Renal cell carcinoma metastasis to the testis

Case contributed by Jonathan A. Hernandez Mancera
Diagnosis certain


Mild testicular pain and palpable testicular mass that had progressively grown in the past few months. 3 years prior he had a partial right nephrectomy for a clear cell renal carcinoma (pT1a). The patient denied fever or other symptoms.

Patient Data

Age: 50 years
Gender: Male

Ultrasound shows a mass in the right testis. It is isoechogenic, well-defined, and round, with large vessels inside and peripherally. Spectral Doppler shows elevated velocities suggesting arteriovenous fistula.

MRI shows the mass with slight hyperintensity compared with the testicular parenchyma on T1-weighted images and hypointensity on T2-weighted images, as well as signal void in the vessels. Post-gadolinium T1 subtraction images show a hyperenhancing mass with early enhancement of the pampiniform plexus.

Case Discussion

The findings in the initial ultrasound did not correspond to the usual findings in primary testicular cancer. The lesion is "encapsulated" and has several enlarged vessels with a Doppler pattern suggestive of arteriovenous fistula. The MRI also shows a mass that is different from what we usually see in seminomas and non-seminomatous germ cell tumors, showing early enhancement that exceeded the enhancement of the rest of the testicular parenchyma. It also showed an arteriovenous fistula, with enhancement of the right pampiniform plexus. We suggested that this mass did not show the usual pattern of primary testicular tumor, which was confirmed at orchiectomy, to be a metastasis of clear cell renal carcinoma.

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