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E2275. A to Z of Paratesticular Pathologies: A Primer for the Radiologists
Authors
  1. Sagar Naik; The University of Texas MD Anderson Cancer Center
  2. Dhakshinamoorthy Ganeshan; The University of Texas MD Anderson Cancer Center
  3. Tara Sagebiel; The University of Texas MD Anderson Cancer Center
  4. Chitra Viswanathan; The University of Texas MD Anderson Cancer Center
  5. Priya Bhosale; The University of Texas MD Anderson Cancer Center
  6. Revathy Iyer; The University of Texas MD Anderson Cancer Center
Background
Paratesticular pathologies are a heterogeneous group of entities the majority of which, unlike testicular lesions, are benign. Interpretation of imaging findings can be challenging for radiologists unfamiliar with the anatomy and embryology of the scrotum. The paratesticular contents consist of the spermatic cord, epididymis, and the fascia derived from the embryologic descent of the testis through the abdominal wall. Most diseases either arise from these structures or are part of a contiguous process from adjacent organs. These entities can be further classified into fluid density lesions such as epididymal cysts, solid masses such as adenomatoid tumors, inflammatory lesions such as epididymitis, and hernias. Imaging plays a crucial role in diagnosis and differentiation between the entities, and consequently, in determination of appropriate management. The purpose of this educational exhibit is to describe the imaging spectrum and management of paratesticular pathologies.

Educational Goals / Teaching Points
To describe the anatomy, embryology, and pathology of paratesticular scrotal contests. To describe the typical and atypical imaging features of the various benign and malignant entities and methods of differentiating from each other. To describe the current management of paratesticular pathologies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Paratesticular pathologies are a diverse group of entities that, unlike testicular pathologies, are largely benign. Normal anatomic structures that comprise the extratesticular scrotum include the epididymis, the spermatic cord, and the fascia derived from the embryologic descent of the testis. Identification of these structures, and further categorization to solid vs cystic vs inflammatory allows for accurate characterization of the pathology. For example, cysts, spermatoceles, benign tumors such as adenomatoid and rarely, malignant tumors such as sarcoma arise from the epididymis. The spermatic cord can give rise to varicoceles, lipoma, and aggressive angiomyxoma. Within the fascia that includes the tunica vaginalis, vas deferens, and lymphatic channels, one may encounter hematoma/ hematocele, pyoceles, benign tumors such as fibrous pseudotumor, lymphangioma, and lipoma, malignant tumors such as aggressive angiomyxoma, and inflammatory conditions such as granuloma. US and MRI are the mainstay in the diagnosis of paratesticular pathologies. The imaging protocol for evaluation of paratesticular pathologies and imaging features unique to the various entities will be discussed in this exhibit.

Conclusion
Imaging plays a very important role in the detection, characterization and diagnosis of paratesticular pathologies. An understanding of the anatomy, epidemiology and pathogenesis particular to each paratesticular organ is crucial to reliable differentiation and diagnosis. Since clinical management is highly dependent upon accurate diagnosis radiologists should be aware of the imaging features that allow identification of this varied group of entities.