 Introduction/Background Palpable scrotal abnormalities are caused by a variety of disorders, ranging from indolent benign conditions to aggressive tumors as well as infectious and vascular processes, often requiring emergent surgical intervention [1- 3]. In these patients, the diagnostic workup typically begins with a complete clinical history and physical examination, including analysis of risk factors, often followed by imaging [4,5]. Germ cell testicular tumors (GCTT) are the most frequently diagnosed cancer in young men and constitute approximately 95% of all testicular tumors [6]. It is estimated that 1 in 250 men will develop GCTT during their lifetime, most often between 20 to 34 years of age, representing 0.5% of all new malignancies [6]. GCTT histologically include seminoma and nonseminoma (52% and 48%, respectively) or mixed tumors [7]. Most patients with GCTT are diagnosed quite early and present with stage I disease, when the tumor is confined to the testicle; in these patients, inguinal orchiectomy is the first recommended maneuver that has both diagnostic and therapeutic aims [13]. Close clinical and imaging surveillance with or without short-course adjuvant chemotherapy are accepted alternatives for patients with stage I disease [6]. In patients with more advanced disease presenting with extratesticular tumor, several courses of chemotherapy followed by the judicious surgical removal of residual tumor is commonly used. High-risk patients and those with relapsing or refractory disease are referred to specialized tertiary centers for advanced high-dose chemotherapy plus autologous hematopoietic support [8]. Special Imaging Considerations Contrast-enhanced ultrasound (CEUS) and US shear-wave elastography (SWE) are gaining clinical acceptance as useful additions to first-line US examinations of the scrotum in patients with newly diagnosed palpable scrotal abnormality. aThomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Newly Diagnosed Palpable Scrotal Abnormality.  Introduction/Background Palpable scrotal abnormalities are caused by a variety of disorders, ranging from indolent benign conditions to aggressive tumors as well as infectious and vascular processes, often requiring emergent surgical intervention [1- 3]. In these patients, the diagnostic workup typically begins with a complete clinical history and physical examination, including analysis of risk factors, often followed by imaging [4,5]. Germ cell testicular tumors (GCTT) are the most frequently diagnosed cancer in young men and constitute approximately 95% of all testicular tumors [6]. It is estimated that 1 in 250 men will develop GCTT during their lifetime, most often between 20 to 34 years of age, representing 0.5% of all new malignancies [6]. GCTT histologically include seminoma and nonseminoma (52% and 48%, respectively) or mixed tumors [7]. Most patients with GCTT are diagnosed quite early and present with stage I disease, when the tumor is confined to the testicle; in these patients, inguinal orchiectomy is the first recommended maneuver that has both diagnostic and therapeutic aims [13]. Close clinical and imaging surveillance with or without short-course adjuvant chemotherapy are accepted alternatives for patients with stage I disease [6]. In patients with more advanced disease presenting with extratesticular tumor, several courses of chemotherapy followed by the judicious surgical removal of residual tumor is commonly used. High-risk patients and those with relapsing or refractory disease are referred to specialized tertiary centers for advanced high-dose chemotherapy plus autologous hematopoietic support [8]. Special Imaging Considerations Contrast-enhanced ultrasound (CEUS) and US shear-wave elastography (SWE) are gaining clinical acceptance as useful additions to first-line US examinations of the scrotum in patients with newly diagnosed palpable scrotal abnormality. aThomas Jefferson University Hospital, Philadelphia, Pennsylvania.