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The Role of Imaging in the Diagnosis, Staging, and Management of Testicular Cancer

¹ All authors: Department of Diagnostic Radiology, Royal Marsden Hospital, Down Rd., Sutton, Surrey SM2 5PT, England.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —42-year-old man with stage IIA disease from right-sided nonseminomatous germ cell tumor. Contrast-enhanced CT shows response to chemotherapy. CT scan shows 10-mm aortocaval node (arrow) behind third part of duodenum.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —42-year-old man with stage IIA disease from right-sided nonseminomatous germ cell tumor. Contrast-enhanced CT shows response to chemotherapy. CT scan obtained after patient underwent treatment with chemotherapy shows that there has been complete response.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —23-year-old man with stage IIB disease from left-sided nonseminomatous germ cell tumor. Contrast-enhanced CT scan shows 4-cm left paraaortic node (arrow).

View larger version (135K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —24-year-old man with recurrent nonseminomatous germ cell tumor. Contrast-enhanced CT scan shows 1.5-cm echelon node (arrow) on left psoas muscle.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —21-year-old man with metastatic nonseminomatous germ cell tumor. Contrast-enhanced CT scans show multiple lung metastases (A) and multiple liver metastases (B), along with large retroperitoneal disease that is invading left renal vein (arrow, B).

View larger version (127K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —21-year-old man with metastatic nonseminomatous germ cell tumor. Contrast-enhanced CT scans show multiple lung metastases (A) and multiple liver metastases (B), along with large retroperitoneal disease that is invading left renal vein (arrow, B).

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —55-year-old man with seminoma. Contrast-enhanced CT shows response to chemotherapy. Image shows that large retroperitoneal nodal mass (arrow) is causing obstruction to right kidney.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —55-year-old man with seminoma. Contrast-enhanced CT shows response to chemotherapy. Image obtained 6 months after A shows excellent response with minimal soft tissue (arrow), which resolved on subsequent imaging (not shown).

View larger version (182K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —24-year-old man with paraaortic relapse from undifferentiated malignant teratoma (embryonal carcinoma) of testis. Contrast-enhanced MDCT images show value of multiplanar reformations. Paraaortic node (arrow) is not readily seen from adjacent bowel loops on axial (A), sagittal (B), and coronal (C) images.

View larger version (116K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —24-year-old man with paraaortic relapse from undifferentiated malignant teratoma (embryonal carcinoma) of testis. Contrast-enhanced MDCT images show value of multiplanar reformations. Paraaortic node (arrow) is not readily seen from adjacent bowel loops on axial (A), sagittal (B), and coronal (C) images.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —24-year-old man with paraaortic relapse from undifferentiated malignant teratoma (embryonal carcinoma) of testis. Contrast-enhanced MDCT images show value of multiplanar reformations. Paraaortic node (arrow) is not readily seen from adjacent bowel loops on axial (A), sagittal (B), and coronal (C) images.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —24-year-old man with paraaortic relapse from undifferentiated malignant teratoma (embryonal carcinoma) of testis. Contrast-enhanced MDCT images show value of multiplanar reformations. Oblique coronal multiplanar reformatted image shows left paraaortic node (arrow).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —60-year-old man with residual mass after undergoing chemotherapy treatment for seminoma. Unenhanced CT scan shows residual retroperitoneal mass (arrow).

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —60-year-old man with residual mass after undergoing chemotherapy treatment for seminoma. Corresponding 18F-FDG PET image shows no increased activity in residual mass (arrow). Subsequent follow-up over 2 years has shown no evidence of recurrent disease.

View larger version (97K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —52-year-old man previously treated for stage IV nonseminomatous germ cell tumor had slowly rising tumor marker level but no apparent disease on contrast-enhanced CT; 18F-FDG PET/CT images were obtained. Fused color-coded FDG PET/CT images show increased uptake in nodes. Uptake is seen in supraclavicular fossa (arrow, A) and posterior mediastinum (arrow, B).

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —52-year-old man previously treated for stage IV nonseminomatous germ cell tumor had slowly rising tumor marker level but no apparent disease on contrast-enhanced CT; 18F-FDG PET/CT images were obtained. Fused color-coded FDG PET/CT images show increased uptake in nodes. Uptake is seen in supraclavicular fossa (arrow, A) and posterior mediastinum (arrow, B).

View larger version (125K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —52-year-old man previously treated for stage IV nonseminomatous germ cell tumor had slowly rising tumor marker level but no apparent disease on contrast-enhanced CT; 18F-FDG PET/CT images were obtained. Fused color-coded FDG PET/CT images show increased uptake in nodes. Small nodes (arrow) can in retrospect be seen on unenhanced CT images through supraclavicular fossa (C) and mediastinum (D).

View larger version (65K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8D —52-year-old man previously treated for stage IV nonseminomatous germ cell tumor had slowly rising tumor marker level but no apparent disease on contrast-enhanced CT; 18F-FDG PET/CT images were obtained. Fused color-coded FDG PET/CT images show increased uptake in nodes. Small nodes (arrow) can in retrospect be seen on unenhanced CT images through supraclavicular fossa (C) and mediastinum (D).

View larger version (19K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —Simplified flowchart of diagnostic and treatment pathways in patient with testicular germ cell tumor.

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