title: Testis ultrasound in Klinefelter syndrome infertile men: making the diagnosis and avoiding inappropriate management.
abstract: To compare the testicular Color Doppler ultrasound (US), hormone levels, and histological results from 67 infertile men with Klinefelter syndrome (KS), vs. 66 non-KS non-obstructive azoospermic men.
  
  
  
  Scrotal US images were collected from 67 infertile KS and 66 non-obstructive, non-KS azoospermic men. The testis volume, echotexture, vascularity, and microliths were evaluated and graded. We defined the following echo pattern alteration groups: normal, striated, coarse, and measurable nodules. The vascularization was classified as low, normal, moderate, or strong. Testosterone, follicle-stimulating hormone, luteinizing hormone, and inhibin B levels were determined. Large testicular nodules were removed. A testicular biopsy and sperm extraction was performed in 18 of the KS, and all of the 66 non-KS men.
  
  
  
  The mean testis volume was low in the KS, compared to the non-KS patients: i.e., 2 vs. 8 mL (P < 0.0001). The distributions in the echotexture groups differed markedly, with coarse or nodular patterns in the KS men, and normal/striated patterns in the control patients (P < 0.0001). The vascularization and microlithiasis grades were higher in the KS patients than the control men (P < 0.0001 and P < 0.001, respectively). All of the nodules removed from the KS patients were benign Leydig cell tumors, and all of the biopsies showed marked Leydig cell hyperplasia, with spermatogenesis in only two patients. The non-KS biopsies were predominantly Sertoli cell-only syndrome.
  
  
  
  Small testes, with a coarse or nodular echotexture, hypervascularization, and microlithiasis are associated with KS. The KS nodules were benign Leydig cell tumors/hyperplasias.
authors.affiliation: Service de Radiologie diagnostique et interventionelle, Hôpitaux Paris Sud, Site Bicêtre, 78, avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France. laurence.rocher@aphp.fr.|Faculté Paris Sud, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France. laurence.rocher@aphp.fr.|Institut Langevin, 1 rue Jussieu, 75005, Paris, France. laurence.rocher@aphp.fr.
authors.forename: Laurence
authors.initials: L
authors.lastname: Rocher
authors.affiliation: Service de Radiologie diagnostique et interventionelle, Hôpitaux Paris Sud, Site Bicêtre, 78, avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France.
authors.forename: Loris
authors.initials: L
authors.lastname: Moya
authors.affiliation: Hopital Necker, Faculté Paris 5, Service de Radiologie, 149 rue de Sèvres, 75015, Paris, France.|Institut Langevin, 1 rue Jussieu, 75005, Paris, France.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Correas
authors.affiliation: Service de Santé publique et d'épidémiologie, Hôpitaux Paris Sud, Site Bicêtre, 78 avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mutuon
authors.affiliation: Service d'anatomo-pathologie, Hôpitaux Paris Sud, Site Bicêtre, 78 avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France.|Faculté Paris Sud, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Ferlicot
authors.affiliation: Service d'endocrinologie, Hôpitaux Paris Sud, Site Bicêtre, 78 avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France.|Faculté Paris Sud, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Young
authors.affiliation: Service d'Urologie, Hôpitaux Paris Sud, Site Bicêtre, 78 avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Izard
authors.affiliation: Faculté Paris Sud, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Benoit
authors.affiliation: Service de Biologie Hormonale, Hôpitaux Paris Sud, Site Bicêtre, 78 avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France.|Faculté Paris Sud, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Brailly-Tabard
authors.affiliation: Service de Radiologie diagnostique et interventionelle, Hôpitaux Paris Sud, Site Bicêtre, 78, avenue du Général Leclerc, 94275, Le Kremlin Bicêtre Cedex, France.|Faculté Paris Sud, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France.
authors.forename: Marie France
authors.initials: MF
authors.lastname: Bellin
mesh_terms: D000328:Adult; D006801:Humans; D007246:Infertility / Q000150:complications* / Q000000981:diagnostic imaging; D007713:Klinefelter Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D013737:Testis / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
keywords: Color Doppler ultrasound; Hypogonadism; Klinefelter syndrome; Leydig cell tumors; Male infertility; Testis tumors