Metastatic Disease (Male Genital Tract)

Olya Polishchuk

Mary Wyers, M.D.

Children's Memorial Hospital

Abstract

12 year old male with an abdominal mass

Keywords

retroperitoneal mass, sarcoma, CT, 39


Publication Date: 2004-06-18

History

12 year old male with an abdominal mass

Findings

There is a right-sided multilobulated retroperitoneal mass. It has mixed attenuation with central low density and it is located just inferior to the right kidney. The inferior vena cava is compressed by the mass. There is mild to moderate hydronephrosis of the right kidney. There is right sided perinephric and paracolic soft tissue stranding as well as a small amount of free fluid in the right lower quadrant.

Diagnosis

Undifferentiated sarcoma of the epididymis, metastatic lymphadenopathy.

Differential

Metastatic disease from another source, primary tumor of the retroperitoneum (sarcoma), treated lymphoma, possibly tuberculosis.

Discussion

Testicular tumors account for approximately 1% of all childhood malignancies and for 2% to 3% of solid malignant tumors in boys. Approximately 90% of testicular tumors in young boys are of germ cell origin; up to 25% of these are bening teratomas, and the remainder are endodermal sinus tumors. The common adult neoplasms, such as seminoma, embryonal carcinoma, teratocarcinoma, and choriocarcinoma, are usually not seen until puberty. Nongerminal cell or gonadal stromal tumors account for about 10% of testicular tumors in prepubertal boys.

Testicular tumors initially metastasize to lymph nodes in the paraaortic chain; subsequently they spread to iliac, mediastinal, and supraclavicular nodes. Between 10% and 20% of patients with testicular cancers have regional or retroperitoneal lymph node involvement at presentation. Testicular neoplasms metastasize via hematogenous routes to the lungs and liver.

Undifferentiated sarcoma of the epididymis is very uncommon, but the pattern of disease is similar as in metastatic cancer of the testicle.

References

  1. Siegel, M.J., PEDIATRIC BODY CT; Lippincott, Williams & Wilkins, 1999, 300-301.

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