Discrete, solid, intratesticular mass on grayscale ultrasound with abnormal intrinsic vessels on color Doppler

Most common neoplasm in males aged 15-34

Mostly unilateral; contralateral tumor develops eventually in 8%

Seminoma is most common pure germ cell tumor of testis

On ultrasound, seminomas usually well-defined, hypoechoic, and solid without calcification or tunica invasion

Tumors < 1.5 cm commonly hypovascular, and tumors > 1.6 cm more often hypervascular

Embryonal cell carcinomas are aggressive tumors, may invade tunica albuginea and distort testicular contour

US used to identify and characterize scrotal mass; CT or MR for metastatic staging; PET to evaluate posttreatment residual masses

Lymph nodes < 1 cm suspicious if located in typical drainage areas; left renal hilus and right retrocaval in location

Lymphoma

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  Older male > 60

Hematoma

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  Pain after trauma and avascular on color Doppler

Segmental infarct

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  Present with acute pain rather than painless palpable mass

Focal orchitis

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  Present with acute pain and fever

Epidermoid cyst

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  Characteristic “onion ring” concentric layers, avascular on color Doppler, well-defined rim

Associated with testicular maldescension, previous contralateral cancer, infertility, and family history of tumor

Beta hCG elevated in pure or mixed embryonal carcinoma or choriocarcinoma; also in 15-20% of those with advanced seminoma

Elevated α-fetoprotein (AFP) levels > 10,000 microg/L found almost exclusively in patients with NSGCTs (not seen with pure seminomas) and hepatocellular carcinoma

Lactate dehydrogenase (LDH) has independent prognostic significance: Increased levels reflect tumor burden, growth rate, and cellular proliferation

Document whether lesion is palpable

Look for lymph nodes

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  Along right side of IVC for right-sided tumors

  
  
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  Along left renal vein for left-sided tumors