testicular ultrasound

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

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

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

“Winston”

7 year old male Mastiff Presented for enlarged prostate Ultrasound findings included prostatomegaly

and a small left testicular nodule

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

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

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

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)

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

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

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??

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)

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)

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