The MRI sequences demonstrate a well-marginated ovoid soft tissue mass within the left scrotal sac with no visualization of the normal testicular tissue. It shows an intermediate signal intensity on T1WI (slightly higher than that of muscles), intermediate to high signal intensity on T2WI with punctate areas a marked high signal and restricted diffusion on DWI/ADC. The postcontrast sequences show a heterogeneous enhancement with multiple areas of cystic necrosis. There is an involvement of the tunica albuginea with extension to the ipsilateral epididymis. The right testis appears normal. Bilateral small inguinal lymph nodes (diameter <5 mm).
A thoraco-abdomino-pelvic CT scan (not shown) did not show any distant metastases. The patient underwent left orchidectomy a few days later.