the cysts i.e. serous, mucoid or keratinous fluid, it may present as anechoic or complex structure [Fig. 6]. Non-germ cell tumours Sex cord-stromal tumours Sex cord-stromal (gonadal stromal) tumors of the testis, account for 4 per cent of all testicular tumors. The most common are Leydig and Sertoli cell tumors. Although the majority of these tumors are benign, these tumors can produce hormonal changes, for example, Leydig cell tumor in a child may produce isosexual virilization. In adult, it may have no endocrine manifestation or gynecomastia, and decrease in libido may result from production of estrogens. These tumors are typically small and are usually discovered incidentally. They do not have any specific ultrasound appearance but appear as well-defined hypoechoic lesions. These tumors are usually removed because they cannot be distinguished from malignant germ cell tumors. Leydig cell tumors are the most common type of sex cord–stromal tumor of the testis, accounting for 1%–3% of all testicular tumors. They can be seen in any age group, they are generally small solid masses, but they may show cystic areas, hemorrhage, or necrosis. Their sonographic appearance is variable and is indistinguishable from that of germ cell tumors. Sertoli cell tumors are less common, constituting less than 1% of testicular tumors. They are less likely than Leydig cell tumors to be hormonally active, but gynecomastia can occur. Sertoli cell tumors are typically well-circumscribed, unilateral, round to lobulated masses. Lymphoma Clinically lymphoma can manifest in one of three ways: as the primary site of involvement, or as a secondary tumor such as the initial manifestation of clinically occult disease or recurrent disease. Although lymphomas constitute 5% of testicular tumors and are almost exclusively diffuse non-Hodgkin B-cell tumors, only less than 1% of non-Hodgkin lymphomas involve the testis. Patients with testicular lymphoma are usually old aged around 60 years of age, present with painless testicular enlargement and less commonly with other systemic symptoms such as weight loss, anorexia, fever and weakness. Bilateral testicle involvements are common and occur in 8.5% to 18% of cases. At sonography, most lymphomas are homogeneous and diffusely replace the testis [Fig. 7]. However focal hypoechoic lesions can occur, hemorrhage and necrosis are rare. At times, the sonographic appearance of lymphoma is indistinguishable from that of the germ cell tumors [Fig. 8], then the patient's age at presentation, symptoms, and medical history, as well as multiplicity and bilaterality of the lesions, are