Presentation
Pelvic pain with a palpable mass.
Patient Data
Large ill-defined pelvic soft tissue mass of supra and left paravesical location. It displays a low signal on T1, intermediate signal on T2 with large areas of restricted diffusion. The postcontrast sequences show a heterogeneous enhancement of the solid non-necrotic component. A large contact is noted with the bladder dome, sigmoid colon and small bowel with no fatty interface. The left external iliac vein is invaded with circumferential encasement of the external iliac artery. There is an extension along the inguinal canal with invasion of the spermatic cord.
A mild effusion is seen in Douglas pouch.
Small left inguinal lymphadenopathy.
Case Discussion
MRI features of a large pelvic mass extending along the inguinal canal in a patient known for undescended left testis are highly suggestive of malignant transformation.
The patient underwent an ultrasound-guided biopsy with a histopathological exam that confirmed the diagnosis of a testicular seminoma.
Testicular seminomas are a type of germ cell tumor and the most common testicular tumors, accounting for ~45% of all primary testicular tumors.
Undescended testis is the major risk factor for testicular germ cell tumors.
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