Jayapal Praveen,  Alharthi Omar,  Thakor Avnesh

Final Pr. ID: Poster #: CR-018

HISTORY AND CLINICAL COURSE:A 16-year-old male presented with worsening abdominal pain, non-bloody diarrhea, and unintentional weight loss. On exam, he had diffuse abdominal tenderness and unnoticed left testicular swelling. US demonstrated a heterogeneous left testicular mass; CT demonstrated a large heterogeneous left testicular mass with extensive tumor thrombus propagating along the left gonadal vein, into the renal vein, the IVC, right atrium, right ventricle with several metastatic pulmonary emboli. The patient underwent left orchiectomy, and pathology showed testicular mixed germ cell tumor with immature teratoma and yolk sac components. The patient was referred to our institution for further management of his intravascular and intracardiac tumor components, given the patient’s pathology fell under an intermediate category based on the “Intermediate Germ Cell Consensus classification” which supports treatment with curative intent given an 80% long-term survival rate.
PROCEDURE:An open surgical approach was used to remove tumor tissue from the right heart and supra-hepatic IVC. Percutaneous endovascular thrombectomy was then used to remove the tumor from the infra-hepatic IVC and the left renal vein 24 hours after the cardiac surgery.
Step 1: Distal Embolic Control: A single disc from an Inari Flow Triever device was deployed, via the right internal jugular vein, below the level of the hepatic veins to provide distal embolic control throughout the procedure. This is an alternative application for this device.
Step2: IVC tumor removal: An Inari Clot Triever device was deployed via the right common femoral vein. Multiple 360-degree sweeps throughout the IVC to ensure intravascular tumor removal as validated on follow-up IVC venography.
Step 3: Left renal vein tumor removal: The left renal vein thrombus was removed using a combination of the Flow Triever and aspiration catheter systems. IVUS and left renal venogram confirmed the tumor removal.
FOLLOW-UP:The hospital course was uneventful. The patient was anticoagulated with a tight INR goal of 1.5-2 to balance the need for anticoagulation and avoiding the risk of bleeding from recent cardiac surgery. Chemotherapy with Bleomycin, Cisplatin, and Etoposide was initiated upon discharge and will be reviewed by surgical oncology for retroperitoneal nodal clearance later. This case demonstrates the multi-disciplinary team approach to caring for a complex case of an extensive testicular tumor in a pediatric patient. Read More

Authors:  Jayapal Praveen , Alharthi Omar , Thakor Avnesh

Keywords:  Endovascular, thrombectomy, testicular tumor

Harvey Carly,  Allbery Sandra,  Powers Andria

Final Pr. ID: Poster #: CR-074

Juvenile Granulosa Cell Tumor of the Testis is a rare testicular tumor that falls within the category of stromal cord neoplasms. There have been less than 50 cases described in the literature with all cases being described as having a cystic component (1, 2). We present a case of a 6 month old boy presenting with unilateral scrotal swelling. Ultrasound evaluation revealed an entirely solid, hypervascular, intratesticular mass. Alpha-fetoprotein levels were negative. At surgery, radical orchiectomy was performed and pathology revealed a Juvenille Granulosa Cell Tumor.

Testicular tumors arising in the neonatal and prepubescent period are a unique set of tumors distinct from their adult counterparts. In this younger age group, germ cell tumors predominate. Of the germ cell tumors, Yolk Sac tumors are the main tumor of clinical significant, and the reason why alpha-fetoprotein is such a relevant marker (3). Stromal cell tumors account for only a small percentage of testicular tumors within this age group. When they do occur, Juvenile Granulosa Cell Tumors (JGC) predominate, particularly if the child is under 1 year of age, with this tumor type being the most common testicular tumor present at birth (3,4). JGC tumors are associated with genetic and structural anomalies of the Y chromosome, ambiguous genitalia, and contralateral undescended testis. One of their defining pathologic characteristics is positive staining with Inhibin (3).To date there are no cases of metastatic JGC tumors. In all reported cases, Sonographic evaluation demonstrates a grossly multicystic tumor (2). The adult variant of Granulosa Cell tumors can appear as a solid mass with little or no cystic component and carries the risk of metastasis of approximately 20% (2). Surgical management of testicular JGC tumors has largely been radical orchiectomy but, some studies have shown tumor sparing excision to be curative in cases with salvageable testicular parenchyma (2). This finding highlights the importance of including stromal cell tumors, particularly JGC, in the differential for solid appearing testicular masses in the neonate. With more reported cases of JGC tumors of the testes, surgical management could include a more conservative approach. Although JGC tumor of the testis is not known to be malignant, given the atypical features of this tumor and similarities with its more malignant adult counterpart, close surveillance is warranted to ensure benign course. Read More

Authors:  Harvey Carly , Allbery Sandra , Powers Andria

Keywords:  Juvenille Granulosa Cell Tumor, Testicular Tumor, Pediatric, Solid

Osinska Aleksandra,  Wozniak Magdalena,  Materniak Andrzej,  Wyzkiewicz Karolina,  Bialek Wiktoria,  Sochocki Radoslaw

Final Pr. ID: Poster #: CR-020

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder of the central nervous system characterized by antibodies targeting NMDA receptors. It primarily affects adolescent and young adult females and frequently coexists with ovarian teratoma. The disease often begins with psychiatric symptoms such as agitation, hallucinations, or affective instability, which may delay proper diagnosis and treatment.
A 16-year-old girl was admitted to a psychiatric ward due to acute behavioral disturbances and depressive symptoms. Four days after admission, she developed impaired consciousness (GCS 9) and focal neurological signs, including right eye divergent strabismus and bilateral Babinski reflex. Cerebrospinal fluid analysis revealed lymphocytic pleocytosis and elevated protein concentration. Anti-NMDAR antibodies were detected in cerebrospinal fluid. MRI showed hyperintense lesions in the occipital lobes. Abdominal ultrasound identified a right ovarian mass; urgent surgical resection confirmed an immature teratoma. The patient received combined immunotherapy including corticosteroids, intravenous immunoglobulins, plasma exchange, and rituximab. Gradual clinical improvement was observed over subsequent weeks.

This case illustrates the complex neuroimmunological interaction between ovarian teratoma and the central nervous system. Psychiatric symptoms were the initial manifestation, delaying recognition of the underlying encephalitis. The presence of anti-NMDAR antibodies in cerebrospinal fluid and identification of ovarian teratoma confirmed the diagnosis. Early tumor resection combined with immunotherapy significantly improves outcomes and reduces neurological sequelae.

Acute-onset psychiatric symptoms in adolescent females should prompt consideration of autoimmune encephalitis, especially in the presence of an ovarian mass. Early detection and multidisciplinary management are crucial for full recovery and prevention of long-term complications. Read More

Authors:  Osinska Aleksandra , Wozniak Magdalena , Materniak Andrzej , Wyzkiewicz Karolina , Bialek Wiktoria , Sochocki Radoslaw

Keywords:  Testicular Tumor

Chen Paula,  Marine Megan,  Misseri Rosalia,  Kaefer Martin,  Karmazyn Boaz

Final Pr. ID: Poster #: EDU-021

Testicular tumors in children often pose diagnostic challenges. There is a bimodal age distribution and the pathology encountered is age-related. The purpose of this exhibit is to familiarize pediatric radiologists with the types of testicular tumors, the different incidence of malignant tumors among age groups, as well as benign lesions with specific characteristics on ultrasound that do not require surgery.

In addition, we will discuss special situations related to specific syndromes such as Peutz-Jeghers and androgen insensitivity syndromes. We will discuss the role of imaging in guiding patient management.

1. Overview of pediatric testicular tumor types by age
a. Early childhood, pre-pubertal, pubertal
b. Incidence of malignant tumors in each age group

2. Imaging and lab workup of testicular tumors
a. US Imaging characteristics of various tumors
b. Potential role for contrast enhanced US
c. Lab workups
d. Indications for abdominal and pelvic CT scans
e. Follow up after tumor resection

3. Lesions with specific US characteristics that do not require surgery
a. Congenital Adrenal Rests
b. Rete testis
c. Intratesticular varicose veins

4. Management options
a. Radical orchiectomy
b. Testicular sparing/Enucleation
c. Follow-up

5. Special situations
a. Syndromes
b. Microlithiasis Read More

Authors:  Chen Paula , Marine Megan , Misseri Rosalia , Kaefer Martin , Karmazyn Boaz

Keywords:  Testicular tumors, Ultrasound

Silva Gleidson,  Gupta Kanika,  Mcgraw Marty,  Koberlein George,  Verhage Thomas,  Kucera Jennifer

Final Pr. ID: Poster #: EDU-056

Scrotal and paratesticular abnormalities in the pediatric population encompass a wide spectrum of conditions, ranging from benign congenital anomalies to rare but potentially aggressive neoplastic processes. Timely and accurate identification of these entities is critical for guiding appropriate clinical management, minimizing unnecessary surgical procedures, and ensuring prompt diagnosis of serious or life-threatening conditions. This pictorial review offers a thorough and visually rich overview of both frequently encountered and uncommon testicular and paratesticular lesions in children. Common findings such as hydrocele, varicocele, inguinal hernia, and epididymal cysts are presented alongside rare and unusual entities including supernumerary testis, scrotal plexiform neurofibroma, testicular adrenal rest tumors, epididymal cystadenoma, and rhabdomyosarcoma. The various types of spermatic cord hydroceles will also be shown. For each condition, characteristic imaging features are illustrated using multiple modalities—ultrasound, MRI, and CT—highlighting key diagnostic clues that aid in differentiating these lesions from mimics with similar clinical or radiologic presentations. By emphasizing the salient imaging findings and providing practical tips for interpretation, this educational exhibit aims to enhance radiologists’ awareness of rare pediatric scrotal pathologies, improve diagnostic confidence, and ultimately contribute to better-informed treatment decisions and optimized patient outcomes. Read More

Authors:  Silva Gleidson , Gupta Kanika , Mcgraw Marty , Koberlein George , Verhage Thomas , Kucera Jennifer

Keywords:  Testicles, Testicular Tumor, Scrotum