What is the differential diagnosis?
Common - testicular teratoma, yolk sac tumour. Less commonly - paratesticular rhabdomyosarcoma, metastasis
Which serological marker is most helpful in the diagnosis?
Alpha fetoprotein, which is elevated in around 90% of yolk sac tumours.
What is the predominant mode of spread for testicular germ cell tumours?
Lymphatic. Hence, the lymphatic drainage pathway should be imaged when the diagnosis is suspected, as part of the initial workup.
The right testis is grossly enlarged and replaced with a heterogeneous, hyperechoic mass with multiple cystic areas within it. The mass contains extensive internal vascularity with some low resistant arterial waveforms.
No inguinal or intra-abdominal lymphadenopathy seen.