MRI in the Histologic Characterization of Testicular Neoplasms
Athina C. Tsili1,
Constantine Tsampoulas1,
Xenofon Giannakopoulos2,
Dimitrios Stefanou3,
Yiannis Alamanos4,
Nikolaos Sofikitis2 and
Stavros C. Efremidis1
1 Department of Clinical Radiology, University Hospital of Ionnina, Leoforos S.
Niarchou, 45500, Platia Pargis, 2, 453 32, Ioannina, Greece.
2 Department of Urology, University Hospital of Ionnina, Leoforos S. Niarchou,
45500, Ioannina, Greece.
3 Department of Pathology, University Hospital of Ionnina, Leoforos S. Niarchou,
45500, Ioannina, Greece.
4 Department of Hygiene and Public Health, Panepistimioupolis, Leoforos S.
Niarchou, 45500, Ioannina, Greece.
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Fig. 1A —43-year-old man with left testicular seminoma. Coronal T2-weighted
(A) and contrast-enhanced T1-weighted (B) images show
multinodular intratesticular mass lesion (arrows). Tumor is
homogeneous and of low signal intensity on T2-weighted image (A)
compared with normal testicular parenchyma. After gadolinium administration,
there is enhancement of tumor septa (B). Imaging features suggest
seminomatous lesion. Small right hydrocele (stars) is also seen.
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Fig. 1B —43-year-old man with left testicular seminoma. Coronal
T2-weighted (A) and contrast-enhanced T1-weighted (B) images
show multinodular intratesticular mass lesion (arrows). Tumor is
homogeneous and of low signal intensity on T2-weighted image (A)
compared with normal testicular parenchyma. After gadolinium administration,
there is enhancement of tumor septa (B). Imaging features suggest
seminomatous lesion. Small right hydrocele (stars) is also seen.
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Fig. 1C —43-year-old man with left testicular seminoma.
Photomicrograph of histologic section shows seminoma of classic type. Tumor
cells are uniform with abundant clear cytoplasm and are arranged in nests
outlined by fibrous bands. (H and E, x400)
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Fig. 2A —26-year-old man with teratocarcinoma of right testicle.
Transverse (A) and sagittal (B) T2-weighted images depict left
testicular mass (arrow, A; long arrow, B) with
markedly heterogeneous signal. Tumor is surrounded by low-signal-intensity
halo (long arrow, B), corresponding histologically to a
fibrous capsule. There is invasion of the tunica albuginea by the tumor
(short arrow, A).
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Fig. 2B —26-year-old man with teratocarcinoma of right testicle.
Transverse (A) and sagittal (B) T2-weighted images depict left
testicular mass (arrow, A; long arrow, B) with
markedly heterogeneous signal. Tumor is surrounded by low-signal-intensity
halo (long arrow, B), corresponding histologically to a
fibrous capsule. There is invasion of the tunica albuginea by the tumor
(short arrow, A).
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Fig. 2C —26-year-old man with teratocarcinoma of right testicle.
Sagittal contrast-enhanced T1-weighted image shows heterogeneous enhancement
of tumor. Areas of hyperintensity within lesion on T2-weighted images that did
not enhance after gadolinium administration (arrows) proved
histologically to represent areas of necrosis. Imaging features in this case
suggest nonseminomatous lesion.
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Fig. 2D —26-year-old man with teratocarcinoma of right testicle.
Photomicrograph of histologic section shows heterogeneous tumor containing
squamous epithelium, cartilage, and embryonic body (center of
photo—mixed teratoma and embryonal carcinoma). (H and E, x100)
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Fig. 3B —29-year-old man with mature cystic teratoma of left testicle.
Transverse T1-weighted (B) and fat-suppressed T1-weighted (C)
images show areas (arrows) of high signal intensity and loss of
signal on fat-suppressed images, compatible with presence of fat.
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Fig. 3C —29-year-old man with mature cystic teratoma of left testicle.
Transverse T1-weighted (B) and fat-suppressed T1-weighted (C)
images show areas (arrows) of high signal intensity and loss of
signal on fat-suppressed images, compatible with presence of fat.
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Fig. 4A —28-year-old man with seminoma of left testicle. Coronal
T2-weighted (A) and contrast-enhanced T1-weighted (B) images
depict large left testicular mass. Tumor is heterogeneous but mainly of low
signal intensity on T2-weighted image (A). There are multiple septa
(arrows, B) within the lesion, detected both on T2-weighted
and contrast-enhanced T1-weighted images, suggesting diagnosis of seminoma.
There is interruption of tunica albuginea by tumor (arrow, A),
suggestive of invasion, which was proven histologically. Star indicates right
testicle.
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Fig. 4B —28-year-old man with seminoma of left testicle. Coronal
T2-weighted (A) and contrast-enhanced T1-weighted (B) images
depict large left testicular mass. Tumor is heterogeneous but mainly of low
signal intensity on T2-weighted image (A). There are multiple septa
(arrows, B) within the lesion, detected both on T2-weighted
and contrast-enhanced T1-weighted images, suggesting diagnosis of seminoma.
There is interruption of tunica albuginea by tumor (arrow, A),
suggestive of invasion, which was proven histologically. Star indicates right
testicle.
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Fig. 4C —28-year-old man with seminoma of left testicle. Transverse
T1-weighted image depicts small hyperintense focus (arrow) within
mass, corresponding to area of hemorrhage. Star indicates right testicle.
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Fig. 5A —47-year-old man with left testicle seminoma invading
ipsilateral spermatic cord. Sagittal T2-weighted (A), coronal
T2-weighted (B), and contrast-enhanced T1-weighted (C) images
depict large tumor involving left testicle and invading epididymis and
spermatic cord. Tumor is inhomogeneous but mainly hypointense on T2-weighted
images. There are bandlike structures (arrows) within mass that are
of low signal intensity on T2-weighted images. These structures enhance more
than rest of tumor after gadolinium administration, indicating fibrovascular
septa.
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Fig. 5B —47-year-old man with left testicle seminoma invading
ipsilateral spermatic cord. Sagittal T2-weighted (A), coronal
T2-weighted (B), and contrast-enhanced T1-weighted (C) images
depict large tumor involving left testicle and invading epididymis and
spermatic cord. Tumor is inhomogeneous but mainly hypointense on T2-weighted
images. There are bandlike structures (arrows) within mass that are
of low signal intensity on T2-weighted images. These structures enhance more
than rest of tumor after gadolinium administration, indicating fibrovascular
septa.
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Fig. 5C —47-year-old man with left testicle seminoma invading
ipsilateral spermatic cord. Sagittal T2-weighted (A), coronal
T2-weighted (B), and contrast-enhanced T1-weighted (C) images
depict large tumor involving left testicle and invading epididymis and
spermatic cord. Tumor is inhomogeneous but mainly hypointense on T2-weighted
images. There are bandlike structures (arrows) within mass that are
of low signal intensity on T2-weighted images. These structures enhance more
than rest of tumor after gadolinium administration, indicating fibrovascular
septa.
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Fig. 5D —47-year-old man with left testicle seminoma invading
ipsilateral spermatic cord. Photomicrograph of histologic section shows
testicular seminoma. Neoplastic cells infiltrate spermatic cord. (H and E,
x100)
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Fig. 6 —23-year-old man with embryonal carcinoma of right testicle.
Transverse T2-weighted image shows small tumor (arrow) involving
right testicle. Lesion is relatively homogeneous and hypointense, suggesting
diagnosis of seminoma.
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Fig. 7A —28-year-old man with anaplastic seminoma of right testicle.
Coronal T2-weighted (A) and contrast-enhanced T1-weighted (B)
images show large inhomogeneous right testicular mass invading ipsilateral
epididymis (long arrow). Finding was confirmed on histology. Because
of mass heterogeneity, both on unenhanced and contrast-enhanced MR images, it
was incorrectly characterized as nonseminomatous lesion. There is also small
right hydrocele (short arrow, A). Star indicates left
testicle.
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Fig. 7B —28-year-old man with anaplastic seminoma of right testicle.
Coronal T2-weighted (A) and contrast-enhanced T1-weighted (B)
images show large inhomogeneous right testicular mass invading ipsilateral
epididymis (long arrow). Finding was confirmed on histology. Because
of mass heterogeneity, both on unenhanced and contrast-enhanced MR images, it
was incorrectly characterized as nonseminomatous lesion. There is also small
right hydrocele (short arrow, A). Star indicates left
testicle.
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