Metastatic testicular cancer

Case contributed by David van Gelderen
Diagnosis almost certain

Patient Data

Age: 15 years
Gender: Male

Chest and Abdominal X-rays

x-ray

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

AXR demonstrates a large central mass, displacing bowel.

Chest & Abdo CT reformats

ct

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

Reformatted coronal abdominal CT demonstrates extensive retroperitoneal lymphadenopathy.

Lt & Rt Testicular US

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 tumor.

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 recognize, in order to exclude a testicular malignancy if not clinically apparent.

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