Ultrasound of the scrotum shows innumerable testicular micro | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Ultrasound of the scrotum shows innumerable testicular microlithiasis. Testicular microlithiasis represents intratubular calcifications. This case is an extreme example of the findings. In most cases, this is considered a benign finding. There is some controversy as to whether patients with testicular microlithiasis have an increased risk of testicular malignancy. #TummyTuesday

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/ 1. Background and Case Overview: Synchronous bilateral testicular germ cell tumors (BTGCTs) are very rare in pediatric patients. Cryptorchidism significantly increases the risk of testicular cancer, making early diagnosis essential. This study presents a case of a 16-year-old boy with a history of bilateral cryptorchidism and orchidopexy, who developed bilateral seminoma. 2. Clinical Findings and Diagnosis: The patient presented with right testicular induration. Physical examination revealed Tanner stage 3 genitalia and full induration of the right testicle, but no mass in the left. Scrotal ultrasound showed bilateral testicular nodules with increased vascularity and microlithiasis, raising suspicion for germ cell tumors. 3. Treatment and Results: A bilateral orchiectomy with intraoperative biopsy was performed. Histopathology confirmed bilateral seminoma, stage I, with no metastasis. Follow-up tumor markers and imaging were normal. 4. Discussion and Recommendations: Bilateral seminoma in pediatric patients is extremely rare, especially when synchronous. Cryptorchidism remains a key risk factor, emphasizing the need for long-term monitoring. Diagnosis relies on clinical exam, imaging, and biopsy. Treatment often involves orchiectomy, impacting hormonal and fertility functions. Given the rarity, a multidisciplinary approach is essential, including fertility preservation and hormonal follow-up. Early detection through ultrasound remains critical for high-risk patients. ](https://app.figure1.com/cdn-cgi/image/format=auto,quality=85,width=168,height=168,fit=cover,gravity=auto/https://figure1-pro-prod.imgix.net/cases/images/47089bdacadbe0aa49f745c18614519e91e4497c495d1c43b70d570d277e7d2f.png)](https://app.figure1.com/case-detail/524c21c9-a07f-4760-b10d-4ebc4b6050da)

  1. Background and Case Overview: Synchronous bilateral testicular germ cell tumors (BTGCTs) are very rare in pediatric patients. Cryptorchidism significantly increases the risk of testicular cancer, making early diagnosis essential. This study presents a case of a 16-year-old boy with a history of bilateral cryptorchidism and orchidopexy, who developed bilateral seminoma.
  2. Clinical Findings and Diagnosis: The patient presented with right testicular induration. Physical examination revealed Tanner stage 3 genitalia and full induration of the right testicle, but no mass in the left. Scrotal ultrasound showed bilateral testicular nodules with increased vascularity and microlithiasis, raising suspicion for germ cell tumors.
  3. Treatment and Results: A bilateral orchiectomy with intraoperative biopsy was performed. Histopathology confirmed bilateral seminoma, stage I, with no metastasis. Follow-up tumor markers and imaging were normal.
  4. Discussion and Recommendations: Bilateral seminoma in pediatric patients is extremely rare, especially when synchronous. Cryptorchidism remains a key risk factor, emphasizing the need for long-term monitoring. Diagnosis relies on clinical exam, imaging, and biopsy. Treatment often involves orchiectomy, impacting hormonal and fertility functions. Given the rarity, a multidisciplinary approach is essential, including fertility preservation and hormonal follow-up. Early detection through ultrasound remains critical for high-risk patients.



18 year old male with bilateral testicular pain. #ultrasonography](https://app.figure1.com/case-detail/656449c5-cec8-4783-9b52-1f7c44c1055c)



Testicle (bivalved) from a 40 yo. Orange arrow is normal testicular parenchyma. Blue arrow is tumor (rhabdomyosarcoma) completely involving the epididymis.](https://app.figure1.com/case-detail/6668cd49-965b-4223-b5e2-341225820bfc)



Ultrasound images of the right testis show a nonseminomatous germ cell tumor (arrow) of the lower poly. Nonseminomatous germ cell tumors are the most common primary testicular malignancy and typically occur in men in the late second to the third decade of life. #TummyTuesday](https://app.figure1.com/case-detail/6af90e34-87ba-4a8d-b061-170270ad4270)