Metastatic testicular cancer

Case contributed by Dr David van Gelderen

Patient Data

Age: 15 years
Gender: Male

Chest and Abdominal X-rays

Modality: X-ray

CXR demonstrates a bulky left hilum and central mediastinum, suspicious for lymphadenopathy.

AXR demonstrates a large central mass, displacing bowel.

Chest and Abdominal CT reformats

Modality: CT

Reformatted coronal chest CT demonstrates bulky left hilar and mediastinal lymphadenopathy.

Reformatted coronal abdominal CT demonstrates extensive retroperitoneal lymphadenopathy.

Left and Right Testicular Ultrasound

Modality: Ultrasound

Left testicular ultrasound demonstrates two microliths and is otherwise normal, consistent with "limited" testicular microlithiasis.

Right testicular ultrasound demonstrates a large heterogeneous mass, consistent with a tumour.

Case Discussion

1. Without the testicular US findings, the most likely differential diagnosis is lymphoma.

2. In the setting of a testicular mass, the most likely differential becomes metastatic testicular malignancy, particularly given the patient's age.

3. The findings on CXR and AXR are therefore important to recognise, in order to exclude a testicular malignancy if not clinically apparent.

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Case Information

rID: 22442
Case created: 1st Apr 2013
Last edited: 8th Dec 2016
Inclusion in quiz mode: Included

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