Presentation
Painless left testicular swelling. Treated for left epididymo-orchitis for six months without any improvement.
Patient Data
The MRI sequences demonstrate a well-marginated ovoid soft tissue mass within the left scrotal sac with no visualisation of the normal testicular tissue. It shows an intermediate signal intensity on T1WI (slightly higher than that of muscles), intermediate to high signal intensity on T2WI with punctate areas a marked high signal and restricted diffusion on DWI/ADC. The postcontrast sequences show a heterogeneous enhancement with multiple areas of cystic necrosis. There is an involvement of the tunica albuginea with extension to the ipsilateral epididymis. The right testis appears normal. Bilateral small inguinal lymph nodes (diameter <5 mm).
A thoraco-abdomino-pelvic CT scan (not shown) did not show any distant metastases. The patient underwent left orchidectomy a few days later.
Coloured images of the MRI images.
This MRI exam was performed one month after surgery without postcontrast sequences because the patient had immediately a thoraco-abdomino-pelvic CT with contrast.
Small fluid collection is seen within the operative site as well as the right inguinal region with no tumour remnant. Note a small left inguinal lymphadenopathy with restricted diffusion.
The thoraco-abdomino-pelvic CT with contrast (not shown) revealed multiple lymphadenopathies of the para-aortic, left common iliac, bilateral external iliac, and left inguinal chains up to 25 mm of the short-axis diameter with no other distant metastases.
Case Discussion
MRI features of a testicular tumour, histologically proven as non-seminomatous germ cell tumour (mixed germ cell tumour).
Additional contributors: R. Bouguelaa MD, D. Hamidi, MD