Testicular tumors and patterns of metastasis

One feature of testis GCTs that has significantly affected its successful management is the predictable and systematic pattern of metastatic spread from the primary site to the retroperitoneal lymph nodes and subsequently to the lung and posterior mediastinum [8,9]. Lymphatic spread is common to all histologic subtypes of GCT, although choriocarcinoma often metastasizes hema-togenously [9]. Anatomic studies in the early 1900s identified the primary lymphatic drainage of the testis to the area of its embryologic origin, the retroperitoneal lymph nodes adjacent to the aorta and inferior vena cava [8]. The primary "landing zone'' for the right-sided testicular tumors includes the interaortocaval region, followed by the precaval and preaortic nodes, while that for left-sided tumors is the para-aortic and preaortic nodes [8,10-12]. Furthermore, multiple mapping studies have clearly shown that multifocality and contralateral spread increase with pathologic stage, particularly with right-sided tumors, and that more caudal deposits of metastatic disease to distal iliac, pelvic, and inguinal nodes usually reflects retrograde spread secondary to bulky retroperitoneal disease [9-12].

0 0

Post a comment