Hola amigos, hoy os presento un caso ecográfico. Se trata de un varón de 30 años, asintomático, con un tumor testicular derecho. Se le realizó una ecografía testicular.
¿Cuál sería vuestro diagnóstico?
1. Quiste epidermoide
2. Tumor germinal
3. Absceso
4. Infarto focal
Podéis dejar vuestra opinión hasta el viernes, día en que se dará la solución.
Hallazgos ecográficos:
- Testículo derecho de diámetro normal (A)
- Tumoración sólida testicular derecha polar superior de 1,8 cm (A-C,flechas rojas)
- Presencia de imágenes lineales hiperecoicas en “capas de cebolla” (A,B, flechas blancas)
- Ausencia de señal doppler intratumoral (C, flechas amarillas)
En un paciente asintomático, sin antecedentes patológicos, el diagnóstico más probable reside entre quiste epidermoide o infarto focal. Ambas lesiones tienen ausencia de señal doppler en el interior. Si se identifican las “capas de cebolla”, el diagnóstico es muy sugestivo, aunque no patognomónico. Un teratoma podría simularlo.
La posibilidad de tumor germinal tipo seminoma o teratoma es menos probable por la ausencia de vascularización.
La opción de absceso intratesticular no se adecua a un paciente asintomático, excepcional sin afectación del epidídimo.
Diagnóstico final: quiste epidermoide.
Quiste epidermoide:
- Tumor testicular benigno (1% de las N. Testiculares)
- desarrollo capa ectodérmica de teratoma
- metaplasia de rete testes o quiste inclusión simple
- Típico de adolescentes y adultos jóvenes
- Presentación típica: masa indolora de 1 a 3 cm
- Quistes llenos de material cremoso (flecha), en láminas (queratina)
- No potencial maligno
- Marcadores tumorales negativos
Para un diagnóstico definitivo, puede ser útil completar el estudio con RM testicular. Los tumores germinales son hiperintensos en T2 e isointensos en T1 y captan contraste, mientras que el quiste epidermoide es hiperintenso en T1 y T2 por su contenido en queratina. Tienen una cápsula hipointensa en T2.
Referencia: Price EB Jr. Epidermoid cysts of the testis: a clinical and pathologic analysis of 69 cases from the testicular tumor registry. J Urol 1969; 102:708–713.
Caso preparado por el Dr. Jordi Puig.
resp quiste dermoide
quiste epidermoide
Infarto focal
Se trata de una lesión nodular bien definida intratesticular, la ausencia de flujo Doppler me orienta a quiste epidermoide.
Seminoma
Tumor Germinal. Creo es lo primero que debemos considerar ante lesión de esas características.
Me parece un seminoma
T. epidermoide
Based on the well-defined intratesticular nodular lesion and the absence of Doppler flow, it is likely an epidermoid cyst.
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Asymptomatic, con un tumor testicular derecho. Se le realizó una ecografía testicular.
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Se trata de un varón de 30 años, asintomático, con un tumor testicular derecho. Se le realizó una ecografía testicular.
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It involves a 30-year-old male, asymptomatic, with a right testicular tumor. A testicular ultrasound was performed.
Based on the information provided, I would lean towards a germ cell tumor as the most likely diagnosis given the patient’s age and the presence of a testicular mass. However, further imaging and clinical correlation are essential for a definitive diagnosis.