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Solid Extratesticular Masses in Children: Radiographic and Pathologic Correlation

Tammy Sung1, Wolfram F. J. Riedlinger2, David A. Diamond3 and Jeanne S. Chow4

1 Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115.
2 Department of Pathology, Children's Hospital Boston, Boston, MA 02115.
3 Department of Urology, Children's Hospital Boston, Boston, MA 02115.
4 Department of Radiology, Children's Hospital Boston, Boston, MA 02115.


Figure 1
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  		Fig. 1A —4-year-old boy who presented with painless enlargement of right scrotum due to paratesticular rhabdomyosarcoma. Sagittal sonogram of right testicle shows heterogeneous solid mass (arrows) encircling testis (T) separate from epididymis (E). After surgical excision, pathology showed embryonal-type rhabdomyosarcoma.

 

Figure 2
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  		Fig. 1B —4-year-old boy who presented with painless enlargement of right scrotum due to paratesticular rhabdomyosarcoma. Photomicrograph of histopathologic specimen shows highly cellular neoplasm composed of abundant small, round blue cells arranged with lack of cohesive pattern. (H and E, x10)

 

Figure 3
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  		Fig. 1C —4-year-old boy who presented with painless enlargement of right scrotum due to paratesticular rhabdomyosarcoma. Photomicrograph of histopathologic specimen shows tumor, composed of undifferentiated small, round to spindle cells with dark nuclei and scant cytoplasm and interspersed differentiated rhabdomyoblasts with eosinophilic cytoplasm. Tumor cells are surrounded by connective tissue with variable myxoid appearance. (H and E, x60)

 

Figure 4
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  		Fig. 2A —15-year-old boy who presented with enlarging painless right scrotal mass due to rhabdomyosarcoma. Sagittal sonogram shows hypoechoic mass (M) (arrow) that is separate from adjacent testis (T) and compresses epididymis (E). There is increased blood flow to mass by color Doppler (not shown). Surgical excision was performed.

 

Figure 5
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  		Fig. 2B —15-year-old boy who presented with enlarging painless right scrotal mass due to rhabdomyosarcoma. Photomicrograph of histopathologic specimen shows undifferentiated small, round to spindle cells with dark nuclei and scant cytoplasm embedded in connective tissue with focal myxoid appearance. Interspersed are well-differentiated rhabdomyoblasts with eosinophilic cytoplasm. (H and E, x60)

 

Figure 6
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  		Fig. 3A —14-year-old boy with painless right scrotal mass secondary to fibrous pseudotumor. Sagittal sonogram of right scrotum shows hypoechoic mass (M) (arrow) in epididymis that is discrete and separate from testis (T).

 

Figure 7
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  		Fig. 3B —14-year-old boy with painless right scrotal mass secondary to fibrous pseudotumor. Photomicrograph of histopathologic specimen shows granulation tissue composed of capillary-size vessels associated with chronic inflammatory lymphoplasmacytic cell infiltrate in background of focal hyalinized fibrous tissue. (H and E, x40)

 

Figure 8
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  		Fig. 4A —17-year-old boy who presented with firm, mobile, nonpainful left scrotal mass secondary to inflammatory pseudotumor. Sagittal sonogram shows part of normal left testis (T) and large hypoechoic mass (M) (arrow) that is superior to testis. Mass is homogeneous and well defined and has mild peripheral vascular flow on color Doppler evaluation (not shown).

 

Figure 9
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  		Fig. 4B —17-year-old boy who presented with firm, mobile, nonpainful left scrotal mass secondary to inflammatory pseudotumor. Photomicrograph of histopathologic specimen shows predominantly collagen-filled stroma in a vaguely nodular pattern with rare interspersed chronic inflammatory cells. There is neither hemorrhage nor necrosis evident. (H and E, x20)

 

Figure 10
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  		Fig. 4C —17-year-old boy who presented with firm, mobile, nonpainful left scrotal mass secondary to inflammatory pseudotumor. Photomicrograph of histopathologic specimen shows associated mixed acute and chronic inflammatory infiltrate encompassing neutrophils, lymphocytes, plasma cells, histiocytes, eosinophils, and occasional mast cells. Within collagenous background are spindle cells without nuclear hyperchromasia or cytologic atypia. (H and E, x20)

 

Figure 11
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  		Fig. 5A —7-day-old male neonate who presented with severe swelling of scrotum secondary to meconium periorchitis. Transverse sonogram of scrotum shows marked skin thickening and complex fluid collections surrounding testis (T). Multiple echogenic foci with shadowing (arrow) represent calcified meconium.

 

Figure 12
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  		Fig. 5B —7-day-old male neonate who presented with severe swelling of scrotum secondary to meconium periorchitis. Photomicrograph of histopathologic specimen reveals chronically inflamed myxoid stroma with massive accumulation of polymorphonuclear leukocytes and intermixed chronic inflammatory cells and with histiocytes harboring browning meconium pigment in their cytoplasm. (H and E, x40)

 

Figure 13
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  		Fig. 6A —14-year-old boy who presented with hard, mobile, painless scrotal mass secondary to cellular neurofibroma. Transverse sonogram of bilateral testes (T) shows a hypoechoic mass (N) that is discrete from adjacent testicle.

 

Figure 14
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  		Fig. 6B —14-year-old boy who presented with hard, mobile, painless scrotal mass secondary to cellular neurofibroma. Sagittal sonogram of same patient shows hypoechoic paratesticular mass (N) (arrow) with increased flow on color Doppler that is discrete from adjacent testicle (T).

 

Figure 15
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  		Fig. 6C —14-year-old boy who presented with hard, mobile, painless scrotal mass secondary to cellular neurofibroma. Photomicrograph of histopathologic specimen shows elongated, irregularly shaped cells without nuclear atypia. Lesional cells with wavy, dark-staining nuclei are arranged in interlacing bundles, small whorls, and short fascicles. They are embedded in moderate amounts of mucoid or collagenous matrix. Mast cells, lymphocytes, and occasional xanthoma cells are present elsewhere. (H and E, x40)

 

Figure 16
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  		Fig. 7A —18-year-old man who presented with palpable right scrotal mass and vague right testicular pain for 2 months secondary to chronic epididymitis. Sagittal sonogram of right scrotum shows a solid hypoechoic mass (E) that appears separate from testis (T) and epididymis with increased flow on color Doppler imaging. At inguinal exploration, biopsy of mass and pathology showed chronic epididymitis with fibrosis.

 

Figure 17
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  		Fig. 7B —18-year-old man who presented with palpable right scrotal mass and vague right testicular pain for 2 months secondary to chronic epididymitis. Photomicrograph of histopathologic specimen shows variable numbers of chronic inflammatory cells (i.e., lymphocytes, plasma cells, and histiocytes within collagenized stroma surrounding unremarkable epididymal tubules and ducts). Lymphoid follicles with reactive germinal centers and noncaseating epithelioid granulomas, resulting from sperm-spillage, are seen elsewhere. (H and E, x20)

 

Figure 18
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  		Fig. 8A —15-year-old boy who presented with 1-week history of right groin and scrotal pain due to torsed appendix testis. Parasagittal sonogram shows right testis (T) with adjacent hyperechoic mass (A) without appreciable flow on color Doppler evaluation.

 

Figure 19
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  		Fig. 8B —15-year-old boy who presented with 1-week history of right groin and scrotal pain due to torsed appendix testis. Transverse sonogram of same patient shows heterogeneously echogenic paratesticular mass (A). Although physical examination and sonogram were consistent with torsed appendix testis, patient underwent surgical scrotal exploration.

 

Figure 20
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  		Fig. 8C —15-year-old boy who presented with 1-week history of right groin and scrotal pain due to torsed appendix testis. Photomicrograph of histopathologic specimen shows marked hemorrhagic infarction and ectatic and congested vascular spaces with leakage and resulting fresh hemorrhage. Scattered hemosiderin pigment-laden macrophages can be found in areas. (H and E, x10)

 

Figure 21
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  		Fig. 9A —4-day-old male neonate who presented with swollen penis and swollen, firm scrotum after circumcision, found to have scrotal abscesses. Sagittal sonogram shows skin thickening and hyperemia of scrotal skin consistent with cellulitis. Complex cystic collection is adjacent to testis (T).

 

Figure 22
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  		Fig. 9B —4-day-old male neonate who presented with swollen penis and swollen, firm scrotum after circumcision, found to have scrotal abscesses. Transverse sonogram shows marked increased flow surrounding testis (T) and adjacent complex fluid collection. At surgery, bilateral scrotal abscesses were incised and drained.

 

Figure 23
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  		Fig. 9C —4-day-old male neonate who presented with swollen penis and swollen, firm scrotum after circumcision, found to have scrotal abscesses. Photomicrograph of histopathologic specimen shows sheets of abundant polymorphonuclear leukocytes and nuclear fragments consistent with abscess. (H and E, x20)

 

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