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]

Overview

Abdominal and pelvic CT scans may be diagnostic of seminoma. CT scan may detect metastases of seminoma to the para-aortic, inguinal, or iliac lymph nodes. Visceral metastasis may also be seen.

CT scan may be helpful in the diagnosis of seminoma. Findings on CT scan suggestive seminoma specialy among nonspecific symptoms patients. Abdominal and pelvic CT scans are important in visualizing metastases

CT

• Abdominal and pelvic CT scans are important in visualizing metastases both as a part of primary staging of seminoma 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.
• Abdominl and pelvic CT scan may be helpful in the diagnosis of seminoma. Findings on CT scan diagnostic ofseminoma include:
  • Retroperitoneal lymph nodes
  • Metastases to the para-aortic lymph nodes ( It is the first site of spread lymphatic drainage at the level of the renal vessels)
    • Bulky nodal
    • Density homogenous,
    • Tend to encase surrounding vessels
  • Inguinal or iliac lymph node metastases suggest
    • lymphatic spread by the scrotum
    • local tumor extension further the tunica vaginalis
  • Visceral metastases
    • Staging CT of the chest is only indicated when regional para-aortic lymph node spread is present or if there is an abnormal CXR.
  • Metastases to the para-aortic lymph nodes until level of 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.
  • Chest CT is indicated when
    • CXR is abnormal
    • Regional para-aortic lymph node spread is present.