Testicular seminoma

Q: What is the differential for this retroperitoneal mass? show answer

A: Most likely represent nodal enlargement. Possibilities in thus young patient include lymphoma and testicular neoplasms.

Q: Look carefully at the inferior most aspect of the CT. Did you see an abnormality? show answer

A: A partially imaged left scrotal mass is noted.

Q: What is the most likely diagnosis? show answer

A: Testicular seminoma.

Q: What is the typical appearance of non-seminomatous germ cell tumours of the testis on ultrasound? show answer

A: Usually appear more heterogeneous than both normal testicular parenchyma and seminomas, often with cysts and calcification.

Q: Why are the pelvic and inguinal nodes not enlarged? show answer

A: Lymphatic drainage occurs along the course of arterial supply (general anatomic principle) and thus the first nodes affected are the para-aortic nodes at the level of the renal arteries (level of gonadal artery origin).

Q: What is the differential of a unilateral testicular mass? show answer

A: The list is long (see related article) but includes: testicular neoplasms (seminoma most common); testicular infections (including TB); involvement by systemic disease (e.g. sarcoidosis, lymphoma)...