June 6, 2009

Paraaortic Nodal Metastasis from Testicular Cancer

Fig. 1: Axial CT image of the abdomen at the level below the left renal vein shows large matted left paraaortic lymph nodes (arrowheads) in a 32-year-old man.
Fig.2: Testicular ultrasound was performed to search for a primary tumor. Sagittal ultrasound image of the left testis shows a small hypoechoic mass in the testis.

Paraaortic Nodal Group
  • Can be divided into subgroups based on relationship with aorta and IVC: right lateroaortic (aortocaval, laterocaval, precaval, retrocaval), left lateral aortic, preaortic, retroaortic.
  • Paraaortic pathway spread of tumor bypasses lymph nodes in pelvis, most common in ovarian and testicular carcinoma
  • From ovaries and testicles, lymphatic vessels follow gonadal vessels to paraaortic or paracaval lymph nodes at the renal hila.
  • Search for testicular/ovarian tumors if you see isolated paraaortic lymphadenopathy below the renal hila!

Lymphatic Drainage of Testes
  • Two sets of lymph drainage, superficial and deep
  • Superficial vessels drain surface of tunica vaginalis
  • Deep vessels drain epididymis and testis
  • Right testicular tumor can spread across midline, whereas left testicular tumors usually do not
  • Occasionally, external iliac nodes drain the testis
Our case: left testicular seminoma with paraaortic nodal metastasis.

Park JM, Charnsangavej C, Yoshimitsu K, et al. Pathways of nodal metastasis from pelvic tumors: CT demonstration. Radiographics 1994;14:1309-1321.

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