Epididymal masses: impact of sonographic diagnosis on management

ABSTRACT

The aim of this work is reported the experience of using the scrotal ultrasound [USS] and color doppler flow studies [CDS] in the evaluation of epididymal masses For that, sixty three cases of epididymal masses were studied. Their ages ranged from 10 to 78 years with mean age of 35.5 years. The evaluations were included history taking, clinical examination routine laboratory investigations and USS with CDS. Clinical presentation included painless scrotal mass [34 cases] and scrotal pain [15 cases], while the masses were detected incidentally in [14 cases]. In 5 cases, serum levels of a-fetoprotein, beta-human chorionic gonadotropin [HCG], FSH, LH, estradiol, prolactin and testosterone were measured. On USS, 58 [92.1%] masses were within the epididymis, and 5 [7.9%] cases were indeterminate On USS the epididymal masses localized as following 35 [55.6%] were located in the head of the epididymis, 15 [23.8%] in the tail and in 8 [12.7%] cases the masses were occupied the whole epididymis Sonographic echogenicity ranged from hypoechoic to hyperechoic relative to that of the testis. Forty-nine [77.8%] masses were cystic and anechoic and 14[22.2] were solid [5 hypoechoic, 3 hyperechoic and 6 had mixed echogenicity] The longest diameter of the masses ranged from 5.5 to 85 mm [mean, 32.5 mm] as measured by USS. In 44 [69.8%] cases there were associated hydrocele. CDS revealed increased vascularity of the lesions in 10[15.9%] cases and decreased vascula.rity in 4 [6.3%] cases while the 49[77.8%] cystic masses were avascular. Surgery was required in 18 [28.6%] cases. Pathological evaluation of the 18 specimens revealed 17 benign masses and one malignant lesion [rhabdomyosarcoma] Benign lesions consisted of 7 cysts, 6 benign inflammatory nodule [4 had fibrous pseudotumors and 2 had tubercubus epididymitis] 3 adenomatoid tumors and one fibroma. The USS is valuable in localization of epididymal masses and in differentiation between cystic and solid masses but even with CDS could not differentiate inflammatory from neoplastic solid lesions