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.

Reference:

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