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We report 2 cases of embryonal rhabdomyosarcoma, a rare malignant tumor, arising from the tunica dartos in the scrotum. Sonography revealed that each tumor had clear boundaries, a complete capsule, abundant blood flow, and an internal hypoechoic signal. Patients with embryonal rhabdomyosarcoma who have suspected lymph node metastases or distant metastatic lesions should undergo computed tomography. Our 2 cases were confirmed by subsequent histopathologic diagnosis and immunohistochemical staining with desmin and myogenin. The 2 patients were treated surgically with radical excisions and chemotherapy but without radiotherapy. To our knowledge, no cases of embryonal rhabdomyosarcoma originating from the scrotal tunica dartos have previously been reported in the medical literature.

Cystic lymphangioma is a common benign tumor caused by lymphatic malformation. The scrotum is a very rare site for this tumor and only few cases have been reported in the literature. We herewith present a rare case of cystic lymphangioma of the scrotum in an ado-lescent who presented with an incidental scrotal swelling with no other abnormality, where the diagnosis was suspected on scrotal ultrasonography.

Introduction: Paratesticular tumors are rare. Most of them are benign, and adenomatoid tumors are most common. These tumors sometimes infiltrate the testicular parenchyma and require differential diagnosis with malignant tumors. In such cases, intraoperative biopsy allows for performing conservative surgery., Materials and Methods: A retrospective study of nine patients with paratesticular adenomatoid tumors seen during a nine-year period (2000-2008) is reported., Results and Conclusions: Patient age (mean, 49.6 years) and most common initial signs (tender nodule) are reported. The tumor most commonly occurred as a small, usually oval, nodule in the tail of epididymis. Our series included a case each of intraparenchymal tumor of the testis and tumor of the tunica vaginalis. Diagnosis was initially made based on a ultrasound scan and subsequently confirmed by histology. Differential diagnosis and surgical treatment, performed in all patients, are reported, and also the pathological features of surgical specimens.

Perineal lipoma is a rare condition which is commonly associated with scrotal anomalies and may be diagnosed as ambiguous genitalia. We report on a baby with penoscrotal transposition (PST) consisting of bifid scrotum and hypospadias with chordee associated with perineal lipoma. The affected baby was one twin of an IVF pregnancy referred to our center for ambiguous genitalia by fetal ultrasound. Examination of the uterus revealed a dichorionic, diamniotic twin pregnancy. Fetal ultrasound and MRI in our center revealed an exophytic perineal mass, which likely represented a lipoma, separate from the abnormally appearing phallus and scrotum (hypospadias with chordee and a bifid scrotum). This likely fell into the PST spectrum. There were no additional abnormalities in the other structures and no structural abnormality of co-twin was detected. Fetal growth of both twins was appropriate for gestational age. Babies were born at term and the findings of the affected twin correlated with the fetal diagnoses. While some reports show PSTs are associated with multiple anomalies, in this case no additional anomalies were identified. Perineal lipomas are commonly associated with scrotal abnormalities and anorectal malformations. It is hypothesized that these anomalies develop because of the perineal lipoma. MRI combined with ultrasound clearly defined the anomaly prenatally and allowed for accurate prenatal counseling and coordination of postnatal care., (Copyright 2010 S. Karger AG, Basel.)

Sonography is the imaging modality of choice for the scrotum because it is simple, relatively inexpensive, and quick. Recent technological advances and transducer improvements have led to exquisite high-resolution detail in gray-scale as well as Doppler imaging. The purposes of this pictorial essay are to review the anatomy and embryology of the scrotal contents and to review the various scrotal and extrascrotal pathologic conditions, including acute scrotum, pediatric and adult testicular and extratesticular scrotal neoplasms, traumatic lesions, and miscellaneous other scrotal lesions., ((c) 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2010.)

We report the sonographic findings in a case of lymphoma, which mimicked chronic inflammation. Scrotal gray-scale sonography revealed an irregularly margined, hypoechoic mass in the right testis and epididymis. Color Doppler sonography showed increased blood flow within the hypoechoic lesions in both testis and epididymis. Pathologic examination revealed a diffuse involvement of the testis and epididymis.

The patient was a 34-year-old man presenting with the right intra-scrotal painless mass. With a diagnosis of right intrascrotal tumor, the patient underwent right high orchiectomy. The pathological diagnosis of pleomorphic rhabdomyosarcoma arisen from the right spermatic cord was made. Computed tomography revealed a single metastasis in the para-vena cava lymph node. Systemic chemotherapy with vincristine, actinomycin D, plus cyclophosphamide (VAC therapy), and etoposide plus cisplatin (EP therapy) were made according to Intergroup Rhabdomyosarcoma Study (IRS)-IV Regimen 45. But the chemotherapy was ineffective and a retoroperitoneal lymphadenectomy (RPLND) was therefore performed. After 3 months following RPLND, the tumor relapsed in a pelvic lymph node involved in right ureter and ileocaecal valve. Resection of the tumor with ileocaecum was performed and then intraoperative radiotherapy (15 Gy) against the tumor bed was performed to ensure the curative effects. After his recovery, he received a total of 6 courses of systemic chemotherapy consisting of vincristin, ifosphamide, etoposide (IRS-IV Regimen 47). The patient was rigorously followed up for 42 months after the final chemotherapy, with no tumor recurrence.

Severe forms of male-factor infertility are associated with an increased risk of testicular cancer and scrotal ultrasonography is widely used for diagnosis. In this study, 2172 male members of infertile couples referred to our Reproductive Medicine Unit were submitted to scrotal ultrasonography and 835 selected patients had been followed during a 2-year period. Eight out of nine neoplastic nodules found at the initial examination were unpalpable and discovered by ultrasonography. Ten tumoral lesions were found in 370 testicular biopsies performed for diagnostic purposes or to extract spermatozoa; and eight additional neoplastic lesions were discovered during the 2-year follow-up of 835 patients. The cumulative rate of neoplastic disease was 3.2%. Thirteen cases (1.5%) were malignant (12 germ cell tumours and one non-Hodgkin lymphoma of testicular origin); the remaining 14 were benign forms (Leydig cell tumours and hyperplasias, Sertoli cell nodules, adenomatoid tumours). Testicular volume (cut-off: 12ml) resulted weakly correlated with germ cell cancer (p=n.s., odds ratio 2.01) while low total sperm count (<40x10(6)) (p=0.002, odds ratio 8.4), previous cryptorchidism (p=0.04, odds ratio 7.5) and hypergonadotrophic hypogonadism (p=0.04, odds ratio 7.9) were associated with an increased risk. But a stronger correlation with germ cell cancer was found in the patients with some utrasonographic anomalies, i.e. testicular microlithiasis (p=0.0015, odds ratio 37.1) or larger calcifications not fitting the description of testicular microlithiasis (p<0.0001, odds ratio 69.5). Our findings indicate that scrotum ultrasonography should always be advised in subfertile men with <40x10(6) spermatozoa/ejaculate or hypergonadotrophic hypogonadism or previous cryptorchidism, and that particular care should be taken in the presence of testicular microlithiasis or testicular calcifications. These men should be aware of the existence of higher risk of testicular cancer and trained in testicular self-examination.

Ultrasound is a routine investigation for the assessment of scrotal masses. Many of the detected lesions involve the paratesticular structures. The most common paratesticular masses in clinical practice are epididymal cysts and spermatoceles, but there are a large number of other pathologies that can be encountered and may result in diagnostic uncertainty. This review covers a wide range of the common and the rare, but important, causes of paratesticular masses. The ultrasound findings (both typical and atypical) of these lesions are clarified, and emphasis is given to the features that help to differentiate between them.

We present a case of scrotal lymphangioma in a 25-year-old man. The patient presented with scrotal swelling and an ultrasound scan demonstrating a complex extratesticular cystic mass around the left spermatic cord. He underwent excision of the mass, followed by orchiectomy for recurrence. This case was interesting for several reasons. First, scrotal lymphangioma, although very rare, is usually seen in infants and children. Second, for a symptomatic extratesticular cystic mass, surgery might be warranted. Finally, although primary excision is the treatment of choice in the younger individual, the same might not be true for the rare adult with this disease.

Carcinoma in vesical diverticula is a rare clinical entity and rarer still is the herniation of the vesical diverticulum into the scrotal sac. Carcinoma arising within a vesical diverticulum often represents a diagnostic as well as a therapeutic challenge, with overall poor outcome despite all available forms of treatment. Multidetector CT helps in the diagnosis and detailed evaluation of carcinoma arising from the vesical diverticulum by allowing excellent reconstructions in any desired plane. We report here a case of transitional cell carcinoma arising in a herniated vesical diverticulum with hepatic metastasis.

Background & Objective: It's difficult to distinguish peripheral primitive neuroectodermal tumor (PNET) from other small round cell tumors such as Ewing's sarcoma by histological examination. This study was to analyze the CT and MRI features of peripheral PNET., Methods: The CT and MRI records of 7 patients with pathologically proved peripheral PNET were reviewed., Results: The tumors were located in the left ala nasi, right lower jaw bone, left chest wall, right chest wall, left spermatic cord, paraspinal, and lumbar vertebral canal. The tumors in soft tissue showed resembled non-calcified, ill-defined soft tissue masses with cystic or necrotic areas on CT images, with heterogeneous enhancement on contrast images. The tumors in the bone showed lytic lesions with large soft tissue masses on CT images. The tumors in the paraspinal and vertebral canal showed well-defined soft tissue masses without involving cord and cauda equine on MRI, and showed isointensity or hypointensity on T1WI and isointensity or hyperintensity on T2WI., Conclusions: The imaging features of peripheral PNET are non-specific. CT and MRI are useful in delineating the extent, finding distant metastasis, predicting respectability and monitoring treatment of peripheral PNET.

Sarcomas are rare and account for approximately 1% of all malignancies. The subtype angiosarcoma is derived from vascular and lymphatic tissue and generally has a poor prognosis. Prior radiation therapy is a known risk factor for the development of angiosarcomas. We present what we believe to be the first case of an angiosarcoma arising in the epididymis in an 80-year-old man who presented with right scrotal swelling.

A 4.5-cm elastic, non-dolent mass in the left spermatic cord was diagnosed in a 57-year-old man and totally excised by a scrotal access. Histologically a cellular angiofibroma was diagnosed. These benign tumours are very rare. In women the most common sites are the vulvovaginal, in men the inguinoscrotal region.

Objective: To evaluate the differential diagnosis of scrotal mass with color Doppler ultrasound., Methods: Retrospective analysis was made of 21 cases of scrotal mass confirmed both surgically and pathologically in our hospital., Results: Eight of the total number were malignancy of the testis origin, accounting for 38.1% of whole study group and 13 were benign, accounting for 61.9%. Of the 13 benign cases, only 2 were of the testis origin (15.4%) while the other 11 (84.6%) were not., Conclusion: Color Doppler ultrasound plays an increasingly important role in the differential diagnosis of scrotal mass.

Objective: To elevate the diagnosis and differential diagnosis levels of epididymal mass by sonography., Methods: This was a retrospective study of 179 cases of epididymal mass treated by surgery in our hospital between 1990 and 2005. The analysis was focused on pathological and sonographic features., Results: 179 patients with mean age of 51.4 +/- 14.7 were enrolled. The epididymal mass was classified into four groups: epididymal cyst (n = 98), nonspecific epididymitis (n = 27), tuberculous epididymitis (n = 33) , and epididymal tumor (n = 21). Epididymal cyst could be easily diagnosed by ultrasound, the diagnostic rate was 93.8%, but nonspecific epididymitis and tuberculous epididymitis were hard to differentiate, complicating with multiple organs lesions may distinguish tuberculous from nonspecific epididymitis. Tuberculous epididymitis could be easily diagnosed when cold abscess, calcification and sinus tract emerged. The majority epididymal tumors were benign, and malignant cases were rarely seen. Patient's history, physical examination and sonographic features were all essential to make a right diagnosis., Conclusion: Ultrasound features may be helpful to the differential diagnosis of epididymal mass and ultrasound should be the first choice of image detection in epididymal lesions.

Background: 18F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is a functional and metabolic imaging modality that is efficacious in nodal staging and detection of extranodal involvement for malignant tumors., Objective: We describe the novel use of PET for staging patients with invasive extramammary Paget's disease (EMPD) and discuss the potential advantages of this technology relative to other diagnostic modalities., Methods: We evaluated three patients with invasive EMPD whose staging was made by PET at Hokkaido University Hospital., Results: All lymph nodes detected by PET were over 10 mm. Distant internal metastases were not seen in all cases. PET failed to detect 10 and 5 to 7 mm nodal involvement but succeeded in detecting nodes over 10 mm., Conclusions: These data suggest that PET may be useful in determining disease activity at the time of initial diagnosis but is less useful and proves difficult to detect a small or subclinical involvement. This is the first report of PET being used for invasive EMPD.

Whole body 18 F-fluorodeoxyglucose (FDG) positron emission tomography was performed for staging in 7 extramammary Paget's disease patients and 4 tests showed mild FDG uptake at the primary sites. Histologically, all 4 tumors were found to be thicker than 2 cm. Among the 4 patients, 2 showed multiple hypermetabolic foci of skeletal metastasis and lymph node involvement.

Diagnostic imaging has played a major role in the evaluation of patients with the cancers of the reproductive tract. The imaging modalities have included ultrasonography, computed tomography, magnetic resonance imaging, hysterosalpingography, and scintigraphy with radiolabeled monoclonal antibodies. Positron emission tomography (PET) with [F-18]fluorodeoxyglucose also has been shown to be useful in the imaging evaluation of these patients. Clinical applications have included initial staging and posttherapy restaging of disease, detecting metastatic disease, differentiating posttherapy anatomic alterations from recurrent or residual disease, and predicting and evaluating treatment response. In this article, we review the diagnostic utility of dedicated PET and combined PET-computed tomography systems in the imaging assessment of reproductive tract malignancies (excluding prostate cancer) in both sexes with an emphasis on fluorodeoxyglucose applications.

A 40-year-old man presented with a 1-month history of a large, painless, rapidly growing right scrotal mass. Examination, ultrasonography, and intraoperative inspection did not exclude an intratesticular tumor, and a radical orchiectomy was performed. Histology was typical for adenomatoid tumor, but gross and microscopic inspection revealed bundles of tumor extending from the tunica albuginea into the testicular parenchyma. In this case the rapid growth, large size, and the inability to exclude an intratesticular origin directed suspicion toward a malignant neoplasm. In hindsight, the tumor's unique pattern of extension into the adjacent testicular parenchyma confounded the preoperative diagnosis.

Rhabdomyosarcoma is the most common tumour of the lower genitourinary tract in children in the first two decades. Paratesticular rhabdomyosarcoma is associated with a significantly better outcome than lesions elsewhere in the genitourinary tract. Although ultrasound is considered the imaging modality of choice for evaluating intrascrotal pathology, the ultrasound appearance of paratesticular rhabdomyosarcoma has rarely been reported and may be confused with other disease entities such as epididymitis, adenomatoid tumour and leiomyoma. We present the ultrasound features of a paratesticular rhabdomyosarcoma, discussing the clinical features and differential diagnosis.

Ganglioneuroma is a rare benign tumor, usually seen in children and young adults, arising in the central nervous system. Most of the noncranial ganglioneuromas are located in the posterior mediastinum and the retroperitoneum. We report the first case of a primary, adult paratesticular ganglioneuroma that presented as a paratesticular mass. The patient underwent surgical intervention for diagnostic and therapeutic purposes.

Sarcomas of the seminal vesicle are very rare and poorly documented; as it is not always possible to pinpoint a truly vesicular origin of the pelvic mass due to local spread at the time of presentation. The purpose of the article is to document and characterize a rhabdomyosarcoma of the seminal vesicle of which to the knowledge of the authors there has been no previous report in the English literature.

Extratesticular neoplasms are rare but clinically significant lesions that affect patients of all ages. These neoplasms are generally asymptomatic but may have potentially life-threatening sequelae. Lipoma is the most common primary benign paratesticular neoplasm and the most common tumor of the spermatic cord. Adenomatoid tumor is the most common tumor of the epididymis, followed by leiomyoma. In adult patients, it is imperative to consider sarcomas in the differential diagnosis of all solid tumors of the scrotum. The most common sarcomatous tumors in pediatric patients are embryonal sarcoma and rhabdomyosarcoma. Metastases, particularly from testicular, prostatic, renal, and gastrointestinal primary malignancies, can also occur. Mimics of paratesticular neoplasms including polyorchidism and splenogonadal fusion are rare but must also be considered for optimal management. Ultrasonography (US) is currently the imaging modality of choice. However, US findings are often variable and nonspecific and do not usually allow definitive characterization. Specific computed tomographic and magnetic resonance imaging findings with respect to tumor location, morphologic features, and tissue characteristics can aid in the evaluation of paratesticular neoplasms and help narrow the differential diagnosis., (Copyright RSNA, 2003)

Purpose: To report a case of spermatic cord leiomyosarcoma metastatic to the orbit., Design: Case report., Methods: A 78-year-old man presented with progressive redness, proptosis, and decreasing vision of the left eye of 3 weeks' duration. Computed tomography revealed an intraconal mass (1.5 x 2 cm) inferior to and displacing the left optic nerve., Results: A left lateral orbitotomy was performed, and a well-demarcated mass was removed from the surrounding tissue. A follow-up computed tomography of the chest and abdomen was consistent with metastatic disease to the lungs and liver., Conclusions: Spermatic cord leiomyosarcoma is a rare cause of metastatic lesions to the orbit.

Pathological processes of the scrotum are very numerous. They are composed by few common well known diseases and a large spectrum of rare lesions. The testis may be involved by some systemic diseases. Ultrasound is the main modality for scrotal imaging and complementary to clinical evaluation. When a tumoral process is suspected, surgery is required to confirm the diagnosis and provide histology. The role of MR remains under evaluation.

A 54-year-old male was referred to our hospital with the chief complaint of a painless inguinal mass. A hard mass was palpable beside the left spermatic cord, which was covered with a soft tissue mass. Computed tomographic scan showed an inguinal mass, which was well enhanced to vascular density. The operative appearance indicated a tumor in the left spermatic cord, so we performed a radical orchiectomy. Histopathological diagnosis was lipoleiomyosarcoma. Lipoleiomyosarcoma of the spermatic cord is quite rare, and our case was considered as the first report in Japan.

Ultrasonography (US) with a high-frequency (7.5-10-MHz) transducer has become the imaging modality of choice for examination of the scrotum. US examination can provide information valuable for the differential diagnosis of a variety of disease processes involving the scrotum that have similar clinical manifestations (eg, pain, swelling, or presence of mass). The pathologic condition that may be at the origin of such symptoms can vary from testicular torsion to infection to malignancy. The ability of color and power Doppler US to demonstrate testicular perfusion aids in reaching a specific diagnosis in patients with acute scrotal pain. This review covers the anatomy of the scrotum and the scanning protocol for scrotal US, as well as detailed descriptions of disease processes and their US appearances. Newly described conditions such as intratesticular varicoceles and other benign intratesticular cystic lesions are also discussed.

It is discussed a dermoid cyst case that depends on paratesticular structures, clinical entity which has low frequency of presentation. It is analyzed the controversial terminology of this tumours and are established anatomopathological criteria for this disease.

Leiomyosarcoma of the seminal vesicle is exceedingly rare. The ultrasound and CT findings in a recent case are described. These consist of a mass causing enlargement of the right seminal vesicle with involvement of the urinary bladder and prostate. The prostate gland was displaced inferiorly and to the left. Surgical resection and subsequent histology confirmed the diagnosis. The role of imaging in retrovesical masses is also discussed.

Malignant tumors of the small bowel are usually associated with digestive and general symptoms. We report the case of a 26-year-old patient who presented with right lumbar pain and right testicular pain. Final diagnosis was lymphoma of the terminal ileum involving the right pelvic ureter and the right vas deferens. We discuss frequency and mechanisms of this very unusual extension of malignant small bowel tumors.

The extratesticular scrotal contents consist of the epididymis, spermatic cord, and fascia derived from the embryologic descent of the testis through the abdominal wall. As opposed to intratesticular masses, most extratesticular masses are benign. Cystic masses (including hydroceles, epididymal cysts, and varicoceles) are easily diagnosed with ultrasonography (US) and are benign. Epididymitis is a common extratesticular lesion as well as the most frequent cause of an acute scrotum. It may be either acute or chronic and can be potentially complicated by epididymo-orchitis or scrotal abscess. Findings include epididymal enlargement, skin thickening, hydroceles, and hyperemia. The epididymis can also be affected by sarcoidosis, a noninfectious granulomatous disorder. The most common extratesticular neoplasms are lipomas (most often arising from the spermatic cord) and adenomatoid tumors (most often found in the epididymis). Despite their relative rarity, malignant neoplasms do occur and include rhabdomyosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, mesothelioma, and lymphoma. These tumors are often large at the time of presentation. The US findings of solid masses are often nonspecific. Magnetic resonance imaging can be very helpful in the evaluation of some of these disorders, allowing for a more specific diagnosis in cases of lipoma, fibrous pseudotumor, and polyorchidism., (Copyright RSNA, 2003.)

Retroperitoneal lymphangioma is extremely rare. It may obstruct or invade surrounding vital organs, which may result in lethal effects to the host. Although surgical excision has been suggested as the first choice for treatment, complete extirpation is often impossible. Moreover, the rates of postoperative morbidity and disease recurrence remain high. We report a case of a huge retroperitoneal lymphangioma extending to the flank and scrotum that was successfully treated by intralesional OK-432 sclerotherapy without any serious complications.

The patient was a boy two years and six months old. He was brought to our University Hospital with the chief complaint of scrotal mass for two years. On palpation, the mass was discriminated from the testis, epididymis and spermatic cord. The mass was followed by ultrasonography and we found two masses at the age of two years and six months. The tumors were surgically resected and they were 0.5 x 0.5 x 0.5 cm, 1.5 x 1.0 x 0.5 cm in size, respectively. Histopathological examination revealed venous and capillary hemangioma. We discuss this case, and review the literature.

Cystic lymphangioma is a congenital lymphatic malformation that is a rare cause of extratesticular scrotal masses in children; it is frequently misdiagnosed preoperatively. Complete excision is curative, but recurrence may result from incomplete excision. We report a case of cystic lymphangioma of the scrotum in a 3-year-old boy, which had been previously diagnosed as a hydrocele. Gray-scale sonography showed a multicystic extratesticular lesion; color Doppler sonography further characterized the lesion by showing blood flow within the septa. CT scanning ruled out extrascrotal involvement. The cystic mass was surgically resected. The appearance of the lesion both macroscopically and microscopically was consistent with a diagnosis of cystic lymphangioma. The child recovered uneventfully and was discharged on the third day after surgery; no evidence of recurrence was found in 6 months of follow-up. In such cases of scrotal masses in children, gray-scale and color Doppler sonography, followed by CT or MRI, are useful in diagnosing cystic lymphangioma, differentiating it from other lesions, and defining its extent, thus allowing proper surgical planning., (Copyright 2002 Wiley Periodicals, Inc.)

Scintigraphic techniques have contributed to many aspects of our understanding of genital and reproductive physiology and pathophysiology. Few of these methods have become mainstream diagnostic techniques; nonetheless, their flexible, physiologic, and intrinsically quantitative nature have contributed information and insights not readily available by other means. The techniques discussed in this review measure various dynamic processes within the body, including blood flow, variation of blood volume, and lymphatic and fallopian tube transport. Dynamic measurement of these processes exploits nuclear medicine's ability to radiolabel and monitor substances while preserving normal physiologic behavior. Consideration of these methods will potentially stimulate future development and application of radionuclide techniques to emerging questions in the fields of reproductive and genital physiology.

A 79-year-old man presented with a history of nocturia. On rectal examination a solid mass above the prostate gland was discovered. Computerized tomography (CT) and ultrasound (US) showed that the mass was solid and was arising from the seminal vesicle. After a needle biopsy, pathology and immunocytochemistry confirmed the mass to be Schwannoma. Tumors of the seminal vesicle are rare. To our knowledge Schwannoma of the seminal vesicle has not been described before.

Background: This study aimed to evaluate the utility of ultrasound in the diagnosis of inguinal hernias and obscure groin pain., Methods: A series of 65 consecutive groin explorations performed subsequently to percutaneous ultrasound examination were prospectively evaluated. Patients were examined in an office setting. The examination included a history and a physical. Then an ultrasound of the inguinal region was performed. Ultrasound was performed by the staff surgeon and fellows. Patients then were taken to surgery for either a laparoscopic or open hernia repair. The preoperative and operative findings were compared to determine the utility of groin ultrasound., Results: A series of 41 patients presenting with symptoms of groin pain or palpable groin bulge were evaluated with ultrasound of the groin. Of these patients, 24 went on to have bilateral repairs, bringing the study total to 65 groins. Surgery involved 50 laparoscopic and 15 open hernia repairs. This included 20 groins without hernia, as determined by physical examination, and 45 groins with a palpable hernia. Overall, ultrasound was used to identify the type of hernia correctly (direct vs indirect) with 85% success. In the 20 patients who had no palpable bulge, ultrasound identified a protrusion (hernia or lipoma) in 17. Two of these were false positives, and the three negative ultrasound examinations were false negatives. Thus ultrasound identified the pathology in a groin without a palpable bulge at an accuracy of 75%. The overall accuracy in finding a hernia of any kind by ultrasound was 92%., Conclusion: Ultrasound is a useful adjunct in evaluating the groin for hernia, and can be performed by surgeons.

Objective: To review the ultrasonographic technique, anatomy, and pathologic entities found in the scrotum during evaluation of scrotal masses, acute scrotal pain, and male infertility., Method: A pictorial review of cases with diagrams of pertinent anatomic features and findings is presented., Results: Ultrasonography in conjunction with color and pulsed Doppler imaging has supplanted other imaging modalities in the evaluation of scrotal diseases and disorders. Ultrasonography is valuable in the evaluation of the acutely painful scrotum in addition to scrotal masses and male infertility. Advances in ultrasonographic spatial and low-contrast resolution have improved our ability to more clearly define diagnoses for the referring urologist and have led to new observations that are currently being investigated and have yet to be fully understood. Microlithiasis and the mottled appearance of seminiferous tubule sclerosis and atrophy are 2 such entities. This article reviews the pertinent normal scrotal anatomy and the use of ultrasonography in the evaluation and classification of acute scrotal pain, scrotal masses, male infertility, and trauma. This review article also discusses pitfalls of color Doppler imaging in assessment of the scrotum and how to avoid them., Conclusion: The use of ultrasonography in the evaluation of the scrotum benefits from an understanding of scrotal anatomy and familiarity with potential pitfalls of color Doppler and pulsed Doppler evaluation.

Aggressive angiomyxoma (AAM) is a rare, locally infiltrative tumor that occurs almost exclusively in the pelvic and perineal regions of women of childbearing age. We report the unusual case of a 26-year-old man with an AAM presenting as a slowly enlarging scrotal mass. Gray-scale scrotal sonography demonstrated a well-demarcated, hypoechoic, extratesticular, extraepididymal mass with multiple thin, echogenic internal septa. The mass arose inferior to the left testicle and displaced the testicle cephalad. Color Doppler sonography revealed surrounding vascularity but no Doppler signals within the mass. The testicles and epididymides demonstrated normal echogenicity and vascularity. Histologic examination of the excised mass revealed a well-demarcated, nonencapsulated lesion composed of spindle-shaped cells in a myxoid background with a prominent vascular component., (Copyright 2001 John Wiley & Sons, Inc.)

Purpose: To treat patients with prostate cancer and seminal vesicle invasion with monotherapeutic three dimensional computed tomography (3-DCT)-guided posterior pararectal brachytherapy., Methods and Materials: Three hundred and sixty two patients with clinical stage T1 a,b or T2 a,b of prostate cancer were referred for 3-DCT-guided brachytherapy. Each underwent ftirther staging with 3-D CT-guided pararectal biopsy of the seminal vesicles under local anesthesia during the pre-treatment CT-planning. Forty-three patients (12%) were upstaged to T3 cNoMo disease. In the set of 43 patients, Eight had Gleason's score< or =6, 24 Gleason's score=7, and 11 patients > or =8. Initial PSA was <10 ng/ml in 14 patients, 10-20 ng/ml in 11 patients, and >20 in 18 patients. Of the 43 patients, 37 patients were treated monotherapeutically with 3-D CT-guided brachytherapy. No patients received hormone therapy after the implant. The prescribed dosage to the seminal vesicles and prostate is 120 Gy with Pd-103 seeds and 144 Gy with 1-125 seeds., Results: The prescribed dosage was achieved in all 37 patient's throughout the seminal vesicles whose range of target radiation extended 5-10 mm outside the target in the adjacent fat as calculated with post-implant CT-dosimetry with Varian Brachy Vision or MMS software. Prostate Specific Antigen (PSA) outcome data were available in 34 patients treated with monotherapy and follow up ranged from 12-56 months (median, 24 months). Decreased PSA levels were stratified into six groups based on the presenting Gleason's score and initial PSA. In the first group (with Gleason's score< or =6 and initial PSA <20 ng/ml), PSA levels decreased to less than 0.5 ng/ml in all seven patients (100%) after brachytherapy. In the second group (with Gleason's=7 and initial PSA<20 ng/ml), PSA levels decreased to less than 1 ng/ml in 11 of 13 patients (85%); additionally PSA levels decreased to less than 0.5 ng/ml in ten patients (77% in this group). In the third group (with Gleason's score=7 and initial PSA> 20 ng/ml), PSA decreased to less than 0.5 ng/ml in four out of eight patients (50%). All of the patients in the fourth group (with Gleason's score> or =8 and initial PSA<20 ng/ml) decreased their PSA levels to less than 0.5 ng/ml in three of three patients. PSA decreased less than 0.5 ng/ml in two out of three patients (67% in the last group with Gleason's score> or =8 and initial PSA> 20 ng/ml). There were no patients with Gleason's score of 1-6 and greater than 20 ng/ml initial PSA. Patients, irrespective of the Gleason's score and PSA, had an overall response of decreased PSA (less than 1 ng/ml) of 79%., Conclusion: 3-D CT-guided brachytherapy delivers adequate dosage to the seminal vesicles. Clinical and biochemical results are encouraging in patients with low initial PSA levels regardless of their Gleason's scores, but longer-term data in a greater number of patients is necessary.