A 51-year-old man was referred at the urological department due to the primary suspicion of a left testicular cancer. Staging computed tomography of the thorax, abdomen, and pelvis was negative for lymphatic or hematogeneous metastatic tumor spread. Moreover, testicular tumor markers such as α-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-hCG), and preoperative hormone levels (testosterone, LH, FSH) were within normal ranges.\nTesticular ultrasound confirmed a 0.9 × 0.9 × 1.0 cm rounded, peripheral, and hyperechoic lesion of the lower pole of the left testicle (Fig. a) connected with the tunica albuginea, without pathological signs of the right testicle. No exact vascular signs or vascular flow within this lesion were reproducible on baseline color and power Doppler sonography (Fig. b). Contrast-enhanced ultrasound (LOGIQ E9 ultrasound machine by GE Healthcare, Fairfield, Connecticut, USA) was performed as an additional diagnostic tool to clarify the vascularization of the suspicious lesion. Interestingly, the lesion was contrast-absorbing after bolus contrast agent application of 2.4 cc (SonoVue, Bracco, Milan, Italy), Fig. c. Moreover, real-time elastography (RTE) of the left testis was performed to evaluate the tissue elasticity of the tumor mass, showing a hard lesion (Fig. d). In summary, multiparametric ultrasound confirmed a vascularized and hardened lesion, therefore being suspicious of testicular cancer.\nNext, inguinal exploration with organ-sparing surgery and tumor enucleation was performed without ischemia. Intraoperative frozen section analysis of the tumor and tumor bed biopsies was performed, providing no evidence of malignant germ cell tumor or testicular intraepithelial neoplasia (TIN). Final pathology report confirmed a completely removed adenomatoid tumor of the left testicle arising from the tunica albuginea.
A 39-year-old male presented with a palpable mass in the right side of the scrotum. There was no history suggestive of urinary infection, genito-urinary tuberculosis or epididymo-orchitis. On local examination, a mass was identified in the right testis which was 2×1.5 cm in size, firm in consistency and well-marginated with smooth swelling. The overlying skin and surrounding adenexa appeared normal. Serum levels of AFP and β-HCG were within normal limits. Scrotal ultrasound revealed a solid mass in the epididymal body of the right scrotum that was hypoechoic compared with the testicular parenchyma.