A 24 yr old man presented with retroperitoneal, necrotic, heterogenous enhancing mass on CT near the hilum of the left kidney. What is the most probable diagnosis
Correct Answer: metastatic germ cell tumour
Description: Ans is 'a' i.e. metastatic germ cell tumor "Testicular tumors tend to metastasize via the lymphatic system. In general, the testicular lymphatics, which follow the course of the testicular arteries/veins, drain directly into the lymph nodes in or near the renal hilus. After involvement of these sentinel nodes, the lumbar paraaortic nodes become involved (unilaterally or bilaterally), followed by spread to the mediastinal and supraclavicular nodes or hematogenous dissemination to the lungs, liver and brain. Lee SagelThis necrotic retroperitoneal mass represents necrotic lymph nodes.Necrotic lymph nodes usually suggest malignant metastasis; however benign inflammatory diseases may also cause necrotic lymphadenopathy.Lymphoma though a common cause of retroperitoneal lymphadenopathy usually does not show necrosis, and is thus ruled out.Metastases to retroperitoneal lymph nodes may come from virtually any abdominal or pelvic neoplasm, but the most common ones are testicular, prostatic, cervical, endometrial, and renal.Carcinomas of the bladder, prostate, cervix, and uterus initially spread to the pelvic nodes.Testicular, ovarian, and fallopian tube malignancies spread first to the retroperitoneal nodes adjacent to or near the renal hila but may involve the pelvic nodes by retrograde spread.Testicular neoplasms are the most common solid tumor in men 15 to 34 years old .(Ref: Lee Sagel)
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