A 41 Year old gentleman with a large abdominopelvic mass and abdominal pain.

A 41 Year old gentleman with a large abdominopelvic mass and abdominal pain.

A 41-Year-old gentleman with a large abdominopelvic mass and abdominal pain

  • Large solid cystic mass in the midline lower abdomen and pelvis, containing multiple clusters of curvilinear coarse calcification.
  • Moderate ascites.
  • Extensive omental caking and multiple large scattered peritoneal deposits and abnormal nodular peritoneal enhancement.
  • Abnormal nodular enhancement along the surfaces of the small bowel suggests serosal deposits.
  • Multiple scattered solid cystic abnormally enhancing lesions of varying sizes in the liver, compatible with hepatic metastases.
  • The metastasis in segment VI demonstrates focal rupture into the perihepatic region.
  • Bilateral inguinal hernias containing ascites and abnormal peritoneal enhancement. The spermatic cords are not visualized in the groin region on either side.


Non-seminomatous germ cell tumors arising from undescended testes with disseminated metastases.


  • The absence of spermatic cords in both inguinal regions clinches the diagnosis of bilateral cryptorchidism.
  • With cryptorchidism, there is an increased risk of developing testicular germ cell tumors (incidence 1 in 2000). This risk is higher in bilateral cases and in abdominal cryptorchidism.
  • In men with untreated cryptorchidism, a secondary malignancy in an undescended testes manifests as an intra-abdominal mass. The imaging clues include:
    • An ipsilateral draining vein that empties into the inferior vena cava (if right sided) or the left renal vein (if left sided).
    • An empty ipsilateral scrotal sac or absence of spermatic cord structures in the groin region are further pointers.

Testicular tumours

  • 95 % of testicular tumours are germ cell tumours (GCT) and 5 % are sex cord stromal tumours.
  • Approximately 50 % of GCTs are seminomas and 50 % are nonseminomatous germ cell tumors.
  • Radiologically:
    • Seminomas are homogenous, solid lobulated masses with intervening fibrovascular septae.
    • Nonseminomatous GCTs are heterogenous with areas of necrosis and hemorrhage.
  • Nonseminomatous GCTs grow more rapidly and are more likely to be metastatic at presentation when compared to seminomas.
  • Sites of metastases from GCTs:
    Retroperitoneal and mediastinal lymph nodes, lung, liver, brain, and bone.
  • Extragonadal sites of GCTs:
    Anterior mediastinum, sacrococcygeal region, pineal gland, and neurohypophysis
  • The radiologist plays a key role in the initial staging of disease, identifying the prognostic factors and also in the assessment of treatment response and treatment related toxicity.


  1.  Coursey Moreno C, Small WC, Camacho JC et al. Testicular tumors: what radiologists need to know—differential diagnosis, staging, and management. RadioGraphics 2015;35(2):400–415.
  2.  Monica J Wood, Richard Thomas, Stephanie A Howard, Marta Braschi-Amirfarzan. Imaging of metastatic germ cell tumors in male patients from initial diagnosis to treatment-related toxicities: A primer for radiologists. AJR 2020;214:24-33
  3.  Para, Sajad & Pal, Dilip. (2016). Spontaneous Massive Hemoperitonium Secondary to Bleeding of a Hepatic from a Testicular Germ Cell Tumour-An Ususual Presentation. Scholars Journal Of Medical Case Reports. 4. 401-403. 10.21276/sjmcr/2016.4.6.12.
  4.  Yu MH, Kim YJ, Park HS, Jung SI, Jeon HJ. Imaging Patterns of Intratumoral Calcification in the Abdominopelvic Cavity. Korean J Radiol. 2017;18(2):323?335. doi:10.3348/kjr.2017.18.2.323
  5.  Dolapsakis C, Pavli P, Panagopoulos A, et al. Haemoperitoneum Due to Spontaneous Rupture of a Liver Metastasis. Eur J Case Rep Intern Med. 2019;6(7):001142. 2019 Jun 26. doi:10.12890/2019_001142

Dr. Anoop Mangalappilly
DNB Resident
Manipal Hospitals Radiology Group

Dr. Anita Nagadi 
Senior Consultant Radiology
Manipal Hospitals Radiology Group