Genitourinary Radiology > Male Pelvis > Testis > Seminoma


Seminomas are the most common malignancy of males age 15-30, usually presenting as a painless scrotal mass. Risk factors include cryptorchidism, maternal diethylstilbestrol use, and testicular atrophy. Germ cell tumors comprise 95% of testicular cancer, 40% of these are seminomas, and 40% showed mixed histologic pattern. This page will consider seminomas only.

Ultrasonography demonstrates areas of uniformly decreased echogenicity, usually focal but may be diffuse and may cause bulging of the tunica albuginea.

Staging is performed by computed tomography:

    I—tumor confined to testis
    II—extratesticular spread:
      A. minimal nodal metastases, limited to infradiaphragmatic stations
      B. bulky retroperitoneal nodal metastases
    III—lymphatic involvement above diagphragm
    IV—extranodal metastases (pulmonary, hepatic, osseous, CNS)

Gray scale ultrasound image of both testicles shows a markedly abnormal hypoechoic left testicle when compared with the right. There are bilateral small hydroceles (h). Left sided orchiectomy was performed in this patient with seminoma.

Color flow ultrasound imaging in patient with painless scrotal swelling shows multifocal testicular masses in one testicle. There is slightly increased flow.

In another patient, gray scale ultrasound image shows multiple masses in association with testicular microlithiasis (arrows).

Gray scale ultrasound image shows multiple bulky masses (M) distending this testicle.

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