Testicular adrenal rests
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Updates to Article Attributes
Testicular adrenal rests are a rare cause of a testicular mass.
Terminology
Testicular adrenal rests can be known by a variety of terms 2:
testicular adrenal rest tumour (TART)
testicular adrenal rest tissue
testicular tumour of the adrenogenital syndrome
testicular adrenal-like tissue
Epidemiology
Can be found in the testis and surrounding tissues in 7.5-15% of newborns and ~1.5% of adults.
Clinical presentation
Usually, adrenal rests are asymptomatic. If these cells are exposed to elevated levels of adrenocorticotropic hormone, they can enlarge to form masses. They are associated with patients with congenital adrenal hyperplasia and rarely in patients with Cushing syndrome.
Pathology
Aberrant adrenal rests represent collections of cells that have become trapped within the developing gonad during fetal development. The rests are usually <5 mm.
Radiographic features
Ultrasound
As with evaluation of other testicular pathology, ultrasound is the modality of choice.
The sonographic appearance of adrenal rests is variable, with some series describing predominantly hypoechoic masses and others reporting heterogeneously hyperechoic masses with shadowing. Lesions are typically multiple, bilateral, and eccentrically located, usually within the mediastinum testis. Variable vascularity on colour Doppler has been reported, being hypovascular rather than hypervascular 4.
MRI
T1: iso- or slight hyperintense signal
T2: hypointense signal
DWI: no diffusion restriction
T1 C+ (Gd): avid homogeneous post-contrast enhancement
Treatment and prognosis
It is important to suggest this in the differential diagnosis in the appropriate setting as they are benign lesions and unnecessary orchidectomy can be avoided. Appropriate hormone serum bloodwork can help secure the diagnosis.
Treatment with glucocorticoid replacement therapy results in stabilisation or regression of the masses.
Differential diagnoses
-<p><strong>Testicular adrenal rests</strong> are a rare cause of a <a href="/articles/bilateral-testicular-lesions">testicular mass</a>.</p><h4>Terminology</h4><p>Testicular adrenal rests can be known by a variety of terms <sup>2</sup>:</p><ul>-<li><p>testicular adrenal rest tumour (TART)</p></li>-<li><p>testicular adrenal rest tissue</p></li>-<li><p>testicular tumour of the adrenogenital syndrome</p></li>-<li><p>testicular adrenal-like tissue</p></li>-</ul><h4>Epidemiology</h4><p>Can be found in the testis and surrounding tissues in 7.5-15% of newborns and ~1.5% of adults.</p><h4>Clinical presentation</h4><p>Usually, adrenal rests are asymptomatic. If these cells are exposed to elevated levels of adrenocorticotropic hormone, they can enlarge to form masses. They are associated with patients with <a href="/articles/congenital-adrenal-hyperplasia">congenital adrenal hyperplasia</a> and rarely in patients with <a href="/articles/cushing-syndrome">Cushing syndrome.</a></p><h4>Pathology</h4><p>Aberrant adrenal rests represent collections of cells that have become trapped within the developing <a href="/articles/gonads">gonad</a> during fetal development. The rests are usually <5 mm.</p><h4>Radiographic features </h4><h5>Ultrasound</h5><p>As with evaluation of other testicular pathology, ultrasound is the modality of choice.</p><p>The sonographic appearance of adrenal rests is variable, with some series describing predominantly hypoechoic masses and others reporting heterogeneously hyperechoic masses with shadowing. Lesions are typically multiple, bilateral, and eccentrically located, usually within the <a href="/articles/mediastinum-testis">mediastinum testis</a>. Variable vascularity on colour Doppler has been reported, being hypovascular rather than hypervascular <sup>4</sup>.</p><h5>MRI</h5><ul>-<li><p><strong>T1:</strong> iso- or slight hyperintense signal</p></li>-<li><p><strong>T2:</strong> hypointense signal</p></li>-<li><p><strong>DWI:</strong> no diffusion restriction</p></li>-<li><p><strong>T1 C+ (Gd):</strong> avid homogeneous post-contrast enhancement</p></li>-</ul><h4>Treatment and prognosis</h4><p>It is important to suggest this in the differential diagnosis in the appropriate setting as they are benign lesions and unnecessary orchidectomy can be avoided. Appropriate hormone serum bloodwork can help secure the diagnosis.</p><p>Treatment with glucocorticoid replacement therapy results in stabilisation or regression of the masses.</p><h4>Differential diagnoses</h4><ul>-<li><p><a href="/articles/testicular-cancer">testicular cancer</a></p></li>-<li><p><a href="/articles/testicular-abscess">testicular abscess</a></p></li>-<li><p><a href="/articles/leydig-cell-hyperplasia">Leydig cell hyperplasia</a></p></li>- +<p><strong>Testicular adrenal rests</strong> are a rare cause of a <a href="/articles/bilateral-testicular-lesions">testicular mass</a>.</p><h4>Terminology</h4><p>Testicular adrenal rests can be known by a variety of terms <sup>2</sup>:</p><ul>
- +<li><p>testicular adrenal rest tumour (TART)</p></li>
- +<li><p>testicular adrenal rest tissue</p></li>
- +<li><p>testicular tumour of the adrenogenital syndrome</p></li>
- +<li><p>testicular adrenal-like tissue</p></li>
- +</ul><h4>Epidemiology</h4><p>Can be found in the testis and surrounding tissues in 7.5-15% of newborns and ~1.5% of adults.</p><h4>Clinical presentation</h4><p>Usually, adrenal rests are asymptomatic. If these cells are exposed to elevated levels of adrenocorticotropic hormone, they can enlarge to form masses. They are associated with patients with <a href="/articles/congenital-adrenal-hyperplasia">congenital adrenal hyperplasia</a> and rarely in patients with <a href="/articles/cushing-syndrome">Cushing syndrome.</a></p><h4>Pathology</h4><p>Aberrant adrenal rests represent collections of cells that have become trapped within the developing <a href="/articles/gonads">gonad</a> during fetal development. The rests are usually <5 mm.</p><h4>Radiographic features </h4><h5>Ultrasound</h5><p>As with evaluation of other testicular pathology, ultrasound is the modality of choice.</p><p>The sonographic appearance of adrenal rests is variable, with some series describing predominantly hypoechoic masses and others reporting heterogeneously hyperechoic masses with shadowing. Lesions are typically multiple, bilateral, and eccentrically located, usually within the <a href="/articles/mediastinum-testis">mediastinum testis</a>. Variable vascularity on colour Doppler has been reported, being hypovascular rather than hypervascular <sup>4</sup>.</p><h5>MRI</h5><ul>
- +<li><p><strong>T1:</strong> iso- or slight hyperintense signal</p></li>
- +<li><p><strong>T2:</strong> hypointense signal</p></li>
- +<li><p><strong>DWI:</strong> no diffusion restriction</p></li>
- +<li><p><strong>T1 C+ (Gd):</strong> avid homogeneous post-contrast enhancement</p></li>
- +</ul><h4>Treatment and prognosis</h4><p>It is important to suggest this in the differential diagnosis in the appropriate setting as they are benign lesions and unnecessary orchidectomy can be avoided. Appropriate hormone serum bloodwork can help secure the diagnosis.</p><p>Treatment with glucocorticoid replacement therapy results in stabilisation or regression of the masses.</p><h4>Differential diagnoses</h4><ul>
- +<li><p><a href="/articles/testicular-cancer">testicular cancer</a></p></li>
- +<li><p><a href="/articles/testicular-abscess">testicular abscess</a></p></li>
- +<li><p><a href="/articles/leydig-cell-hyperplasia">Leydig cell hyperplasia</a></p></li>
Image 9 MRI (T2 fat sat) ( create )
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