What is the MOST LIKELY diagnosis? You are shown longitudinal gray scale image of the testis in an asymptomatic 57 year old man (Figure 2). A color flow Doppler ultrasound of the abnormal area did not reveal any flow.

Tubular ectasia of the rete testis

A. Correct. Tubular ectasia is a benign condition and occurs usually in men older than 55 years of age. It is located in or adjacent to the mediastinum testis. It is usually bilateral and is accompanied by spermatocele. B. Incorrect. Larger serpiginous structures are present in intratesticular varicoceles. The appearance is similar to extratesticular varicoceles, and would have blood flow within. C. Incorrect. Testicular cystic tumors can occur anywhere; however mediastinum testis is not a characteristic location for them. The tubular ectasia occurs classically adjacent to mediastinum testis and is postero-lateral in location. Cystic immature teratoma is the main differential consideration and it usually has rind of echogenic tissue around it. D. Incorrect. Testicular abscesses have irregular, shaggy margins with peripheral hyperemia. They usually occur as complication of epididymo- orchitis or secondary to infection in testicular hematoma.