Seminoma CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

CT

• Abdominal and pelvic CT scans are important in visualizing metastases both as a part of primary staging of seminoma a and in primary diagnosis when a testicular mass is unknown.
• Metastases to the para-aortic lymph nodes at the level of the renal vessels are the typical first site of spread owing to the lymphatic drainage of the testicles relating to embryological testicular descent. The nodal metastases are often bulky, of homogenous density, and tend to encase surrounding vessels.
• Inguinal or iliac lymph node metastases suggest lymphatic spread via the scrotum and therefore local tumor extension beyond the tunica vaginalis.
• Visceral (distant) metastases are seen in around 5% of patients at presentation (lung, liver, bone, brain). Staging CT of the chest is only indicated when regional para-aortic lymph node spread is present or if there is an abnormal CXR.
• Following therapy, lymph node metastases reduce markedly in size but some inactive abnormal tissue persists which can be difficult to distinguish from residual disease and follow up monitoring is required.