Cystic retroperitoneal metastasis from testicular seminoma, radiologically mimicking as lymphangioma

Biswajit Sahoo,Alamelu Alagappan,Mahesh Sultania,Ranjan Kumar Patel,Shilpy Jha

doi:10.1186/s43055-021-00691-y

Abstract

BackgroundRetroperitoneal nodal metastasis in a primary testicular tumor is not uncommon and usually presents as solid or solid-cystic nodal masses. A completely cystic appearance with fluid attenuation or fluid signal intensity on computed tomography (CT) and magnetic resonance imaging (MRI), respectively, is an uncommon presentation. There are many case reports of different types of cystic retroperitoneal masses; however, to our knowledge, metastatic retroperitoneal cystic masses showing fluid attenuation/fluid signal intensity on CT/ MRI secondary to primary testicular seminoma masquerading as cystic lymphangioma has been rarely reported in the medical literature. Our case report reports a case of a metastatic retroperitoneal cystic mass in a known case of testicular seminoma patient, which was misdiagnosed as cystic lymphangioma initially based on imaging.Case presentationA 55-year-old—patient presented to our hospital with abdominal pain, which was on and off in character. The patient underwent routine ultrasound abdomen, CT and MRI, which revealed multiple cystic lesions in the retroperitoneum. Initially, a provisional diagnosis of cystic lymphangioma was made based on the utterly cystic nature of the lesion and the presence of calcification. However, fine-needle aspiration cytology (FNAC) confirmed the metastatic origin of the lesion and was strengthened by the previous clinical history of orchidectomy.ConclusionThe treatment strategy for cystic retroperitoneal masses varies depending on the cause and its nature, so differentiation between the cystic masses is essential. Metastasis should also be kept in the differentials in all cystic retroperitoneal masses. Moreover, clinical history and FNAC can assist in making the correct diagnosis.

Highlights

Primary testicular tumors often produce nodal retroperitoneal metastases, which are usually solid or solidcystic in appearance due to necrosis
The treatment strategy for cystic retroperitoneal masses varies depending on the cause and its nature, so differentiation between the cystic masses is essential
Clinical history and fine-needle aspiration cytology (FNAC) can assist in making the correct diagnosis

Summary

Conclusion

CT or MRI can be beneficial in diagnosing a cystic retroperitoneal mass. It provides essential information regarding the exact location, origin, and involvement of adjacent structures. Few of them were showing septal and wall calcifications These all-radiological features were highly suggestive of retroperitoneal cystic lymphangioma. His age, i.e., 55 years, and the presence of a discrete cystic node in the left inguinal region raised suspicion of some other pathology. Differentiation between the retroperitoneal cystic masses is essential as the treatment strategy varies depending on the cause and its nature. Retroperitoneal metastatic nodes in a case of primary testicular seminoma with an utterly cystic nature is a rare clinical entity.

Introduction

Discussion