The purpose of this study was to determine the gray-scale and color Doppler sonographic appearance of testicular lymphoma and leukemia to aid in its differentiation from primary testicular neoplasms and inflammatory processes.

We retrospectively reviewed the testicular sonograms of eight male patients 5-74 years old (mean age, 43 years) with pathologically proved testicular leukemia or lymphoma. All patients presented with testicular enlargement. Gray-scale sonograms were obtained to determine the presence or absence of a mass, focal nodule, or diffuse infiltration, as well as the degree of parenchymal echogenicity. Color Doppler sonography was applied in each case to determine the degree of vascularity compared with normal ipsilateral or contralateral testicular parenchyma. In patients with focal, measurable lesions, the size was correlated with its color Doppler sonographic appearance.

Gray-scale sonograms showed either homogeneously hypoechoic testes in patients with diffuse round-cell infiltration or multifocal hypoechoic lesions of various sizes. Five patients had a total of 11 focal lesions that ranged in size from 8 mm to 26 mm in maximum diameter (mean diameter, 16 mm). Color Doppler sonography revealed increased intralesional flow in all areas of lymphomatous or leukemic involvement irrespective of lesion size.

Our results show that testicular lymphoma and leukemia are hypervascular on color Doppler sonograms regardless of the size of the tumor. Although color Doppler sonography may provide useful information, differentiating round-cell infiltration from inflammatory processes of the testes remains difficult.