KEY FACTS
Terminology
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Benign, solid paratesticular tumor of mesenchymal origin
Imaging
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Solid intrascrotal mass, usually extratesticular
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Rounded or oval, well circumscribed, varying echogenicity
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Size: 5 mm to 5 cm
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Hypovascular or avascular on color Doppler US
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Location
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Epididymis: Most common location overall
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May arise in tunica albuginea
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Rarely intratesticular or other locations, such as spermatic cord and prostate
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Top Differential Diagnoses
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Leiomyoma
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Lipoma
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Cystadenoma
Clinical Issues
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Most common solid mass in epididymis
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36% of all paratesticular tumors
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Slowly enlarges over years
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Most surgically excised to confirm diagnosis
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Some urologists and patients elect surveillance
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Age: 20 years and older
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Mean: 36 years
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Rarely seen in boys
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Diagnostic Checklist
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Consider leiomyoma
Scanning Tips
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Gentle transducer pressure may show mass can move independently of testis
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Small adenomatoid tumors of epididymis may be easily missed and, therefore, full visualization of head, body, and tail of epididymis is important on all routine scrotal exams
