Aim: Our study evaluated the incidence, imaging characteristics, and prognosis of brain metastases originating from primary testicular tumors.
Introduction: Approximately 95% of testicular tumors are testicular germ cell tumors (TGCT).1 Sertoli cell tumors are rare non-germ cell origin tumors and account for less than 1% of testicular cancer.2 Brain metastases from germ cell tumors are very uncommon, occurring in less than 2–3% of patients.3 In testicular cell cancer, it is estimated that the incidence of brain metastases is 1–2% in all TGCT, whereas in advanced stages of TGCT the incidence rises to about 10–15% 4–9
Methods: Case records of testicular tumors patients within the IPO Porto data base from 2006 to 2015 were reviewed to identify patients with testicular tumors and evidence of brain metastases.
Results: 368 patients with testicular tumors were identified, with only four having evidence of brain metastases. Histopathological evaluation reveled that one of the patients had a non-germ cell tumor, a Sertoli cell tumor, while others had mixed germ cell tumors. Half of them had only a single right frontoparietal lesion (21mm) or right occipital (42mm), both were heterogeneous in T1WI and T2WI, and with intense and heterogeneous enhancement with gadolinium. The other two patients had multiple lesions. One of them had left frontoparietal (2.2mm, hyperintense in T1) and right occipital (1.8mm, hypointense in T1) lesions, both heterogeneous and predominantly hypointense in T2 and T1WI with no enhancement. The other had right temporal (5mm) and left occipital (11mm) lesions, both isointense in T1W1 and T2WI with intense and homogeneous enhancement. There was no diffusion restriction in all three cases and all four cases were hypointense in T2*.
Conclusion: Although the imaging features of brain metastases differ in some aspects, they all have a hemorrhagic component and a very low survival rate after diagnosis.