Imaging Pearls ❯ GU Misc ❯ Testis
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- Objective: To evaluate whether specific clinical or radiographic factors predict inferior vena cava (IVC) or abdominal aortic (AA) resection or reconstruction (RoR) at the time of postchemotherapy retroperitoneal lymph node dissection (RPLND) for germ cell tumors of the testicle.
Conclusion: Degree of circumferential involvement of the great vessels is an independent predictor for resection or reconstruction of the IVC or AA at postchemotherapy RPLND. Patients at high risk of great vessel reconstruction should be informed accordingly and have the proper teams available for complex vascular reconstruction.
Clinical and Radiographic Predictors of Great Vessel Resection or Reconstruction During Retroperitoneal Lymph Node Dissection for Testicular Cancer
Johnson SC, Smith ZL. Fishman EK et al.
UROLOGY 123; 186-190, 2019 - “The clinical factors identified in our study may potentially aid urologists in preoperative identification of patients at high risk for requiring vascular intervention, allowing for preoperative consultation of additional surgical services, through patient counseling, and referral to high-volume centers if appropriate.”
Clinical and Radiographic Predictors of Great Vessel Resection or Reconstruction During Retroperitoneal Lymph Node Dissection for Testicular Cancer
Johnson SC, Smith ZL. Fishman EK et al.
UROLOGY 123; 186-190, 2019 - "There are important limitations to our study. The deci- sion to perform RoR can be subjective and affected by surgeon experience and comfort level with vascular surgical procedures. That being said, we do think that these objective findings on preoperative imaging may help identify patients at high risk for needing these adjunct vascular procedures. Further, our findings are based on the results of 2 institutions only and due to the low event rate, we were not able to externally validate the model but encourage others to do so.”
Clinical and Radiographic Predictors of Great Vessel Resection or Reconstruction During Retroperitoneal Lymph Node Dissection for Testicular Cancer
Johnson SC, Smith ZL. Fishman EK et al.
UROLOGY 123; 186-190, 2019 - "The degree of circumferential tumor involvement of the aorta ( > 330°) and IVC ( > 135°) is highly associated with the need for RoR during PC RPLND, irrespective of other clinical or radiographic findings. All patients under- going RPLND should be counseled on possible need for vascular intervention, however patients with these tumor characteristics on preoperative imaging should be considered at high risk and planned for accordingly.”
Clinical and Radiographic Predictors of Great Vessel Resection or Reconstruction During Retroperitoneal Lymph Node Dissection for Testicular Cancer
Johnson SC, Smith ZL. Fishman EK et al.
UROLOGY 123; 186-190, 2019
- “Germ cell tumours in men usually arise from the testes, with only 1–2% originating from other locations.These so-called primary extra-gonadal germ cell tumours (EGCTs) are rare, accounting for 0.15–0.2% of all malignancies.They are characterized by their midline location, and have been reported to occur anywhere from the pineal gland to the coccyx, with the commonest locations being the mediastinum and the retroperitoneum.”
Primary retroperitoneal seminoma: an unusual cause of testicular pain Malde S JRSM Open December 2010 vol. 1 no. 7 63 - “Retroperitoneal masses can be caused by a range of benign and malignant conditions. Commonly, these include metastatic lymphadenopathy, lymphoma and liposarcoma. However, retroperitoneal germ cell tumours are rare lesions, accounting for only 4.4% of all malignant primary retroperitoneal tumours.Half of these are seminomatous in nature.”
Primary retroperitoneal seminoma: an unusual cause of testicular pain Malde S JRSM Open December 2010 vol. 1 no. 7 63 - “Retroperitoneal seminomas are rare tumours, and it is difficult to know whether they are true primary tumours or metastases from an occult or regressed testicular primary. In many cases, patients may present with a variety of symptoms and imaging findings are often non-specific. Consequently, the diagnosis is commonly overlooked initially. We recommend that male patients with persistent non-specific genitourinary symptoms and normal testicular investigations undergo a CT scan to exclude the possibility of a retroperitoneal mass. Furthermore, if no testicular abnormality is found in patients confirmed to have an EGCT, regular testicular self-examination is advised to identify the development of tumour recurrence early..”
Primary retroperitoneal seminoma: an unusual cause of testicular pain Malde S JRSM Open December 2010 vol. 1 no. 7 63
- “Cryptorchidism, family history, and infertility are risk factors for testicular cancer. Most testicular cancers occur in young men aged 18–35 years, and seminoma is the most common cell type. Testicular tumors are usually diagnosed at ultrasonography (US) and are staged at computed tomography (CT) or magnetic resonance (MR) imaging.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “The American Cancer Society estimated that 8820 new cases of testicular cancer would be diagnosed in the United States in 2014 but that only about 380 individuals would die of the disease. Testicular cancer is the most common tumor in young adult men, and the majority of cases occur in young men aged 15–35.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “In young men, approximately 95% of testicular cancers are germ cell tumors, and 5% are sex cord–stromal tumors. Ap- proximately 50% of germ cell tumors are seminomas, and approximately 50% are NSGCTs.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “In young men, approximately 95% of testicular cancers are germ cell tumors, and 5% are sex cord–stromal tumors . Approximately 50% of germ cell tumors are seminomas, and approximately 50% are nonseminomatous germ cell tumors (NS- GCTs). Of the NSGCTs, 33% are mixed germ cell tumors, 10% are pure embryonal carcinomas, 4% are teratomas, 1% are yolk sac tumors, and 0.3% are choriocarcinomas. Sex cord–stromal tumors include Leydig cell tumors, Sertoli cell tumors, granulosa cell tumors, and thecomas.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “In men older than 60 years, lymphoma is the most common testicular malignancy . Testicular lymphoma is usually a non-Hodgkin lym- phoma and carries a poor prognosis.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “Metastases to the testes are uncommon.The tumors that most com- monly metastasize to the testicle are cancers of the prostate, lung, kidney, and colon; melanoma; and leukemia. Metastases are bilateral
in 8%–15% of cases, and the mean age at pre- sentation was 55 years in one large series.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “Risk factors for testicular cancer include testicular maldescension , family history, previous history of testicular cancer, and infertility. Maldescended testes are usually surgically moved into the scrotum because this reduces the risk of testicular cancer and also allows increased physical examination surveillance for testicular masses.This procedure is termed orchiopexy.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “The N stage refers to the presence or absence of disease in regional lymph nodes. Abdominal ret- roperitoneal lymph nodes are considered regional lymph nodes.Tumors involving the left testicle typically spread first to left paraaortic lymph nodes just below the left renal vein.Tumors involving the right testicle typically spread first to paracaval, precaval, and retrocaval lymph nodes.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415 - “Approximately 60% of recurrences will be in the retroperitoneum, 25% will be in the lungs, and 10% will be diagnosed solely on the basis of elevated serum tumor markers.”
Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management Moreno CC et al. RadioGraphics 2015; 35:400–415