CASE 17021 Published on 29.10.2020

Multiple type germ cell tumor found in scrotal masses

Section

Uroradiology & genital male imaging

Case Type

Clinical Cases

Authors

Cyndy Guia Yerovi, Miquel Forment Navarro

Department of Radiology, Universitary Hospital of La Ribera, Alzira, Spain

Patient

36 years, male

Categories
Area of Interest Genital / Reproductive system male ; Imaging Technique Ultrasound
Clinical History

A 36-year-old male was admitted to the emergency department with an intense sharp pain in the right testicle in the past 2-3 days which disturbed his sleep, scrotum redness and size enlargement of the right testicle for 2-3 months ago which had been followed by his general physician.

Imaging Findings

US demonstrated a significantly enlarged right testicle compared to the left testicle, measuring 5.5 x 3.8 cm and two intratesticular masses with different sonographic characteristics between them. In the upper pole of the right testicle, a solid intratesticular lesion, predominantly hypoechoic, with hyperechogenic punctate images suggestive of microlithiasis with a small cystic portion, measuring 20 x 25 mm. Beneath this lesion, another heterogeneous 31 x 34 mm intratesticular lesion with slightly hyperechogenic areas and microlithiasis. Both lesions presented flow with CDUS inside its solid portion.

Left testis and both epididymis without lesions.

Laboratory: S. B-HCG – 59 (0 - 3 mUI/mL), S. AFP – 34 (0 - 8 ng/mL)

Right orchidectomy was performed. Histopathology confirmed teratoma 40 % + embryonal cell carcinoma 35% + seminoma 20 % + choriocarcinoma 3% + endodermal sinus tumor 2% + Rete testes and tunica albuginea invasion with Intratubular germ cell neoplasia

Extension CT study didn't show pathological findings.

Discussion

US demonstrated a significantly enlarged right testicle compared to the left testicle, measuring 5.5 x 3.8 cm and two intratesticular masses with different sonographic characteristics between them. In the upper pole of the right testicle, a solid intratesticular lesion, predominantly hypoechoic, with hyperechogenic punctate images suggestive of microlithiasis with a small cystic portion, measuring 20 x 25 mm. Beneath this lesion, another heterogeneous 31 x 34 mm intratesticular lesion with slightly hyperechogenic areas and microlithiasis. Both lesions presented flow with CDUS inside its solid portion.

Left testis and both epididymis without lesions.

Laboratory: S. B-HCG – 59 (0 - 3 mUI/mL), S. AFP – 34 (0 - 8 ng/mL)

Right orchidectomy was performed. Histopathology confirmed teratoma 40 % + embryonal cell carcinoma 35% + seminoma 20 % + choriocarcinoma 3% + endodermal sinus tumor 2% + Rete testes and tunica albuginea invasion with Intratubular germ cell neoplasia

Extension CT study didn't show pathological findings.

Differential Diagnosis List
Testicular non seminoma (mixed) carcinoma S1 (stage IS)
Testicular infarction and haematoma
Testicular infection and inflammation
Testicular lymphoma
Epidermoid cysts
Final Diagnosis
Testicular non seminoma (mixed) carcinoma S1 (stage IS)
Case information
URL: https://www.eurorad.org/case/17021
ISSN: 1563-4086
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