Testicular seminoma
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Andrew Dixon had no recorded disclosures.
View Andrew Dixon's current disclosuresPresentation
Left flank pain.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
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venous phase
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venous phase
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CT of the abdomen and pelvis demonstrates a large para-aortic mass which in places encases the aorta. It is well circumscribed and has a few small vessels passing through it. The mass results in left-sided ureteric obstruction and hydronephrosis.
An abnormality in the left hemiscrotum can be seen on the most caudal aspect of both axial and coronal reconstructions.
2 case questions available
Q: What is the differential for this retroperitoneal mass? show answer
A: Most likely represent nodal enlargement. Possibilities in thus young patient include lymphoma and testicular neoplasms.
Q: Look carefully at the inferior most aspect of the CT. Did you see an abnormality? show answer
A: A partially imaged left scrotal mass is noted.
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US reveals a somewhat heterogenous low echogenicity mass within the left testicle which is enlarged (5.6 cm). The testicle demonstrates normal blood flow.
4 case questions available
Q: What is the most likely diagnosis? show answer
A: Testicular seminoma.
Q: What is the typical appearance of non-seminomatous germ cell tumours of the testis on ultrasound? show answer
A: Usually appear more heterogeneous than both normal testicular parenchyma and seminomas, often with cysts and calcification.
Q: Why are the pelvic and inguinal nodes not enlarged? show answer
A: Lymphatic drainage occurs along the course of arterial supply (general anatomic principle) and thus the first nodes affected are the para-aortic nodes at the level of the renal arteries (level of gonadal artery origin).
Q: What is the differential of a unilateral testicular mass? show answer
A: The list is long (see related article) but includes: testicular neoplasms (seminoma most common); testicular infections (including TB); involvement by systemic disease (e.g. sarcoidosis, lymphoma)...
Case Discussion
The diagnosis or testicular seminoma was confirmed histologically following orchiectomy.
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