008Te Infarcted Seminoma

26-year-old male presents with left testicular pain.
26-year-old male presents with left testicular pain. US in the transverse plane through both testes shows a focal mass in the left testis, hypoechoic and mildly heterogeneous in the central matrix, with a relatively hyperechoic rim.
Ashley Davidoff MD 133542
US in the sagittal plane through both testes shows a focal mass in the left testis, hypoechoic and mildly heterogeneous in the central matrix, with a relatively hyperechoic rim.
Ashley Davidoff MD 133544
Doppler US in the sagittal plane through the left testis shows absent vascularity in the lesion in the center of the testis with hypervascularity surrounding the mass. Differential diagnosis at this stage is a necrotic tumor and an abscess.
Ashley Davidoff MD 133545
MRI
Axial T1 weighted sequence through the left testis shows the mass in the center of the left testis with a rim that is slightly greater than the surrounding rim
Ashley Davidoff MD 133608
Coronal T1 weighted sequence through the left testis shows the mass in the center of the left testis with a rim that is slightly greater in intensity than the surrounding rim
Ashley Davidoff MD 133615

 

Axial T1 with fat saturation sequence through the left testis shows the mass in the center of the left testis with lower intensity center and minimally hyperintense rim
Ashley Davidoff MD 133626
T2 weighted sequence in the sagittal plane through the left testis shows the mass in the center of the left testis with a high intensity central matrix and a rim that is significantly less intense, and then surrounded by normal intensity testis
Ashley Davidoff MD 133632
STIR sequence in the axial plane through the left testis shows the mass in the center of the left testis with a high intensity central matrix and a rim that is significantly less intense, and then surrounded by normal intensity testis
Ashley Davidoff MD 133590
STIR sequence in the coronal plane through the left testis shows the mass in the center of the left testis with a high intensity central matrix and a rim that is significantly less intense, and then surrounded by normal intensity testis
Ashley Davidoff MD 133598
T1 FS post gadolinium weighted sequence in the axial plane through the left testis shows the mass in the center of the left testis with absent perfusion in the central matrix and hyperintense enhancement of the rim of the mass
Ashley Davidoff MD 133574
Post gadolinium subtraction sequence in the coronal plane through the left testis shows the mass in the center of the left testis with absent perfusion in the central matrix and hyperintense enhancement of the rim of the mass
Ashley Davidoff MD 133562

These findings continue to have a narrow differential diagnosis of infarcted necrotic tumor and an abscess

PATHOLOGY

Pathology revealed a totally infarcted seminoma surrounded extensive palisading histiocytic inflammation.  No viable tumor was identified.