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From the Archives of the AFIP

Extratesticular Scrotal Masses: Radiologic-Pathologic Correlation¹

¹ From the Departments of Radiologic Pathology (P.J.W., C.M.S.) and Genitourinary Pathology (I.A.S.), Armed Forces Institute of Pathology, 14th and Alaska NW, Bldg 54, Rm M-121, Washington, DC 20306-6000. Received July 30, 2002; revision requested August 21 and received September 27; accepted September 27. Address correspondence to P.J.W. (e-mail: woodwardp@afip.osd.mil).

View larger version (44K): [in a new window]   Figure 1.  Scrotal embryologic development. Diagram of the fetal scrotum at approximately 12 weeks gestational age shows the processus vaginalis protruding through the layers of the abdominal wall.

View larger version (88K): [in a new window]   Figure 2.  Scrotal embryologic development. Diagram of the adult scrotum shows obliteration of the superior portion of the processus vaginalis and formation of the tunica vaginalis.

View larger version (105K): [in a new window]   Figure 3.  Appendix epididymis. Longitudinal US image shows an appendix epididymis (arrow) projecting from the normal triangular epididymal head (arrowhead). Visualization is aided by the presence of a hydrocele. T = testis.

View larger version (112K): [in a new window]   Figure 4.  Appendix testis. Longitudinal US image shows a small soft-tissue remnant projecting from the superior aspect of the testis (arrow). There is also a moderate-sized hydrocele.

View larger version (70K): [in a new window]   Figure 5.  Diagram depicts the epididymis and contents of the spermatic cord. Cremasteric artery not shown.

View larger version (134K): [in a new window]   Figure 6.  Coronal T2-weighted MR image of the scrotum shows a high-signal-intensity testis within each hemiscrotum. A low-signal-intensity capsule, the tunica albuginea, surrounds each testis. The epididymis (long arrow) is low signal intensity compared with the testis. Also note the small left-sided hydrocele (*), spermatic cord (arrowhead), and varicocele (short arrow).

View larger version (95K): [in a new window]   Figure 7.  Congenital hydrocele. Radiograph of the pelvis taken after injection of contrast material into a right-sided hydrocele, shows the contrast agent moving through a patent processus vaginalis (white arrow) and spilling into the peritoneal cavity (black arrow).

View larger version (145K): [in a new window]   Figure 8a.  Hematocele. (a) Longitudinal US scan shows a complex, heterogeneous fluid collection distorting the left testis (T). (b) Photograph of the gross specimen shows the large hematocele (arrow) compressing the normal testicular parenchyma. T = testis.

View larger version (128K): [in a new window]   Figure 8b.  Hematocele. (a) Longitudinal US scan shows a complex, heterogeneous fluid collection distorting the left testis (T). (b) Photograph of the gross specimen shows the large hematocele (arrow) compressing the normal testicular parenchyma. T = testis.

View larger version (134K): [in a new window]   Figure 9a.  Scrotal abscess with Fournier gangrene. (a) Transverse US image shows a large, complex, heterogeneous fluid collection. It is exerting marked mass effect with displacement and distortion of the testis (arrow). (b) Preoperative photograph shows a tense, swollen scrotum with sloughing and weeping of the dermal tissues.

View larger version (120K): [in a new window]   Figure 9b.  Scrotal abscess with Fournier gangrene. (a) Transverse US image shows a large, complex, heterogeneous fluid collection. It is exerting marked mass effect with displacement and distortion of the testis (arrow). (b) Preoperative photograph shows a tense, swollen scrotum with sloughing and weeping of the dermal tissues.

View larger version (153K): [in a new window]   Figure 10a.  Scrotal mesothelioma. (a) Transverse US image shows a hydrocele with several soft-tissue nodules studding the tunica vaginalis (arrows). (b) Photograph of the resected scrotum demonstrates multiple soft-tissue nodules (arrows).

View larger version (139K): [in a new window]   Figure 10b.  Scrotal mesothelioma. (a) Transverse US image shows a hydrocele with several soft-tissue nodules studding the tunica vaginalis (arrows). (b) Photograph of the resected scrotum demonstrates multiple soft-tissue nodules (arrows).

View larger version (149K): [in a new window]   Figure 11.  Inguinal hernia in a 2-year-old boy. Longitudinal US image of the right inguinal canal shows a fluid-filled loop of bowel (arrow). Peristalsis at the time of examination allowed a definitive diagnosis. EPID = epididymis, RT TEST = right testis.

View larger version (130K): [in a new window]   Figure 12.  Inguinal hernia. Axial CT image shows contrast material-filled loops of bowel and mesenteric vessels (arrow) in the upper portion of the right hemiscrotum.

View larger version (122K): [in a new window]   Figure 13.  Scrotal calculi. Longitudinal US image shows a densely calcified free body with posterior acoustic shadowing (arrow). T = testis.

View larger version (155K): [in a new window]   Figure 14a.  Fibrous pseudotumor in a 61-year-old man. (a) Longitudinal US image shows a solid mass (arrow) adjacent to the testis (TEST) and epididymis (EPI). The mass is hypoechoic compared with the testis and demonstrates faint posterior shadowing. (b) Coronal T2-weighted fat-suppressed image shows a markedly hypointense mass (arrow) with a pedunculated attachment to the tunica. It is surrounded by a high-signal-intensity hydrocele. The mass was isointense relative to the testis on a T1-weighted image (not shown). T = testis. (c) Photograph of the gross specimen shows a rubbery, slightly laminated mass. Scale is in centimeters.

View larger version (129K): [in a new window]   Figure 14b.  Fibrous pseudotumor in a 61-year-old man. (a) Longitudinal US image shows a solid mass (arrow) adjacent to the testis (TEST) and epididymis (EPI). The mass is hypoechoic compared with the testis and demonstrates faint posterior shadowing. (b) Coronal T2-weighted fat-suppressed image shows a markedly hypointense mass (arrow) with a pedunculated attachment to the tunica. It is surrounded by a high-signal-intensity hydrocele. The mass was isointense relative to the testis on a T1-weighted image (not shown). T = testis. (c) Photograph of the gross specimen shows a rubbery, slightly laminated mass. Scale is in centimeters.

View larger version (119K): [in a new window]   Figure 14c.  Fibrous pseudotumor in a 61-year-old man. (a) Longitudinal US image shows a solid mass (arrow) adjacent to the testis (TEST) and epididymis (EPI). The mass is hypoechoic compared with the testis and demonstrates faint posterior shadowing. (b) Coronal T2-weighted fat-suppressed image shows a markedly hypointense mass (arrow) with a pedunculated attachment to the tunica. It is surrounded by a high-signal-intensity hydrocele. The mass was isointense relative to the testis on a T1-weighted image (not shown). T = testis. (c) Photograph of the gross specimen shows a rubbery, slightly laminated mass. Scale is in centimeters.

View larger version (106K): [in a new window]   Figure 15a.  Fibrous pseudotumor in a 26-year-old man. (a) Axial T1-weighted MR image shows an intermediate-signal-intensity mass (arrow) that is isointense relative to the testis (T). (b) On a sagittal T2-weighted fat-suppressed image, the mass is markedly hypointense (arrowhead). It has a broad-based attachment to the capsule of the testis. (c) Low-power photomicrograph (original magnification x4; hematoxylin-eosin stain) shows a hyalinized nodule (arrow) attached to the tunica. The underlying testicular parenchyma (*) is uninvolved.

View larger version (121K): [in a new window]   Figure 15b.  Fibrous pseudotumor in a 26-year-old man. (a) Axial T1-weighted MR image shows an intermediate-signal-intensity mass (arrow) that is isointense relative to the testis (T). (b) On a sagittal T2-weighted fat-suppressed image, the mass is markedly hypointense (arrowhead). It has a broad-based attachment to the capsule of the testis. (c) Low-power photomicrograph (original magnification x4; hematoxylin-eosin stain) shows a hyalinized nodule (arrow) attached to the tunica. The underlying testicular parenchyma (*) is uninvolved.

View larger version (157K): [in a new window]   Figure 15c.  Fibrous pseudotumor in a 26-year-old man. (a) Axial T1-weighted MR image shows an intermediate-signal-intensity mass (arrow) that is isointense relative to the testis (T). (b) On a sagittal T2-weighted fat-suppressed image, the mass is markedly hypointense (arrowhead). It has a broad-based attachment to the capsule of the testis. (c) Low-power photomicrograph (original magnification x4; hematoxylin-eosin stain) shows a hyalinized nodule (arrow) attached to the tunica. The underlying testicular parenchyma (*) is uninvolved.

View larger version (127K): [in a new window]   Figure 16a.  Polyorchidism. (a, b) Coronal T1-weighted (a) and T2-weighted (b) images show two testes within the right hemiscrotum (arrows). They are slightly smaller than, but identical in signal intensity to, the normal left testis. On both images, all three testes are surrounded by a low-signal-intensity tunica albuginea. (c) Photograph obtained after a right inguinal orchiectomy shows two ovoid testes.

View larger version (131K): [in a new window]   Figure 16b.  Polyorchidism. (a, b) Coronal T1-weighted (a) and T2-weighted (b) images show two testes within the right hemiscrotum (arrows). They are slightly smaller than, but identical in signal intensity to, the normal left testis. On both images, all three testes are surrounded by a low-signal-intensity tunica albuginea. (c) Photograph obtained after a right inguinal orchiectomy shows two ovoid testes.

View larger version (113K): [in a new window]   Figure 16c.  Polyorchidism. (a, b) Coronal T1-weighted (a) and T2-weighted (b) images show two testes within the right hemiscrotum (arrows). They are slightly smaller than, but identical in signal intensity to, the normal left testis. On both images, all three testes are surrounded by a low-signal-intensity tunica albuginea. (c) Photograph obtained after a right inguinal orchiectomy shows two ovoid testes.

View larger version (159K): [in a new window]   Figure 17a.  Acute epididymitis. (a) Longitudinal US image shows a markedly thickened, heterogeneous epididymal tail (arrowhead) and edema within the scrotal wall (arrow). T = testis. (b) Color Doppler image shows increased flow. (c) Photograph of the gross specimen shows a markedly thickened, hyperemic epididymis (arrow). T = testis.

View larger version (79K): [in a new window]   Figure 17b.  Acute epididymitis. (a) Longitudinal US image shows a markedly thickened, heterogeneous epididymal tail (arrowhead) and edema within the scrotal wall (arrow). T = testis. (b) Color Doppler image shows increased flow. (c) Photograph of the gross specimen shows a markedly thickened, hyperemic epididymis (arrow). T = testis.

View larger version (134K): [in a new window]   Figure 17c.  Acute epididymitis. (a) Longitudinal US image shows a markedly thickened, heterogeneous epididymal tail (arrowhead) and edema within the scrotal wall (arrow). T = testis. (b) Color Doppler image shows increased flow. (c) Photograph of the gross specimen shows a markedly thickened, hyperemic epididymis (arrow). T = testis.

View larger version (143K): [in a new window]   Figure 18a.  Tuberculous epididymitis. (a) Longitudinal US image shows a heterogeneous, hypoechoic mass in the region of the epididymal tail (arrow). It is difficult to differentiate the mass from a testicular one. T = testis. (b) Photograph of the bivalved testis and epididymis shows a large, firm, yellow epididymal mass that indents the testicular capsule and causes the US appearance (arrows).

View larger version (129K): [in a new window]   Figure 18b.  Tuberculous epididymitis. (a) Longitudinal US image shows a heterogeneous, hypoechoic mass in the region of the epididymal tail (arrow). It is difficult to differentiate the mass from a testicular one. T = testis. (b) Photograph of the bivalved testis and epididymis shows a large, firm, yellow epididymal mass that indents the testicular capsule and causes the US appearance (arrows).

View larger version (141K): [in a new window]   Figure 19a.  Tuberculous epididymo-orchitis. (a) Longitudinal US image shows a markedly enlarged epididymal head (arrowhead) with one large and several smaller hypoechoic masses (curved arrows). There are also multiple small hypoechoic lesions within the testis (straight arrows). (b) Medium-power photomicrograph of the epididymis (original magnification x40; hematoxylin-eosin stain) shows three well-circumscribed granulomas (long arrows) between normal epididymal ducts (short arrows).

View larger version (164K): [in a new window]   Figure 19b.  Tuberculous epididymo-orchitis. (a) Longitudinal US image shows a markedly enlarged epididymal head (arrowhead) with one large and several smaller hypoechoic masses (curved arrows). There are also multiple small hypoechoic lesions within the testis (straight arrows). (b) Medium-power photomicrograph of the epididymis (original magnification x40; hematoxylin-eosin stain) shows three well-circumscribed granulomas (long arrows) between normal epididymal ducts (short arrows).

View larger version (145K): [in a new window]   Figure 20a.  Sarcoidosis. (a) Transverse US image shows a markedly enlarged, hypoechoic epididymis (E). T = testis. (b) Intraoperative photograph shows a diffusely enlarged, lobular epididymis around a normal testis (T). Scale is in inches.

View larger version (119K): [in a new window]   Figure 20b.  Sarcoidosis. (a) Transverse US image shows a markedly enlarged, hypoechoic epididymis (E). T = testis. (b) Intraoperative photograph shows a diffusely enlarged, lobular epididymis around a normal testis (T). Scale is in inches.

View larger version (115K): [in a new window]   Figure 21.  Epididymal cyst. Longitudinal US image shows a large cyst within the head of the epididymis (arrow). The cyst cannot be distinguished sonographically from a spermatocele. T = testis.

View larger version (121K): [in a new window]   Figure 22a.  Adenomatoid tumor. (a) Longitudinal US image shows a well-defined, solid paratesticular mass (arrow). T = testis. (b) Photograph of the gross specimen shows a homogeneous, well-circumscribed, white mass (arrow). Pathologic analysis confirmed it was from the epididymis.

View larger version (67K): [in a new window]   Figure 22b.  Adenomatoid tumor. (a) Longitudinal US image shows a well-defined, solid paratesticular mass (arrow). T = testis. (b) Photograph of the gross specimen shows a homogeneous, well-circumscribed, white mass (arrow). Pathologic analysis confirmed it was from the epididymis.

View larger version (141K): [in a new window]   Figure 23a.  Papillary cystadenoma in a patient with von Hippel-Lindau disease. (a) Longitudinal US image shows a mixed solid and cystic mass arising in the region of the epididymal tail (arrow). T = testis. (b) Medium-power photomicrograph (original magnification x70; hematoxylin-eosin stain) shows an ectatic epididymal duct containing a papillary neoplasm lined by clear cells (arrows). The wall of the duct and the adjacent small tubules are also lined by clear cells (arrowheads).

View larger version (150K): [in a new window]   Figure 23b.  Papillary cystadenoma in a patient with von Hippel-Lindau disease. (a) Longitudinal US image shows a mixed solid and cystic mass arising in the region of the epididymal tail (arrow). T = testis. (b) Medium-power photomicrograph (original magnification x70; hematoxylin-eosin stain) shows an ectatic epididymal duct containing a papillary neoplasm lined by clear cells (arrows). The wall of the duct and the adjacent small tubules are also lined by clear cells (arrowheads).

View larger version (127K): [in a new window]   Figure 24a.  Lymphoma. (a) Transverse US image of the left testis shows an infiltrating, hypoechoic mass (arrow). (b) Longitudinal image of the superior pole of the testis shows an irregularly thickened epididymis (arrows). (c) Axial CT image demonstrates a thickened, enhancing, left spermatic cord. (d) Photograph of the gross specimen of the testis (T), epididymis (E), and spermatic cord (arrows) shows near total replacement of normal parenchyma with a firm, homogeneous, pale yellow, infiltrating tumor.

View larger version (121K): [in a new window]   Figure 24b.  Lymphoma. (a) Transverse US image of the left testis shows an infiltrating, hypoechoic mass (arrow). (b) Longitudinal image of the superior pole of the testis shows an irregularly thickened epididymis (arrows). (c) Axial CT image demonstrates a thickened, enhancing, left spermatic cord. (d) Photograph of the gross specimen of the testis (T), epididymis (E), and spermatic cord (arrows) shows near total replacement of normal parenchyma with a firm, homogeneous, pale yellow, infiltrating tumor.

View larger version (153K): [in a new window]   Figure 24c.  Lymphoma. (a) Transverse US image of the left testis shows an infiltrating, hypoechoic mass (arrow). (b) Longitudinal image of the superior pole of the testis shows an irregularly thickened epididymis (arrows). (c) Axial CT image demonstrates a thickened, enhancing, left spermatic cord. (d) Photograph of the gross specimen of the testis (T), epididymis (E), and spermatic cord (arrows) shows near total replacement of normal parenchyma with a firm, homogeneous, pale yellow, infiltrating tumor.

View larger version (128K): [in a new window]   Figure 24d.  Lymphoma. (a) Transverse US image of the left testis shows an infiltrating, hypoechoic mass (arrow). (b) Longitudinal image of the superior pole of the testis shows an irregularly thickened epididymis (arrows). (c) Axial CT image demonstrates a thickened, enhancing, left spermatic cord. (d) Photograph of the gross specimen of the testis (T), epididymis (E), and spermatic cord (arrows) shows near total replacement of normal parenchyma with a firm, homogeneous, pale yellow, infiltrating tumor.

View larger version (126K): [in a new window]   Figure 25.  Diffuse thickening of the spermatic cord in a patient with chronic epididymitis. Longitudinal US image of the left inguinal canal shows a thickened, tortuous spermatic cord (arrows).

View larger version (139K): [in a new window]   Figure 26a.  New right-sided varicocele in a 67-year-old man with renal cell carcinoma. (a, b) Axial contrast-enhanced CT images show a large, necrotic, right renal mass (arrow in b). (c) CT image obtained at the inguinal level shows dilatation of the vessels in the right spermatic cord (arrow).

View larger version (146K): [in a new window]   Figure 26b.  New right-sided varicocele in a 67-year-old man with renal cell carcinoma. (a, b) Axial contrast-enhanced CT images show a large, necrotic, right renal mass (arrow in b). (c) CT image obtained at the inguinal level shows dilatation of the vessels in the right spermatic cord (arrow).

View larger version (114K): [in a new window]   Figure 26c.  New right-sided varicocele in a 67-year-old man with renal cell carcinoma. (a, b) Axial contrast-enhanced CT images show a large, necrotic, right renal mass (arrow in b). (c) CT image obtained at the inguinal level shows dilatation of the vessels in the right spermatic cord (arrow).

View larger version (114K): [in a new window]   Figure 27a.  Varicocele. (a) Longitudinal US image of the left testis shows multiple, serpiginous, hypoechoic spaces around the testis (T). (b, c) Color Doppler images obtained just above the testis at rest (b) and during the Valsalva maneuver (c) show flow. Note the marked enlargement and increased flow with the Valsalva maneuver.

View larger version (122K): [in a new window]   Figure 27b.  Varicocele. (a) Longitudinal US image of the left testis shows multiple, serpiginous, hypoechoic spaces around the testis (T). (b, c) Color Doppler images obtained just above the testis at rest (b) and during the Valsalva maneuver (c) show flow. Note the marked enlargement and increased flow with the Valsalva maneuver.

View larger version (116K): [in a new window]   Figure 27c.  Varicocele. (a) Longitudinal US image of the left testis shows multiple, serpiginous, hypoechoic spaces around the testis (T). (b, c) Color Doppler images obtained just above the testis at rest (b) and during the Valsalva maneuver (c) show flow. Note the marked enlargement and increased flow with the Valsalva maneuver.

View larger version (117K): [in a new window]   Figure 28a.  Lipoma. (a) Longitudinal US image shows a uniformly hypoechoic mass (cursors) superior to the testis (T). (b, c) The mass has high signal intensity on both T1-weighted (b) and T2-weighted (c) sagittal MR images (arrows). (d) On the coronal T2-weighted, fat-suppressed image, the mass has lower signal intensity (arrow), a finding that confirms the diagnosis of lipoma.

View larger version (104K): [in a new window]   Figure 28b.  Lipoma. (a) Longitudinal US image shows a uniformly hypoechoic mass (cursors) superior to the testis (T). (b, c) The mass has high signal intensity on both T1-weighted (b) and T2-weighted (c) sagittal MR images (arrows). (d) On the coronal T2-weighted, fat-suppressed image, the mass has lower signal intensity (arrow), a finding that confirms the diagnosis of lipoma.

View larger version (109K): [in a new window]   Figure 28c.  Lipoma. (a) Longitudinal US image shows a uniformly hypoechoic mass (cursors) superior to the testis (T). (b, c) The mass has high signal intensity on both T1-weighted (b) and T2-weighted (c) sagittal MR images (arrows). (d) On the coronal T2-weighted, fat-suppressed image, the mass has lower signal intensity (arrow), a finding that confirms the diagnosis of lipoma.

View larger version (122K): [in a new window]   Figure 28d.  Lipoma. (a) Longitudinal US image shows a uniformly hypoechoic mass (cursors) superior to the testis (T). (b, c) The mass has high signal intensity on both T1-weighted (b) and T2-weighted (c) sagittal MR images (arrows). (d) On the coronal T2-weighted, fat-suppressed image, the mass has lower signal intensity (arrow), a finding that confirms the diagnosis of lipoma.

View larger version (163K): [in a new window]   Figure 29a.  Metastatic rhabdomyosarcoma in a 21-year-old man who presented with a palpable scrotal mass. (a) Longitudinal US image of the inferior portion of the right hemiscrotum shows a lobulated soft-tissue mass involving the tunica vaginalis (long arrows) and testicular capsule (short arrow). T = testis. (b, c) Contrast-enhanced axial CT images show a large, heterogeneously enhancing, right scrotal mass (arrow in b) and retroperitoneal adenopathy (arrows in c). There was also extensive pelvic adenopathy with ureteral obstruction that caused the right-sided hydronephrosis and delayed nephrogram. (d) Photograph of the bivalved scrotal specimen shows a fleshy, tan tumor (arrows) surrounding the testis. Scale is in centimeters.

View larger version (111K): [in a new window]   Figure 29b.  Metastatic rhabdomyosarcoma in a 21-year-old man who presented with a palpable scrotal mass. (a) Longitudinal US image of the inferior portion of the right hemiscrotum shows a lobulated soft-tissue mass involving the tunica vaginalis (long arrows) and testicular capsule (short arrow). T = testis. (b, c) Contrast-enhanced axial CT images show a large, heterogeneously enhancing, right scrotal mass (arrow in b) and retroperitoneal adenopathy (arrows in c). There was also extensive pelvic adenopathy with ureteral obstruction that caused the right-sided hydronephrosis and delayed nephrogram. (d) Photograph of the bivalved scrotal specimen shows a fleshy, tan tumor (arrows) surrounding the testis. Scale is in centimeters.

View larger version (131K): [in a new window]   Figure 29c.  Metastatic rhabdomyosarcoma in a 21-year-old man who presented with a palpable scrotal mass. (a) Longitudinal US image of the inferior portion of the right hemiscrotum shows a lobulated soft-tissue mass involving the tunica vaginalis (long arrows) and testicular capsule (short arrow). T = testis. (b, c) Contrast-enhanced axial CT images show a large, heterogeneously enhancing, right scrotal mass (arrow in b) and retroperitoneal adenopathy (arrows in c). There was also extensive pelvic adenopathy with ureteral obstruction that caused the right-sided hydronephrosis and delayed nephrogram. (d) Photograph of the bivalved scrotal specimen shows a fleshy, tan tumor (arrows) surrounding the testis. Scale is in centimeters.

View larger version (138K): [in a new window]   Figure 29d.  Metastatic rhabdomyosarcoma in a 21-year-old man who presented with a palpable scrotal mass. (a) Longitudinal US image of the inferior portion of the right hemiscrotum shows a lobulated soft-tissue mass involving the tunica vaginalis (long arrows) and testicular capsule (short arrow). T = testis. (b, c) Contrast-enhanced axial CT images show a large, heterogeneously enhancing, right scrotal mass (arrow in b) and retroperitoneal adenopathy (arrows in c). There was also extensive pelvic adenopathy with ureteral obstruction that caused the right-sided hydronephrosis and delayed nephrogram. (d) Photograph of the bivalved scrotal specimen shows a fleshy, tan tumor (arrows) surrounding the testis. Scale is in centimeters.

View larger version (135K): [in a new window]   Figure 30a.  Liposarcoma. (a) Axial T1-weighted image shows a large, predominantly high-signal-intensity mass in the right hemiscrotum. T = testis. (b) Coronal gadolinium-enhanced T1-weighted, fat-suppressed image shows loss of signal in the fatty portions and enhancement of the soft-tissue component of the mass. The normal right testis is displaced inferiorly. T = testis. (c) Photograph of the resected tumor shows a lobulated, yellow mass. (d) High-power photomicrograph (original magnification x120; hematoxylin-eosin stain) shows sclerosis with entrapped lipoblasts (arrow) and multinucleated tumor cells (arrowhead).

View larger version (140K): [in a new window]   Figure 30b.  Liposarcoma. (a) Axial T1-weighted image shows a large, predominantly high-signal-intensity mass in the right hemiscrotum. T = testis. (b) Coronal gadolinium-enhanced T1-weighted, fat-suppressed image shows loss of signal in the fatty portions and enhancement of the soft-tissue component of the mass. The normal right testis is displaced inferiorly. T = testis. (c) Photograph of the resected tumor shows a lobulated, yellow mass. (d) High-power photomicrograph (original magnification x120; hematoxylin-eosin stain) shows sclerosis with entrapped lipoblasts (arrow) and multinucleated tumor cells (arrowhead).

View larger version (115K): [in a new window]   Figure 30c.  Liposarcoma. (a) Axial T1-weighted image shows a large, predominantly high-signal-intensity mass in the right hemiscrotum. T = testis. (b) Coronal gadolinium-enhanced T1-weighted, fat-suppressed image shows loss of signal in the fatty portions and enhancement of the soft-tissue component of the mass. The normal right testis is displaced inferiorly. T = testis. (c) Photograph of the resected tumor shows a lobulated, yellow mass. (d) High-power photomicrograph (original magnification x120; hematoxylin-eosin stain) shows sclerosis with entrapped lipoblasts (arrow) and multinucleated tumor cells (arrowhead).

View larger version (183K): [in a new window]   Figure 30d.  Liposarcoma. (a) Axial T1-weighted image shows a large, predominantly high-signal-intensity mass in the right hemiscrotum. T = testis. (b) Coronal gadolinium-enhanced T1-weighted, fat-suppressed image shows loss of signal in the fatty portions and enhancement of the soft-tissue component of the mass. The normal right testis is displaced inferiorly. T = testis. (c) Photograph of the resected tumor shows a lobulated, yellow mass. (d) High-power photomicrograph (original magnification x120; hematoxylin-eosin stain) shows sclerosis with entrapped lipoblasts (arrow) and multinucleated tumor cells (arrowhead).

View larger version (145K): [in a new window]   Figure 31.  Leiomyosarcoma. Sagittal T2-weighted MR image shows a large, solid mass of mixed signal intensity filling the left hemiscrotum (arrow). The testis (not shown) was compressed and displaced medially. B = bladder, arrowhead = prostate.