Learning objectives
The purpose of this educational exhibit is to:
1- Review the embryological development of the male gonad and the adrenal gland;
2- Discussthe most common findings at US and MR imaging that can help to establish an accurate diagnosis;
3- Report our experience with testicular adrenal rests tumors in patients with congenital adrenal hyperplasia;
4- Discuss thedifferential diagnosis of a bilateral testicular lesion.
Background
Embriology
The adrenal glands and the gonads share a common embryological origin.
During the 5thand 6thweek of the embryologicaldevelopment,
mesodermal cells from the posterior abdominal wall,
located between the root of the mesentery and the urogenital ridge,
proliferate and give rise to the adrenalcortex primordium.
By the 7th week of embryological development,
neural crest cells from the sympathetic ganglion migrate towards the center of the adrenal cortex primordiumto form the adrenal medulla.
The gonads originated from the urogenital ridge.
At the beginning of the 5th...
Findings and procedure details
Testicular Adrenal Rests Tumors
Imaging plays an important role in the detection and surveillance of testicular adrenal rest tumors.
Ultrasound (US) is generally considered the first imaging modality for evaluation of TART.
Ultrasound
Ultrasound usully demonstrated hypoechogenic,
intratesticular masses,
usually with ill-defined borders and in most cases bilateral.
Typically these masses are located near the mediastinum testis.
(Fig 1)
Testicular adrenal rests tumor varies in size,
from millimeters to a few centimeters (commonly 3 to 40 mm),
however they usually dontcausearchitectural distortion of the surroundingtesticular...
Conclusion
Imaging plays an important role in the detection and surveillance of testicular adrenal rest tumors.
US and MR imaging features are characteristic in the context of elevated ACTH serum level.
Familiarity with the imaging appearance of the testicular adrenal rests tumors will help to establish an accurate diagnosis and avoid unnecessary invasive procedures.
References
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Testicular adrenal rests in a patient with congenital adrenal hyperplasia: US and MRI features. Computerized Medical...