Multiparametric Ultrasound Diagnostic Approach to Malignancy-Mimicking Adenomatoid Tumors of the Scrotum: Is Strain Elastography Enough?

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2023-07, Vol.59 (7), p.1261
• Main Authors: Corvino, Antonio, Catalano, Orlando, Faggian, Guido, Delli Pizzi, Andrea, Tafuri, Domenico, Corvino, Fabio, Borzelli, Antonio, Picchi, Stefano Giusto, Lassandro, Giulia, Boccatonda, Andrea, Schips, Luigi, Cocco, Giulio
• Format: Article
• Language: English
• Subjects: adenomatoid tumor (AT); Cancer; Case Report; Fertility; multiparametric ultrasound (US); paratesticular tumor (PT); Patients; Prostate; scrotal imaging; strain elastography (SE); Surgery; Tumors; Ultrasonic imaging
• ISSN: 1648-9144; 1010-660X; 1648-9144
• DOI: 10.3390/medicina59071261

Paratesticular tumors (PTs) are very uncommon, accounting for almost 5% of intrascrotal tumors. Of these, adenomatoid tumors (ATs) represent about 30% and most frequently arise in the tail of the epididymis. Ultrasound (US) examination is the first-choice imaging method employed for the evaluation of the scrotum. Unfortunately, there are no specific US-imaging features useful for distinguishing an AT from a malignant lesion. To increase diagnostic accuracy and confidence, new sonographic techniques have incorporated real-time tissue elastography (RTE) under the assumption that malignant lesions are "harder" than benign lesions. : In our paper, we describe a very rare case of a 60-year-old patient with a giant paratesticular mass mimicking malignancy when examined using RTE, i.e., it was stiffer than the surrounding tissue (a hard pattern), which, upon histologic examination, was identified as an AT. : Our case underscores that there is also a significant overlap between different types of scrotal lesions when RTE is used for examination. Thus, if a PT is found, the imaging approach should always be supplemented with more definitive diagnostic methods, such as FNAC or FNAB, which are the only diagnostic methods capable of leading to a certain diagnosis. : Alongside underlining the importance of pre-operative imaging for making correct diagnoses and selecting the correct therapy, we wish to draw our readers' attention to this report in order to demonstrate the clinical implications of a giant AT presenting as stiff lesions when examined using SE.