The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball!
Abstract Background Testicular germ cell tumour is the commonest malignancy affecting males aged between 15 and 35, with an increased relative risk amongst those with a history of cryptorchidism. In patients presenting with locoregional metastatic disease, retroperitoneal and pelvic soft tissue mass...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-05-01
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| Series: | Cancer Imaging |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40644-019-0217-5 |
| _version_ | 1819050480582524928 |
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| author | Te-Jui Hung Luke McLean Catherine Mitchell Claire Pascoe Nathan Lawrentschuk Declan G. Murphy Amir Iravani Dalveer Singh Michael S. Hofman Lamiaa Zidan Tim Akhurst Jeremy Lewin Rodney J. Hicks |
| author_facet | Te-Jui Hung Luke McLean Catherine Mitchell Claire Pascoe Nathan Lawrentschuk Declan G. Murphy Amir Iravani Dalveer Singh Michael S. Hofman Lamiaa Zidan Tim Akhurst Jeremy Lewin Rodney J. Hicks |
| author_sort | Te-Jui Hung |
| collection | DOAJ |
| description | Abstract Background Testicular germ cell tumour is the commonest malignancy affecting males aged between 15 and 35, with an increased relative risk amongst those with a history of cryptorchidism. In patients presenting with locoregional metastatic disease, retroperitoneal and pelvic soft tissue masses are common findings on ultrasound and computed tomography, which has several differential diagnoses within this demographic cohort. On staging 18F-FDG-PET/CT, understanding the typical testicular lymphatic drainage pathway facilitates prompt recognition of the pathognomonic constellation of unilateral absence of testicular scrotal activity, and FDG-avid nodal masses along the drainage pathway. We describe the cases of three young males presenting with abdominopelvic masses, in whom FDG-PET/CT was helpful in formulating a unifying diagnosis of metastatic seminoma, retrospectively corroborated by a history of testicular maldescent. Case presentations In all three cases, the patients were males aged in their 30s and 40s who were brought to medical attention for back and lower abdominal pain of varying duration. Initial imaging evaluation with computed tomography and/or ultrasound revealed large abdominopelvic soft tissue masses, with lymphoproliferative disorders or soft tissue sarcomas being high on the list of differential diagnoses. As such, they were referred for staging FDG-PET/CT, all of whom demonstrated the pathognomonic constellation of, 1) unilateral absence of scrotal testicular activity, and 2) FDG-avid nodal masses along the typical testicular lymphatic drainage pathway. These characteristic patterns were corroborated by a targeted clinical history and examination which revealed a history of cryptorchidism, and elevated β-hCG in two of three patients. All were subsequently confirmed as metastatic seminoma on biopsy and open resection. Conclusion These cases highlight the importance of clinical history and examination for the clinician, as well as a sound knowledge of the typical testicular lymphatic drainage pathway for the PET physician, which would assist with prompt recognition of the characteristic imaging patterns on FDG-PET/CT. It further anecdotally supports the utility of FDG-PET/CT in evaluating undiagnosed abdominopelvic masses, as well as a potential role in the initial staging of germ cell tumours in appropriately selected patients. |
| first_indexed | 2024-12-21T11:48:43Z |
| format | Article |
| id | doaj.art-50824723eb1945a2a3d4e91af33ef595 |
| institution | Directory Open Access Journal |
| issn | 1470-7330 |
| language | English |
| last_indexed | 2024-12-21T11:48:43Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Cancer Imaging |
| spelling | doaj.art-50824723eb1945a2a3d4e91af33ef5952022-12-21T19:05:07ZengBMCCancer Imaging1470-73302019-05-011911710.1186/s40644-019-0217-5The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball!Te-Jui Hung0Luke McLean1Catherine Mitchell2Claire Pascoe3Nathan Lawrentschuk4Declan G. Murphy5Amir Iravani6Dalveer Singh7Michael S. Hofman8Lamiaa Zidan9Tim Akhurst10Jeremy Lewin11Rodney J. Hicks12Cancer Imaging, Peter MacCallum Cancer CentreDepartment of Medical Oncology, Peter MacCallum Cancer CentreDepartment of Pathology, Peter MacCallum Cancer CentreDivision of Cancer Surgery, Peter MacCallum Cancer CentreDivision of Cancer Surgery, Peter MacCallum Cancer CentreDivision of Cancer Surgery, Peter MacCallum Cancer CentreCancer Imaging, Peter MacCallum Cancer CentreCancer Imaging, Peter MacCallum Cancer CentreCancer Imaging, Peter MacCallum Cancer CentreCancer Imaging, Peter MacCallum Cancer CentreCancer Imaging, Peter MacCallum Cancer CentreDepartment of Medical Oncology, Peter MacCallum Cancer CentreCancer Imaging, Peter MacCallum Cancer CentreAbstract Background Testicular germ cell tumour is the commonest malignancy affecting males aged between 15 and 35, with an increased relative risk amongst those with a history of cryptorchidism. In patients presenting with locoregional metastatic disease, retroperitoneal and pelvic soft tissue masses are common findings on ultrasound and computed tomography, which has several differential diagnoses within this demographic cohort. On staging 18F-FDG-PET/CT, understanding the typical testicular lymphatic drainage pathway facilitates prompt recognition of the pathognomonic constellation of unilateral absence of testicular scrotal activity, and FDG-avid nodal masses along the drainage pathway. We describe the cases of three young males presenting with abdominopelvic masses, in whom FDG-PET/CT was helpful in formulating a unifying diagnosis of metastatic seminoma, retrospectively corroborated by a history of testicular maldescent. Case presentations In all three cases, the patients were males aged in their 30s and 40s who were brought to medical attention for back and lower abdominal pain of varying duration. Initial imaging evaluation with computed tomography and/or ultrasound revealed large abdominopelvic soft tissue masses, with lymphoproliferative disorders or soft tissue sarcomas being high on the list of differential diagnoses. As such, they were referred for staging FDG-PET/CT, all of whom demonstrated the pathognomonic constellation of, 1) unilateral absence of scrotal testicular activity, and 2) FDG-avid nodal masses along the typical testicular lymphatic drainage pathway. These characteristic patterns were corroborated by a targeted clinical history and examination which revealed a history of cryptorchidism, and elevated β-hCG in two of three patients. All were subsequently confirmed as metastatic seminoma on biopsy and open resection. Conclusion These cases highlight the importance of clinical history and examination for the clinician, as well as a sound knowledge of the typical testicular lymphatic drainage pathway for the PET physician, which would assist with prompt recognition of the characteristic imaging patterns on FDG-PET/CT. It further anecdotally supports the utility of FDG-PET/CT in evaluating undiagnosed abdominopelvic masses, as well as a potential role in the initial staging of germ cell tumours in appropriately selected patients.http://link.springer.com/article/10.1186/s40644-019-0217-5FDG-PET/CTSeminomaGerm cell tumourCryptorchidismRetroperitoneal |
| spellingShingle | Te-Jui Hung Luke McLean Catherine Mitchell Claire Pascoe Nathan Lawrentschuk Declan G. Murphy Amir Iravani Dalveer Singh Michael S. Hofman Lamiaa Zidan Tim Akhurst Jeremy Lewin Rodney J. Hicks The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball! Cancer Imaging FDG-PET/CT Seminoma Germ cell tumour Cryptorchidism Retroperitoneal |
| title | The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball! |
| title_full | The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball! |
| title_fullStr | The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball! |
| title_full_unstemmed | The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball! |
| title_short | The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball! |
| title_sort | role of 18f fdg pet ct in evaluating retroperitoneal masses keeping your eye on the ball |
| topic | FDG-PET/CT Seminoma Germ cell tumour Cryptorchidism Retroperitoneal |
| url | http://link.springer.com/article/10.1186/s40644-019-0217-5 |
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