E1409. Masses of the Spermatic Cord
  1. Douglas Pierce; Medical College of Wisconsin Affiliated Hospitals
  2. Stacy O'Connor; Medical College of Wisconsin Affiliated Hospitals
  3. Adam Zorn; Medical College of Wisconsin Affiliated Hospitals
Spermatic cord masses comprise an uncommon group of pathologies which may arise from both neoplastic and non-neoplastic processes. The body of relevant published case reports and primary literature is growing; however, due simply to the rarity of their incidence some radiologists may only encounter a few true spermatic cord masses during the span of their careers. Therefore, the purpose of this educational exhibit is to provide an overview of these important and occasionally overlooked lesions via an interactive, self-directed "multiple-choice quiz" format.

Educational Goals / Teaching Points
By the end of this exhibit, the reader should be able to list important non-neoplastic, benign, and malignant masses that may arise from the spermatic cord. Additionally, the reader should be better prepared to provide a reasonable list of differential diagnoses based on patient history and imaging findings. Cases are gathered from an urban- and community-based quaternary-care academic medical center. For each case, a brief history will be provided, accompanied by ultrasound and/or computed tomography images. The reader can then review a list of pathologies provided on each slide and select the best diagnosis. Each case concludes with an explanation and additional imaging, including pathological slides when available.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Non-neoplastic spermatic cord masses include rare entities such as nodular fibrous periorchitis, and mesothelial cysts as well as more common entities such as postoperative hematoma following inguinal hernia repair. Primary neoplastic processes of the spermatic cord are rare yet are the most common neoplasms of the paratesticular region. Often presenting as firm, usually asymptomatic masses, they may be divided into benign (75%) and malignant (25%) subtypes. Of the benign lesions, the most common is lipoma. Malignant neoplasms are most commonly sarcomas, as the spermatic cord arises from the embryonic mesoderm. They include liposarcomas, leiomyosarcomas, rhabdomyosarcomas, and malignant fibrous histiocytomas.

Spermatic cord masses are infrequently encountered in clinical practice, yet they comprise an important group of pathologies. They may be non-neoplastic or neoplastic, and if neoplastic are more likely to be benign. As in other, more common, anatomic sites of primary neoplastic disease, the risk of malignancy mandates a correct diagnosis and appropriate management. Given the important role that imaging plays in diagnosis, this educational exhibit seeks to provide radiologists an appropriate range of differential diagnoses for spermatic cord masses and their respective imaging findings.