testicular ultrasound
DESCRIPTION
Testicular Ultrasound. Normal and Pathologic Appearances. Indications for Testicular Ultrasound. Assessment of palpable abnormalities Breeding soundness examination Assessment of painful or swollen testes Routine assessment of apparently normal intact males. Normal US Appearance. - PowerPoint PPT PresentationTRANSCRIPT
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Testicular Ultrasound
Normal and Pathologic Appearances
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Indications for Testicular Ultrasound
Assessment of palpable abnormalities Breeding soundness examination Assessment of painful or swollen testes Routine assessment of apparently normal
intact males
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Pugh CR, Konde LJ, Park RD. Testicular ultrasound in the normal dog. Veterinary Radiology, 31(4), 1990: 195-199.
Normal US Appearance
Coarse, homogeneous echotexture Central, hyperechoic mediastinum testis—2
mm on sagittal and transverse sections Occasional hyperechoic flecks Tail of epididymis—hypoechoic to anechoic Should be bilaterally symmetric—should vary
by less than 4.5 mm
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Pugh CR, Konde LJ, Park RD. Testicular ultrasound in the normal dog. Veterinary Radiology, 31(4), 1990: 195-199.
Normal Examination
Use a high frequency transducer or standoff pad (we use the 13-5 probe)
Sagittal plane Transverse plane Dorsal plane—good for imaging epididymis
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“Winston”
7 year old male Mastiff Presented for enlarged prostate Ultrasound findings included prostatomegaly
and a small left testicular nodule
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Sonographic evaluation of canine testicular and scrotal abnormalities: a review of 26 case histories. Vet Rad. 1991: 243-250.
Testicular Diseases NEOPLASIA Hernia Hydrocele—compromised lymphatics (e.g. LSA),
hernia, infarction, neoplasia, idiopathic Torsion—often in retained/tumorous testes—US is a
good early diagnostic (before permanent damage) Hematocele—trauma, neoplasia, DM Pyocele (infectious)—Blasto, RMSF(?) Atrophy—contralateral tumor, temp, trauma Cryptorchidism
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Sonographic evaluation of canine testicular and scrotal abnormalities: a review of 26 case histories. Vet Rad. 1991: 243-250.
Testicular Neoplasia
Sertoli Cell Tumor Interstitial Cell Tumor Seminoma
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Sertoli Cell Tumor
From sustentacular cells of seminiferous tubules
Firm, lobulated, white to grey, often large, greasy (eew!)
May show clinical signs of feminization More common in cryptorchid testes
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Sertoli Cell Tumor (cont’d)
Mean age 9.5 yo (younger for cryptorchid dogs)
9% metastasis—MILN, other LNN, rarely spleen, liver, kidney
Rare in cats (2 reports) No characteristic US findings (although one
must wonder if size could be suggestive)
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Interstitial Cell Tumor
Leydig cells between seminiferous tubules Small, discrete, non-palpable (majority under
2 cm) Soft, bulging, bright yellow or orange (!) Often cystic Always scrotal Metastases very rare
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Interstitial Cell Tumor (cont’d)
Increased testosterone productionprostatic disease, perianal gland neoplasia, perineal hernia more common
Rare in cats (1 report—incidental finding) No characteristic US findings
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Seminoma
Germinal epithelium of seminiferous tubule Homogeneous, soft, bulging, cream colored Often large (1 mm to 10 cm diameter; 75%
under 2 cm) Associated with cryptorchidism Rare metastasis—9%. Usually to MILN,
other LNN, occasionally lung Rare in cats—1 report No characteristic US appearance—size??
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Testicular Tumors—More Fun Facts
ANY can show signs of feminization, Sertoli most common
Majority are asymptomatic—may affect fertility Many Vietnam-era MWD’s had seminomas
(herbicide/pesticide exposure??) Syndrome in middle-aged, miniature Schnauzer
cryptorchid male pseudohermaphrodites—Sertoli cell tumor produces estrogen and causes pyometra or mucometra of the remnant uterus!! (6 dogs)
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Staging
Abdominal and testicular ultrasound Thoracic rads (mets rare) Serum testosterone/estrogen/progesterone Abdominal rads (look for masses—retained
testes) CBC—look for bone marrow suppression Coagulation profile (if anemia, petechiae,
hemorrhage)
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McEntee MC. Reproductive Oncology. Clinical Techniques in SA Practice. Aug 2002. 138-143.
Treatment
Castration usually curative Cisplatin has been used Radiation for seminoma metastatic to
sublumbar lymph nodes