A 36-year-old male presents to his primary physician with a painless left testicular mass. A testicular ultrasound is ordered. Based on the provided images, what is the MOST likely diagnosis?
Urinary Imaging
No
U
A
DIAGNOSIS: Seminoma
ANSWER: Seminoma
Testicular seminomas represent the most common malignant tumors of the testis and typically present as a painless and palpable mass. The median age of diagnosis is 35-39. Treatment is typically a radical inguinal orchiectomy. The provided sonographic image demonstrates a solid left intratesticular mass with internal vascular flow in the background of testicular microlithiasis. Findings are concerning for testicular neoplasm and in a 36-year-old, seminoma is the most common neoplasm.
WRONGS ANSWERS:
Non-Hodgkin B-cell lymphoma is the most common testicular malignancy in men older than 60 years old, making this diagnosis unlikely.
Acute orchitis represents testicular infection and inflammation with associated hyperemia which can mimic a seminoma. Acute orchitis typically has associated edema which would appear as testicular hypoechogenicity, not seen in the provided case. Acute orchitis is also typically painful, making this diagnosis less likely in this patient.
Epidermoid cysts represent 1% of all testicular lesions and are made up of keratinized, stratified, squamous epithelium with a fibrous wall. On ultrasound, epidermoid cysts typically have an "onion ring" appearance, not seen in the provided case.
The provided sonographic image demonstrates a solid left intratesticular mass (yellow arrow) in the presence of testicular microlithiasis with internal vascular flow. Findings are concerning for testicular neoplasm and in a 36-year-old, seminoma is the most common neoplasm.
The provided sonographic image demonstrates a solid left intratesticular mass (yellow arrow) in the presence of testicular microlithiasis with internal vascular flow. Findings are concerning for testicular neoplasm and in a 36-year-old, seminoma is the most common neoplasm.
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