB, Ralls PW. Lymphoma and leukemia involving the testicles: findings on gray-scale and color Doppler sonography. AJR Am J Roentgenol. 1995;164:645–7.

    Article  CAS  PubMed  Google Scholar 

  40. Wilson JP, Cooksey G. Testicular pain as the initial presentation of testicular neoplasms. Ann R Coll Surg Engl. 2004;86:284–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Valentino M, Bertolotto M, Derchi L, et al. Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol. 2011;21:1831–40.

    Article  PubMed  Google Scholar 

  42. Gaur S, Bhatt S, Derchi L, Dogra V. Spontaneous intratesticular hemorrhage: two case descriptions and brief review of the literature. J Ultrasound Med. 2011;30:101–4.

    Article  PubMed  Google Scholar 

  43. Carucci LR, Tirkes AT, Pretorius ES, Genega EM, Weinstein SP. Testicular Leydig’s cell hyperplasia: MR imaging and sonographic findings. AJR Am J Roentgenol. 2003;180:501–3.

    Article  PubMed  Google Scholar 

  44. Rocher L, Moya L, Correas JM, et al. Testis ultrasound in Klinefelter syndrome infertile men: making the diagnosis and avoiding inappropriate management. Abdom Radiol. 2016;41:1596–603.

    Article  Google Scholar 

  45. Bilagi P, Sriprasad S, Clarke JL, Sellars ME, Muir GH, Sidhu PS. Clinical and ultrasound features of segmental testicular infarction: six-year experience from a single centre. Eur Radiol. 2007;17:2810–8.

    Article  PubMed  Google Scholar 

  46. Bertolotto M, Derchi LE, Sidhu PS, et al. Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol. 2011;196:834–41.

    Article  PubMed  Google Scholar 

  47. Dogra V, Nathan J, Bhatt S. Sonographic appearance of testicular adrenal rest tissue in congenital adrenal hyperplasia. J Ultrasound Med. 2004;23:979–81.

    Article  PubMed  Google Scholar 

  48. Sommers D, Winter T. Ultrasonography evaluation of scrotal masses. Radiol Clin N Am. 2014;52:1265–81.

    Article  PubMed  Google Scholar 

  49. Balzer BL, Ulbright TM. Spontaneous regression of testicular germ cell tumors: an analysis of 42 cases. Am J Surg Pathol. 2006;30:858–65.

    Article  PubMed  Google Scholar 

  50. Harris RD, Chouteau C, Partrick M, Schned A. Prevalence and significance of heterogeneous testes revealed on sonography: ex vivo sonographic-pathologic correlation. AJR Am J Roentgenol. 2000;175:347–52.

    Article  CAS  PubMed  Google Scholar 

  51. Rebik K, Wagner JM, Middleton W. Scrotal ultrasound. Radiol Clin N Am. 2019;57:635–48.

    Article  PubMed  Google Scholar 

  52. Attieh A, Benelli A, Bertolotto M, Simonato A, Carmignani G, Derchi LE. Sonographic appearances of the postoperative testis. J Clin Ultrasound. 2016;44:12–6.

    Article  PubMed  Google Scholar 

  53. Bertolotto M, Campo I, Buoite Stella A, et al. What is the malignant potential of small (<2cm), nonpalpable testicular incidentalomas in adults? A systematic review. Eur urol focus. 2023;9:361–70.

    Google Scholar 

  54. Scandura G, Verrill C, Protheroe A, et al. Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided. BJU Int. 2018;121:575–82.

    Article  PubMed  Google Scholar 

  55. Bertolotto M, Sidhu PS, Derchi LE. Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol. 2011;196:834–41.

    Article  PubMed  Google Scholar 

  56. Rocher L, Ramchandani P, Belfield J, et al. Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol. 2016;26:2268–78.

    Article  PubMed  Google Scholar 

  57. Boschian R, Liguori G, Bucci S, Bertolotto M, Trombetta C. Intraoperative ultrasound-guided enucleation of testicular nodule. Arch Ital Urol Androl. 2016;88:335–6.

    Article  PubMed  Google Scholar 

  58. Li Q, Vij A, Hahn PF, Xiang F, Samir AE. The value of active ultrasound surveillance for patients with small testicular lesions. Ultrasound Q. 2017;33:23–7.

    Article  PubMed  Google Scholar 

  59. Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics. 2003;23:215–40.

    Article  PubMed  Google Scholar 

  60. Akbar SA, Sayyed TA, Jafri SZ, Hasteh F, Neill JS. Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics. 2003;23:1461–76.

    Article  PubMed  Google Scholar 

  61. Bertolotto M, Borsato A, Derchi LE. Lymphoma of the spermatic cord: sonographic appearance. J Clin Ultrasound. 2014;42:509–12.

    Article  PubMed  Google Scholar 

  62. Secil M, Bertolotto M, Rocher L, et al. Imaging features of paratesticular masses. J Ultrasound Med. 2017;36:1487–509.

    Article  PubMed  Google Scholar 

  63. Valentino M, Bertolotto M, Ruggirello M, Pavlica P, Barozzi L, Rossi C. Cystic lesions and scrotal fluid collections in adults: ultrasound findings. J Ultrasound. 2011;14:208–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Choyke PL, Glenn GM, Wagner JP, et al. Epididymal cystadenomas in von Hippel-Lindau disease. Urology. 1997;49:926–31.

    Article  CAS  PubMed  Google Scholar 

  65. Bertolotto M, Boulay-Coletta I, Butini R, et al. Imaging of mesothelioma of tunica vaginalis testis. Eur Radiol. 2016;26:631–8.

    Article  CAS  PubMed  Google Scholar 

  66. Conzi R, Damasio MB, Bertolotto M, et al. Sonography of scrotal wall lesions and correlation with other modalities. J Ultrasound Med. 2017;36:2149–63.

    Article  PubMed  Google Scholar 

  67. Freeman S, Bertolotto M, Richenberg J, et al. Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading. Eur Radiol. 2020;30:11–25.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Ospedale di Cattinara, Trieste, Italy

    Michele Bertolotto, Irene Campo, Rosaria Perrone, Riccardo Ciabattoni & Maria Assunta Cova

  2. University of Genoa, Genova, Italy

    Lorenzo E. Derchi

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  1. Michele Bertolotto
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  2. Irene Campo
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  3. Rosaria Perrone
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  4. Riccardo Ciabattoni
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  5. Maria Assunta Cova
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  6. Lorenzo E. Derchi
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Correspondence to Michele Bertolotto .

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Editors and Affiliations

  1. Academic Radiology, Department of Translational Research and new Technologies in Medicine and Surgery, University of Pisa, PISA, Pisa, Italy

    Emanuele Neri

  2. Department of Medicine and Surgery, University of Milan Bicocca, and Nuclear Medicine ASST-Ospedale Papa Giovanni XXIII, Bergamo, Italy

    Paola Anna Erba

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Bertolotto, M., Campo, I., Perrone, R., Ciabattoni, R., Cova, M.A., Derchi, L.E. (2023). Testis. In: Neri, E., Erba, P.A. (eds) Multimodality Imaging and Intervention in Oncology. Springer, Cham. https://doi.org/10.1007/978-3-031-28524-0_16

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  • DOI: https://doi.org/10.1007/978-3-031-28524-0_16

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