|ECR 2015 / C-2542|
|Contrast-enhanced ultrasound in the differential diagnosis of small testicular masses|
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The widespread use of US for the diagnostic evaluation of scrotal disorders and current advances in US technology have allowed a more frequent detection of incidental testicular lesions.
Recent studies show that, approximately 80% of non palpable masses are benign . A proper management in differential diagnosis of these benign entities may preclude the need of radical orchiectomy.
In our experience TSS with detailed pre-operative and intra-operative US can be considered a safe procedure, with an optimal concordance between FS and final pathology.
Although sonographic appearance of testicular masses is various and not specific, CEUS increases the confidence of the interpretation of lesion vascularity, especially identifying avascular lesions without malignant potential [8, 10].
Epidermoid cyst of the testis is a rare benign tumor; however, it should be taken in account when considering testicular masses [11-13]. In this setting CEUS represents a useful adjuct to Color Doppler US to recommend suitability for TSS.
In our study CEUS demonstrate a lack of enhancement in two cases of epidermoid cyst. In case of STMs < 15 mm Color Doppler sonography has a low sensitivity in detection of vascular signals and CEUS represent a useful tool to differentiate Epidermoid Cysts from other solid intratesticular lesions. Intraoperative extemporaneous examination showed no evidence of malignancy, enucleation of the mass was performed and FSE confirmed the diagnosis.
CEUS enhancement pattern might be helpful to differential diagnosis of STMs. In our series all cases with absence of hyperenhancing were inflammatory at final pathological examination.
About CEUS hypervascular lesions, we suspect preoperatively all cases of Leydig cell tumor based on the presence of a homogeneous strong enhancement followed by washout. All these lesions were treated with TSS [14, 15]. However, these findings need confirmation on a larger number of patients.
The principal study limitations were represented by the small number of cases and the the heterogeneity of testicular lesions..
In conclusion our findings suggest that, when MR is not available, CEUS may be a valid alternative for the preoperative assessment of STMs; Preoperative diagnosis combining imaging features with normal biochemical tumour markers will allow for testis-sparing surgery and prevent unnecessary orchiectomy.
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