Search Article 
 Advanced search 
About us - Editorial board - Browse articles - Submit article - Instructions - Subscribe - Advertise - Contacts - Login 
  Users Online: 927 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size   

Browse articles
J Clin Imaging Sci 2011,  1:52

Paratesticular Solitary Plasmacytoma

1 Department of Imaging Sciences, University of Rochester School of Medicine, Rochester, NY, USA
2 Department of Pathology and Lab Medicine, Rochester, NY, USA

Date of Submission30-Sep-2011
Date of Acceptance02-Oct-2011
Date of Web Publication25-Oct-2011

Correspondence Address:
Mehmet Ruhi Onur
Department of Imaging Sciences, Research Assistant Professor, University of Rochester School of Medicine, 601 Elmwood Avenue 14642, NY
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2156-7514.86667

Rights and Permissions

Primary solid neoplasms of the extratesticular tissues are rare. The reported prevalence rate of paratesticular neoplasms is between 3% and 16% of all patients referred for scrotal ultrasonography. A plasmacytoma is a discrete, solitary mass of malignant monoclonal plasma cells that can arise in any part of the body. In this report, we present a case of a paratesticular solid mass detected in an 80-year-old patient that proved to be primary extraosseous plasmacytoma on surgery, and discuss its sonographic features.

Keywords: Plasmacytoma, paratesticular mass, sonography

How to cite this article:
Onur MR, Wandtke B, Yao JL, Dogra VS. Paratesticular Solitary Plasmacytoma. J Clin Imaging Sci 2011;1:52

How to cite this URL:
Onur MR, Wandtke B, Yao JL, Dogra VS. Paratesticular Solitary Plasmacytoma. J Clin Imaging Sci [serial online] 2011 [cited 2017 Aug 19];1:52. Available from:

   Introduction Top

Neoplasms arising in the paratesticular region comprise of heterogeneous group of tumors arising from the spermatic cord, epididymis, or vestigial remnants in the scrotum. The majority of paratesticular tumors are benign with the prevalence of malignancy being approximately 3% as opposed to intratesticular masses that are mostly malignant. [1]

A plasmacytoma represents a discrete mass of neoplastic plasma cells identical to plasma cell myeloma but occurs as a localized disease and differs from multiple myeloma with the absence of hypercalcemia, renal insufficiency and anemia, normal skeletal survey, absence of bone marrow plasmacytosis, and serum or urinary para-protein levels being less than 2 g/dl. [2] A plasmacytoma may be medullary (osseous) that occupies bone marrow or extramedullary (extra-osseous). Typical extra-osseous sites of plasmacytoma in the abdominopelvic region include the liver, spleen, and lymph nodes. [3] Occurrence of primary plasmacytoma in the testis and secondary involvement of the testis by relapsing multiple myeloma has been reported. [4],[5]

In this report, we discuss the sonographic features of a primary paratesticular plasmacytoma (PPP) with pathologic correlation and the differential diagnosis of solid paratesticular masses. To our knowledge there is no reported radiologic description of PPP in the literature.

   Case Report Top

An 80-year-old man presented to the hospital with a complaint of a painless scrotal mass. His physical examination revealed a firm, extratesticular scrotal mass. Laboratory tests for alpha fetoprotein (AFP) and beta human chorionic gonadotropin (HCG) were negative.

Ultrasonography was performed with a 12-MHz linear array transducer (Phillips Medical Systems). Gray-scale ultrasound of the scrotum revealed a right side, well-defined paratesticular, solid mass at the superior pole of the testis with spoke wheel appearance [Figure 1a]. Color flow Doppler examination demonstrated increased vascularity of this mass [Figure 1b]. Epididymis was within normal limits. Pampiniform plexus was displaced superiorly. A differential diagnosis of metastatic lesion and paratesticular sarcoma were considered. Surgery confirmed a firm, well-circumscribed solid mass arising from the paratesticular region near the superior pole of the testis.
Figure 1(a): Right paratesticular gray-scale ultrasound of the scrotum in longitudinal plane demonstrates a well-defined solid paratesticular mass with spoke-wheel appearance (arrows).

Click here to view
Figure 1(b): Corresponding color flow Doppler image demonstrates increased internal vascularity

Click here to view

Enucleation of the paratesticular mass was done with preservation of ipsilateral testis and spermatic cord.

Histopathologic examination of the surgical specimen confirmed the diagnosis of primary plasmacytoma consisting of malignant plasma cells. Amyloid deposition was present along with the neoplastic changes [Figure 2a]. The nuclei of plasma cells were localized peripherally with a typical clock-face pattern [Figure 2b].
Figure 2(a): Hematoxylin and eosin stain (100× original magnification) demonstrates amyloid deposition (asterisk) with tumoral cell infiltration (arrowheads)

Click here to view
Figure 2(b): Hematoxylin and eosin stain (400× original magnification) of the tumoral infiltration area reveals typical clock face pattern nuclei (arrowheads) in plasma cells diagnostic of plasmacytoma.

Click here to view

   Discussion Top

Paratesticular tissues are histogenetically derived from a variety of epithelial, mesothelial, and mesenchymal elements and consist of epididymis, spermatic cord, and vestigial remnants. Primary solid neoplasms of the extratesticular tissues are rare, although their reported prevalence varies between 3% and 16% of all patients referred for scrotal ultrasonography. [6]

A plasmacytoma is a discrete, solitary mass of malignant monoclonal plasma cells that can arise in any part of the body. Primary extramedullary plasmacytomas comprise only 4% of all plasma cell malignancies and most often occur in the upper aerodigestive tract. [7] Testicular and paratesticular plasmacytomas are extremely rare. In general plasmacytomas on gray-scale ultrasound have variable echotexture with ill-defined margins and increased vascularity on color flow Doppler evaluation. [4] Testicular plasmacytomas results in enlargement of the testis and ultrasound examination reveals intratesticular ill-defined predominantly hyperechoic masses with hypoechoic areas and linear flame-shaped hypervascularity. This hypervascularity seen in intratesticular plasmacytoma has very close resemblance to testicular lymphoma. [4] Extramedullary plasmacytomas may demonstrate soft tissue attenuation with homogeneous contrast enhancement on computed tomography (CT). [3] Magnetic resonance imaging demonstrates solid tumor that is isointense on T1-weighted and iso- to hyperintense relative to muscle on T2-weighted images with marked enhancement after intravenous contrast administration. [7] A mild heterogeneous F-18 fluoro-d-glucose uptake in a retroperitoneal primary plasmacytoma has been reported on positron emission tomography. [7] Large plasmacytomas may show areas of necrosis and usually present with destruction, infiltration, or encasement of adjacent structures.

Differential diagnosis of benign paratesticular masses includes adenomatoid tumor, lipoma, leiomyoma, fibrous pseudotumor, and sclerosing lipogranuloma. Paratesticular malignant masses to be considered in the differential diagnosis include sarcomas, malignant fibrous histiocytoma, lymphoma, and metastases.

Adenomatoid tumor is the most common epididymal tumor and accounts for approximately 30% of all paratesticular neoplasms, second only to lipoma. [1] Adenomatoid tumors may rarely arise from the testicular tunica and testis and, on rare occasions, occur in the spermatic cord. [8] Majority of adenomatoid tumors are isoechoic relative to the adjacent epididymis and hypovascular on color flow Doppler examination. [1],[8] Leiomyomas have variable ultrasound appearance, depending on whether it is predominantly solid or cystic, and may contain calcifications. Lipomas have a homogeneous hyperechoic appearance on ultrasound. Fibrous pseudotumor appears hypoechoic on ultrasound examination. Fifty percent have an associated hydrocele or hematocele, with 30% having a prior history of trauma or epididymo-orchitis. Sclerosing lipogranuloma are usually associated with foreign body reaction and appear hypoechoic on ultrasound. Solitary fibrous tumors of paratesticular origin are well-defined solid masses and have rich tumor vascularity similar to plasmacytoma. [8]

Rhabdomyosarcoma is the commonest malignant paratesticular tumor in scrotum (40%) that most commonly occurs in children. On ultrasound examination rhabdomyosarcomas have variable echogenicity on gray-scale US secondary to associated hemorrhage and necrosis. Color Doppler ultrasound shows increased flow and low resistance. Ultrasound examination of liposarcomas demonstrates predominantly hyperechoic appearance, although echogenicity may vary. Leiomyosarcomas are typically located in the scrotal part of the spermatic cord and have similar appearance to that of liposarcomas. [8]

Extratesticular metastases have very non-specific appearance and originate from testicular, renal, prostate, and gastrointestinal tumors. Metastatic melanoma, anal carcinoma, and squamous cell lung carcinoma have also been reported. [9]

The paratesticular mass we have described had a very distinct spoke-wheel appearance on gray-scale ultrasound with increased vascularity on color flow Doppler evaluation. This entity has never ever been reported in the imaging literature. Our patient was investigated for the presence of systemic myeloma and no evidence was found.

In conclusion, radiologists should consider extratesticular plasmacytoma in the differential diagnosis of solid and hypervascular paratesticular tumors in an adult since up to 14% of patients may convert to multiple myeloma on follow up. [10]

   References Top

1.Woodward PJ, Schwab CM, Sesterhern IA. From the archives of the AFIP: Extratesticular scrotal masses. Radiographics 2003;23:215-40.  Back to cited text no. 1
2.Oh D, Kim CK, Park BK, Ha H. Primary extramedullary plasmacytoma in retroperitoneum: CT and integrated PET/CT findings. Eur J Radiol 2007;62:57-61.  Back to cited text no. 2
3.Leake PA, Coard KC, Plummer JM. Extramedullary plasmacytoma of the pancreas as an uncommon cause of obstructive jaundice: A case report. J Med Case Reports 2009;3:8785.  Back to cited text no. 3
4.Walker FB, Bluth EI, Kenney A, Beckman EN. Plasmacytoma of the testis. J Ultrasound Med 2005;24:1721-5.  Back to cited text no. 4
5.Rosenberg S, Shapur N, Gofrit O. Plasmacytoma of the testis in a patient with previous multiple myeloma: Is the testis a sanctuary site. J Clin Oncol 2010;28:456-8.   Back to cited text no. 5
6.Ulbright TM, Amin MB, Young RH. Miscellaneous primary tumors of the testis, adnexa, and spermatic cord. In: Rosai J, Sobin LH, eds. Atlas of tumor pathology, fasc 25, ser 3. Washington, DC: Armed Forces Institute of Pathology; 1999. p. 235-366.  Back to cited text no. 6
7.Mimura R, Kamishima T, Kubota KC, Nakano F, Yabe I, Sasaki H, et al. Extramedullary plasmacytoma involving perirenal space accompanied by extramedullary hematopoiesis and amyloid deposition. Jpn J Radiol 2010;28:309-13.  Back to cited text no. 7
8.Akbar SA, Sayyed TA, Jafri SZ, Hasteh F, Neill JS. Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics 2003;23:1461-76.  Back to cited text no. 8
9.Dogra V, Saad W, Rubens DJ. Sonographic appearance of scrotal wall metastases from lung adenocarcinoma. Am J Roentgenol 2002;179:1647-8.  Back to cited text no. 9
10.Alexiou C, Kau RJ, Dietzfelbinger H, Kremer M, Spiess JC, Schratzenstaller B, et al. Extramedullary plasmacytoma. Tumor occurrence and therapeutic concepts. Cancer 1999;85:2305-14.  Back to cited text no. 10

   Authors Top

Mehmet Ruhi Onur


  [Figure 1a], [Figure 1b], [Figure 2a], [Figure 2b]


Previous article   Next article
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
   Case Report
    Article Figures

 Article Access Statistics
    PDF Downloaded410    
    Comments [Add]    

Recommend this journal