Correct answer is: Leukemia

Image Findings:

The examination revealed an enlarged, heterogeneous right testicle, with a normal epididymis. Also, a small homogenous fluid collection, corresponding to a hydrocele was seen (Figure 1 and 2). The color Doppler study showed a pattern of hypervascularity.

Discussion

Leukemia is a cancer of the body’s blood-forming tissues, such as the bone marrow and the lymphatic system. Leukemia can affect adults and children. In acute lymphocytic leukemia, the brain and the spinal cord and the testes in boys are known as sanctuary sites of cancer. Sanctuary sites are extramedullary anatomic locations that have historically been difficult to penetrate with systemic chemotherapy. In the testes, the finding of an enlarged firm testicle and hyperactivity on color Doppler similar to inflammatory findings, should remind the physician of leukemia of the testis.

Teaching Points

Although an enlarged testicle due to leukemia is a rare ultrasound finding, it is important to remember this diagnosis when dealing with a patient with a previous history of leukemia. The differential diagnoses include inflammatory diseases, but the clinical finding of a painless testicle is very important, as this indicates leukemia more than inflammation.

References

1. https://radiopaedia.org/articles/leukaemia-testicular-manifestations-1?lang=us
2. Kocakroc E, Bhatt S, Dogra V S; Ultrasound Evaluation of Testicular neoplasms. Ultrasound Clinics (2), 27-44, 2007.
3. Dogra V, Gottlieb RH, Oka M et al. Sonography of scrotum. Radiology, 227:18-36, 2003.
4. Hortsman WG, Melson GL, Middleton WD et al. Testicular tumors: findings with color Doppler US. Radiology, 185: 733 -37, 1992.