Testicular nonseminomatous mixed germ cell tumor

The MRI sequences demonstrate a well-marginated ovoid soft tissue mass within the left scrotal sac with no visualization of the normal testicular tissue. It shows an intermediate signal intensity on T1WI (slightly higher than that of muscles), intermediate to high signal intensity on T2WI with punctate areas a marked high signal and restricted diffusion on DWI/ADC. The postcontrast sequences show a heterogeneous enhancement with multiple areas of cystic necrosis. There is an involvement of the tunica albuginea with extension to the ipsilateral epididymis. The right testis appears normal. Bilateral small inguinal lymph nodes (diameter <5 mm).

A thoraco-abdomino-pelvic CT scan (not shown) did not show any distant metastases. The patient underwent left orchiectomy a few days later.

Colored images of the MRI images.

This MRI exam was performed one month after surgery without postcontrast sequences because the patient had immediately a thoraco-abdomino-pelvic CT with contrast. 

Small fluid collection is seen within the operative site as well as the right inguinal region with no tumor remnant. Note a small left inguinal lymphadenopathy with restricted diffusion.

The thoraco-abdomino-pelvic CT with contrast (not shown) revealed multiple lymphadenopathies of the para-aortic, left common iliac, bilateral external iliac, and left inguinal chains up to 25 mm of the short-axis diameter with no other distant metastases.