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Prevalence and Significance of Heterogeneous Testes Revealed on Sonography

Ex Vivo Sonographic—Pathologic Correlation

Robert D. Harris1,2, Christine Chouteau2, Michael Partrick1,3 and Alan Schned2,4

1 Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Dr., Lebanon, NH 03756.
2 Dartmouth Medical School, Hanover, NH 03755.
3 Present address: 17509 59th Ave., N.W., Edmonton, Alta., T6MIHI, Canada.
4 Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756.



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  		Fig. 1A. —65-year-old man with scrotal pain and heterogeneous testes. Longitudinal sonogram shows right testis to be heterogeneous and mottled with ill-defined hypoechoic areas (arrows). Similar testicular heterogeneity was seen on left side (not shown). No palpable lesions were present.

 


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  		Fig. 1B. —65-year-old man with scrotal pain and heterogeneous testes. Color Doppler sonogram of right testis reveals mottled areas of slightly decreased echogenicity not corresponding to blood flow. Contralateral testis (not shown) also revealed normal color Doppler flow.

 


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  		Fig. 2A. —Testes from 18-year-old man who died from leukemia and sepsis. Ex vivo longitudinal image shows large hypoechoic area in posterior aspect of superior pole of testis (arrows). Scale markers are 5 mm. Hypoechoic strip in near field of testis was artifactual and did not correspond to pathology.

 


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  		Fig. 2B. —Testes from 18-year-old man who died from leukemia and sepsis. Photograph of gross specimen imaged in A shows pale area (arrows) to be region of tubular atrophy and sclerosis and to correspond to hypoechoic area in A. More normal testicular parenchyma, yellow-brown area, represents most of testis.

 


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  		Fig. 3A. —Testis from 61-year-old man who died from myocardial infarction. Ex vivo sonogram shows fairly homogeneous echotexture and no focal lesions.

 


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  		Fig. 3B. —Testis from 61-year-old man who died from myocardial infarction. Photograph of gross specimen imaged in A shows most of testis is pale bland sclerotic regions with a few interspersed streaks (more yellow streaks at top) of more normal tubules. Reddish brown area at bottom of testis is mediastinum. Presumably, because most of testis was atrophic and sclerotic, no focal lesions were identified on sonography.

 


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  		Fig. 4A. —71-year-old autopsy subject with no scrotal history in medical record and testicular "halo." Longitudinal ex vivo image of left testis reveals circumferential band of hypoechoic tissue (arrows) encompassing entire testis. Note lobular configuration of testis, which represented adhesions of tunica albuginea testis to surrounding structures.

 


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  		Fig. 4B. —71-year-old autopsy subject with no scrotal history in medical record and testicular "halo." Gross pathology of specimen in A shows thickened white tunica albuginea testis (arrows) encircling testis, which has been bivalved. Paler area at top of testis is more sclerotic parenchyma.

 


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  		Fig. 4C. —71-year-old autopsy subject with no scrotal history in medical record and testicular "halo." Photomicrograph of same specimen as B shows abnormally thickened tunica albuginea (TA), which is three times normal thickness and adherent (arrows) to epididymis (E). Testis (te) appears normal. Cleavage plane between tunica and testis is artifact. (Low power, H and E)

 


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  		Fig. 5. —58-year-old man who died from myocardial infarction. Photomicrograph (medium power) reveals normal seminiferous tubules and adjacent tubular atrophy and sclerosis. Tubules at top of image are 2+ to 3+ sclerotic (S) and atrophic, whereas more cellular tubules in bottom half of image appear normal (N) or show mild 1+ sclerosis.

 

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