Presentation
Right testicular mass.
Patient Data
Heterogeneous enhancing mass replacing the right testicle measuring > 10 cm. Moderate right hydrocele expanding the right inguinal canal. Partially necrotic conglomerate retroperitoneal lymphadenopathy measuring > 10 cm encasing and elevating the abdominal aorta off of the spine. Severe narrowing of a left-sided IVC. Distention and heterogeneous enhancement of the IVC and common external iliac veins below the retroperitoneal lymph node conglomerate are suspicious for thrombus. Obstructive moderate right hydroureteronephrosis with transition at the mid-ureter adjacent to the retroperitoneal lymph node conglomerate.
Case Discussion
The right testicle was resected: pathology was reported as 70% malignant teratoma, 20% embryonal cell carcinoma, and 10% yolk sac tumor. Because the testicles arise in the retroperitoneum adjacent to the kidneys and descend into the scrotum during fetal life (see reference), the vascular supply and lymphatic drainage is from/to the retroperitoneum. This embryology explains the location of the nodal metastases.
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