Presentation
The patient presented to the emergency department with three days history of right testicular pain and swelling.
Patient Data
Grayscale ultrasound image of the right testis shows a cluster of coarse calcifications and a small hypoechoic area within the region of the mediastinum testis. No abnormal vascularity is identified on color Doppler imaging.
There is bulky retroperitoneal lymphadenopathy including a few necrotic lymph nodes, highly suspicious for nodal metastases.
Case Discussion
Necrotic retroperitoneal lymphadenopathy with intratesticular calcifications within a small hypoechoic area are highly suspicious of a burned-out testicular tumor in this young patient.
Biopsy of the retroperitoneal lymph nodes confirmed the diagnosis of metastatic germ cell tumor, primary appearing as embryonal carcinoma with necrosis.
A cluster of calcifications within the testis can also potentially represent phleboliths, spermatic granulomas, regions of vascular calcification, sequela of prior trauma or prior necrosis.
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