Cystic retroperitoneal metastasis from testicular seminoma, radiologically mimicking as lymphangioma

Abstract

Background Retroperitoneal nodal metastasis in a primary testicular tumor is not uncommon and usually presents as solid or solid-cystic nodal masses. A completely cystic appearance with fluid attenuation or fluid signal intensity on computed tomography (CT) and magnetic resonance imaging (MRI), respectively, is an uncommon presentation. There are many case reports of different types of cystic retroperitoneal masses; however, to our knowledge, metastatic retroperitoneal cystic masses showing fluid attenuation/fluid signal intensity on CT/ MRI secondary to primary testicular seminoma masquerading as cystic lymphangioma has been rarely reported in the medical literature. Our case report reports a case of a metastatic retroperitoneal cystic mass in a known case of testicular seminoma patient, which was misdiagnosed as cystic lymphangioma initially based on imaging. Case presentation A 55-year-old—patient presented to our hospital with abdominal pain, which was on and off in character. The patient underwent routine ultrasound abdomen, CT and MRI, which revealed multiple cystic lesions in the retroperitoneum. Initially, a provisional diagnosis of cystic lymphangioma was made based on the utterly cystic nature of the lesion and the presence of calcification. However, fine-needle aspiration cytology (FNAC) confirmed the metastatic origin of the lesion and was strengthened by the previous clinical history of orchidectomy. Conclusion The treatment strategy for cystic retroperitoneal masses varies depending on the cause and its nature, so differentiation between the cystic masses is essential. Metastasis should also be kept in the differentials in all cystic retroperitoneal masses. Moreover, clinical history and FNAC can assist in making the correct diagnosis.

A rare case of huge intra-abdominal cystic lymphangioma arising from rectovesical pouch; a case report

“…Complete resection of the mass is preferred over partial resection to avoid future recurrence unless vital structures are involved [11] , [12] . The diagnosis was confirmed by the histopathologic examination which showed, dilated lymphatic spaces lined by bland simple endothelial cells and peripheral lymphoid aggregates along with loose connective tissue stroma, characteristic of cystic lymphangioma [10] .…”

“…Generally, Surgery is recommended for symptomatic cases. Both laparotomy and laparoscopy can be utilized for surgery with an acceptable outcome [3] , [9] , [10] . Open surgery is recommended for larger abdominal cystic lymphangioma due to the uncertainty and difficulty of the procedure.…”