MR imaging of paratesticular bilateral leiomyoma: A case report

Abstract

Paratesticular leiomyoma is a rare benign neoplasm that may arise from smooth muscle cells contained in either the epididymis, the spermatic cord, or the tunica albuginea. Usually patients present a palpable, asymptomatic mass, with a higher prevalence among the fourth and fifth decade of life. In this case report we describe a 57-year-old man with bilateral scrotal palpable masses evaluated with ultrasound and magnetic resonance imaging that were suggestive for leiomyoma. The lesions were surgically removed and pathology revealed no signs of malignancy confirming the diagnostic hypothesis of leiomyoma. Ultrasound is considered the imaging modality of choice for the initial evaluation of testicular masses since it allows an accurate localization (ie testicular vs paratesticular) and can identify signs of malignancy. Magnetic resonance imaging is less frequently performed but can considerably improve lesion characterization.

Keywords: Diagnostics; Leiomyoma; MRI; Paratesticular; US.

Fig. 1

US demonstrates 2 highly heterogeneous paratesticular masses, measuring 45 mm on the right side (A) and 55 mm on the left side (B). These masses appeared round-shaped and with regular margins (C). The testicular US pattern did not show significant anomalies (D).

Fig. 2

Coronal (A) and axial (B-C) Turbo Spin Echo T2-weighted images; coronal (D) T1-weighted unenhanced and axial (E-F) T1-weighted postcontrast images. MR images show the presence in the scrotal sac of the 2 heterogeneous paratesticular masses, 1 for each side, noncapsulated with regular margins. The masses were hypontense on T2-weighted images, isointense on T1-weighted unenhanced images, and showed heterogeneous enhancement after contrast agent injection.

Fig. 3

Gross specimen of the lesion removed from left scrotum.