A Case of Testicular Malakoplakia With Markedly High Signal Intensity on Fat-Suppressed T1-Weighted Images

Testicular malakoplakia is a very rare, chronic granulomatous inflammatory condition that frequently resembles testicular malignancy on imaging studies. Here, we report a case of testicular malakoplakia with characteristic magnetic resonance imaging (MRI) findings and present a brief review of the literature.

A man in his 70s presented with left-sided scrotal pain. Ultrasonography revealed a well-defined hypoechoic intratesticular mass without internal vascularity, whereas computed tomography revealed enlargement of the left testis with a relative hyperattenuation area. MRI demonstrated low signal intensity on T2-weighted images, diffusion restriction, and a markedly high signal intensity on fat-suppressed T1-weighted images with contrast enhancement. Based on these findings, a malignant testicular tumor was suspected, and radical orchidectomy was conducted. Histopathological examination confirmed testicular malakoplakia with characteristic Michaelis-Gutmann bodies.

This case highlights the importance of recognizing T1 shortening on fat-suppressed T1-weighted MRI as a potential imaging modality for malakoplakia.