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Pelvis » Scrotum And Testicles
Germ cell tumor testis: multifocal NSGCT
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Presentation A 22 year old male presents with left testicular firmness. He has no history of trauma. A scrotal ultrasound was performed.
Caption: Sagittal image of the left testis
Description: A poorly defined, rounded hypoechoic lesion is seen within the testicular parenchyma. The echogenic mediastinum of the testis is seen here.
Caption: Sagittal image of the left testis
Description: In a plane slightly below the first image are seen two solid-cystic lesions, one in the center and the larger one at the periphery. Both lesions exhibit edge shadowing.
Caption: Sagittal image of the left testis
Description: The peripheral lesion seen earlier is better demonstrated here. It exhibits more solid component than cystic.
Caption: Transverse image of the left testis
Description: The characteristics of one of the lesions are better defined in this image. The lesion demonstrates solid and cystic components as well as some calcific foci which demonstrate posterior shadowing. A calcific echo is also noted in the testicular parenchyma.
Caption: Sagittal image of the left testis
Description: This image also demonstrates the internal characteristics of the largest lesion. Thick septae and an echogenic solid-appearing nodule are seen within the mass. Also noted is a small hydrocele.
Caption: Sagittal power Doppler image
Description: A vessel is noted feeding one of the hypoechoic masses, but the mass per se shows poor vascularity.
Caption: Sagittal power Doppler image
Description: The peripherally placed lesion shows poor internal vascularity.
Caption: Sagittal power Doppler image
Description: The largest mass in the testis also shows poor internal vascularity.
Differential Diagnosis Multifocal testicular malignancy- possibly non-seminomatous tumor, leukemia, lymphoma
Final Diagnosis Multifocal testicular malignancy –multifocal nonseminomatous germ cell tumor
Discussion An article on testicular germ cell tumors has been discussed in an earlier published case [click here to view].

This case illustrates features of a mixed germ cell tumor. The embryonal variety of nonseminomatous germ cell tumor (NSGCT) is typically a large tumor showing areas of hemorrhage, necrosis and calcification. A teratoma classically shows predominantly cystic components as is seen here along with calcifications.
Case References 1. Teruko Ueno, Yumiko Oishi Tanaka, Michio Nagata, et al. Spectrum of Germ Cell Tumors: From Head to Toe. RadioGraphics 2004; 24:387-404
Follow Up An orchiectomy was done and histology revealed mixed germ cell tumor elements – features of embryonal carcinoma and of mature teratoma.
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