There is a wide spectrum of benign, non-cystic scrotal lesions that show characteristic histo-morphology and natural history. While sonography is the preferred modality for the diagnosis of both testicular and extratesticular masses, MRI is used as a problem-solving modality when sonographic findings are inconclusive. This article reviews the cross-sectional imaging features of benign, non-cystic, intra- and extratesticular lesions. Definitive diagnosis of benign scrotal lesions may lead to conservative management including testicular preserving surgery.
HaasGP, ShumakerBP, CernyJC. The high incidence of benign testicular tumors. J Urol1986;136:1219–20
2.
SerraAD, HricakH, CoakleyFV, Inconclusive clinical and ultrasound evaluation of the scrotum: impact of magnetic resonance imaging on patient management and cost. Urology1998;51:1018–21
3.
PretoriusE. MRI of the male pelvis and bladder. In: SiegelmanES, ed. Body MRI. Philadelphia, PA: Elsevier Saunders, 2005
CarucciLR, TirkesAT, PretoriusES, Testicular Leydig's cell hyperplasia: MR imaging and sonographic findings. Am J Roentgenol2003;180:501–3
10.
AvilaNA, PremkumarA, ShawkerTH, Testicular adrenal rest tissue in congenital adrenal hyperplasia: findings at Gray-scale and color Doppler US. Radiology1996;198:99–104
11.
StikkelbroeckNM, SulimanHM, OttenBJ, Testicular adrenal rest tumours in postpubertal males with congenital adrenal hyperplasia: sonographic and MR features. Eur Radiol2003;13:1597–603
12.
SeidenwurmD, SmathersRL, KanP, Intratesticular adrenal rests diagnosed by ultrasound. Radiology1985;155:479–81
13.
BhattS, RubensDJ, DograVS. Sonography of benign intrascrotal lesions. Ultrasound Q2006;22:121–36
14.
AvilaNA, PremkumarA, MerkeDP. Testicular adrenal rest tissue in congenital adrenal hyperplasia: comparison of MR imaging and sonographic findings. Am J Roentgenol1999;172:1003–6
15.
CabreraMS, VogiatziMG, NewMI. Long term outcome in adult males with classic congenital adrenal hyperplasia. J Clin Endocrinol Metab2001;86:3070–8
16.
BrauersA, StriepeckeE, MersdorfA, Inflammatory pseudotumor of the epididymis. Eur Urol. 1997;32:253–5
17.
ArberDA, KamelOW, van de RijnM, Frequent presence of the Epstein-Barr virus in inflammatory pseudotumor. Hum Pathol1995;26:1093–8
18.
SmithFJ, BilbeyJH, FilipenkoJD, Testicular pseudotumor in the acquired immunodeficiency syndrome. Urology1995; 45:535–7
19.
NavaiN, YapRL, GuptaR, Inflammatory pseudotumor of the testis: a novel presentation of acute retroviral syndrome. Int J Urol2005;12:424–6
20.
HanDP, DmochowskiRR, BlasserMH, Segmental infarction of the testicle: atypical presentation of a testicular mass. J Urol1994;151:159–60
21.
Fernandez-PerezGC, TardaguilaFM, VelascoM, Radiologic findings of segmental testicular infarction. Am J Roentgenol2005;184:1587–93
22.
BertolottoM, DerchiLE, SidhuPS, Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. Am J Roentgeno2011;196:834–41
23.
WoodhouseJB, DelahuntB, EnglishSF, Testicular lipomatosis in Cowden's syndrome. Mod Pathol2005;18:1151–6
24.
LloydKM2nd, DennisM, Cowden's disease. A possible new symptom complex with multiple system involvement. Ann Intern Med1963;58:136–42
25.
WoodhouseJ, FergusonMM. Multiple hyperechoic testicular lesions are a common finding on ultrasound in Cowden disease and represent lipomatosis of the testis. Br J Radiol2006;79:801–3
26.
KroneKD, CarrollBA. Scrotal ultrasound. Radiol Clin North Am1985;23:121–39
27.
HertzbergBS, MahonyBS, BowieJD, AndersonEE. Sonography of an intratesticular lipoma. J Ultrasound Med1985;4:619–21
WoodwardPJ, SchwabCM, SesterhennIA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics2003;23:215–40
30.
AkbarSA, SayyedTA, JafriSZ, Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics2003;23:1461–76
31.
YangDM, KimSH, KimHN, Differential diagnosis of focal epididymal lesions with gray scale sonographic, color Doppler sonographic, and clinical features. J Ultrasound Med2003;22:135–42, quiz 43–4
32.
CassidyFH, IshiokaKM, McMahonCJ, MR imaging of scrotal tumors and pseudotumors. Radiographic2010;30:665–83
33.
PatelMD, SilvaAC. MRI of an adenomatoid tumor of the tunica albuginea. Am J Roentgenol2004;182:415–7
34.
Perez-GuillermoM, ThorA, LowhagenT. Spermatic granuloma. Diagnosis by fine needle aspiration cytology. Acta Cytol1989;33:1–5
35.
SchmidtSS, MorrisRR. Spermatic granuloma: the complication of vasectomy. Fertil Steril1973;24:941–7
36.
BostwickD. Spermatic cord and testicular adnexa. In: BostwickDG, EbleJN, eds. Urological Surgical Pathology. St Louis, MO: Mosby, 1997
37.
HoldenA, ListA. Extratesticular lesions: a radiological and pathological correlation. Australas Radiol1994;38:99–105
