Unusual thoracoabdominal sites of metastases in testicular tumors

Testicular tumors spread in a predictable manner to lymph nodes in the paraaortic chain and then to supradiaphragmatic nodes in the mediastinum and supraclavicular fossae. The most common sites of extranodal disease are the lungs and liver. In a series of 650 patients with testicular tumors who underwent CT examinations unusual sites of thoracoabdominal metastases were demonstrated in 20 patients (23 sites). The sites involved were kidney (six patients), adrenal glands (four patients), inferior vena cava (four patients), muscle (three patients), spleen (two patients), and stomach, pelvic cyst, seminal vesicles and prostate, and pericardium (one patient, each site). Renal metastases were either of soft-tissue density (four patients) or cystic (two patients). Cystic metastases were also identified in the spleen in two patients and in the adrenal gland in one patient. In three of the patients with inferior vena cava involvement, thrombus was seen to extend above the nodal mass over several centimeters. Metastases were demonstrated in the psoas, iliac, and middle gluteal muscles. These were separate from retroperitoneal nodal masses. The ability of CT to identify sites of metastases, which may remain undiagnosed by conventional staging procedures, is emphasized.