Case 84
Presentation
A 24-year-old man presents to his primary physician with severe back pain. Lumbosacral spine films are obtained, and are normal. The patient is treated with anti-inflammatories, but the pain worsens. Ultimately, the primary physician orders a computed tomography (CT) scan.
▪ CT Scan
 Figure 84.1 |
CT Scan Report
A large retroperitoneal mass is noted. The internal organs are normal.
Differential Diagnosis
Metastatic germ cell testicular cancer presents commonly with a retroperitoneal mass. Another possibility is lymphoma. Inflammatory or infectious retroperitoneal processes are extremely rare in young men who are otherwise healthy. Therefore, the most common diagnosis would be neoplasia. Please also refer to Case 62 on retroperitoneal sarcoma.
The patient should have determination of serum alpha-fetoprotein, beta human chorionic gonadotropin (HCG), and lactate dehydrogenase. Elevation of beta HCG or alpha-fetoprotein confirms the diagnosis as metastatic germ cell testicular cancer. If elevation of either of these markers is noted, a testicular
ultrasound should be obtained because most germ cell tumors of the retroperitoneum are metastatic and not primary retroperitoneal tumors. In this particular patient, both alpha-fetoprotein and beta HCG were significantly elevated and the patient was noted to have a solid intratesticular mass.
ultrasound should be obtained because most germ cell tumors of the retroperitoneum are metastatic and not primary retroperitoneal tumors. In this particular patient, both alpha-fetoprotein and beta HCG were significantly elevated and the patient was noted to have a solid intratesticular mass.
Diagnosis
Metastatic nonseminomatous testicular cancer.
