PMC5768970_01
A, Testicular ultrasound examination on the patient's first visit confirmed the presence of a heteroechogenic, hypervascularized mosaic area of 1.5 cmx1.5 cm at the projection of the testis network. B, The testicular tumor had become almost undetectable after 1 month of glucocorticoid therapy
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A scrotal ultrasound examination confirmed the presence of bilateral heteroechogenic, hypovascularized masses near the testes (Figure 2A). TART was identified by ultrasound (Figure 2B). The hormonal status had not changed significantly from the pretreatment status (serum FSH: 2.8 mIU/mL; LH: 1.6 mIU/mL; testosterone: 3.2 ng/mL; estradiol: 18 pg/mL).
Magnetic resonance imaging-realized T2-weighted, low-sign, bilateral, solid enlarged serpiginous lesions in the testicular parenchyma
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The pelvic magnetic resonance imaging (MRI) scan showed irregular, margin, heterogeneous low-signal-intensity tumors that were surrounded by high-signal normal testicular tissue in the T2-weighted image (Figure 3).
Enhanced computed tomography scan revealed diffuse, irregular enlargement of both adrenal glands (A), with no findings in the testes (B)
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An enhanced computed tomography (CT) scan revealed diffuse, irregular enlargement of both adrenal glands, with no finding in the testes (Figure 4A,B).
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Computed tomography scan revealed diffuse, irregular enlargement of both adrenal glands (red circles) and a myelolipoma close to the left adrenal gland (yellow arrow), which was removed by laparoscopic operation afterwards
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An abdominal CT scan for the examination of these conditions revealed the enlargement of the bilateral adrenal glands (Figure 5).
A, Before glucocorticoid therapy, the testicular tumors demonstrated uniform enhancement, with discrete margins that were readily visualized on the T1-weighted images following i.v. gadolinium administration. B, Three years later, the testicular tumors became undetectable on the enhanced T1-weighted images
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All the serum markers for testicular tumors were within the normal range and the testicular MRI showed the same sign as case 1 (Figure 6A). Sperm emerged (concentration: 3.4 x 106/mL; motility: 26%), along with a size reduction in the adrenal hyperplasia and TART (Figure 6B).