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Testicular mass in a resting cell

Q1: What does the ultrasound scan show?
The ultrasound scan shows bilateral hypoechoic intratesticular masses. The margins are well defined and the lesions are in close proximity to the rete testis (mediastinum testis).

Q2: Given the patient’s history, what is the diagnosis?
The diagnosis is bilateral adrenal rest tumours or testicular tumours of adrenogenital syndrome.

Q3: Describe the pathophysiology of these lesions?
An adrenal cortical cell rest, an interstitial cell, and a pleuripotent cell have all been suggested as the origin of testicular masses in congenital adrenogenital syndrome.^1,2 Embryologically the development of the adrenal gland and the genital ridge occurs in close proximity. Adrenal cell rests are therefore known to occur in the spermatic cord, testis, broad ligament, and the ovary.³

The normal pathway of synthesis of the steroids hormones is shown in fig 1. The commonest defect in adrenogenital syndrome or congenital adrenal hyperplasia is complete or partial deficiency of 21-hydroxylase followed by a deficiency of 11-ß-hydroxylase. The enzyme 21-hydroxylase is crucial to the synthesis of both cortisol and aldosterone. A . . . [Full text of this article]

Relevant Article

Testicular mass in a resting cell

S Puppala, M Taneja, and D Cochlin
Postgrad. Med. J. 2004 80: 740. [Extract] [Full Text] [PDF]