Case 5

This is a contrast enhanced CT study showing a large retroperitoneal, left para-aortic hypo-attenuating mass – it demonstrates peripheral enhancement and heterogeneously low enhancement centrally, with surrounding fat stranding.

There is also a heterogeneously enhancing lesion at the upper pole of the left testis. In the context of a testicular lesion, the most likely diagnosis is retroperitoneal metastasis from a testicular primary, which is usually a germ cell tumour. I would ascertain the patient’s age – in an adolescent / young adult, non-seminoma germ cell tumours are most common. In the 4^th decade and middle age, seminomas are most common.

I would complement this CT study with an ultrasound of the testes in the first instance, if this is not already done. I would then inform the referring physician of this finding and recommend discussion at the relevant MDT with a view to obtaining tissue / histopathology diagnosis.