Antonio De Fiores, Clinica Guarnieri, Rome, Italy
Valentina De Marco, Department of Radiology, Policlinico Umberto I, Sapienza Univerity of Rome, Italy
Flavio Barchetti, Department of Radiology, Policlinico Umberto I, Sapienza Univerity of Rome, Italy
Giovanni Barchetti, Department of Radiology, Policlinico Umberto I, Sapienza Univerity of Rome, Italy
Corresponding Author: Flavio Barchetti, flavio.barchetti@live.it, Viale del Policlinico 155, 00161, Telephone Number 3498110106, Fax Number +39064456695

Nevertheless, it is still uncertain if ultrasound surveillance is really necessary in patients with TM in absence of other risk factors such as previous testicular cancer, a history of cryptorchidism or testicular atrophy [4].
We report two cases of a 33-year-old and 39 year-old men respectively, presenting with a retroperitoneal extragonadal tumor and bilateral testicular microlithiasis, without a focal testicular mass found on ultrasonography.

Primary retroperitoneal germ cell tumors account for approximately 30% of extragonadal germ cell tumors and about 10% of all primary malignant retroperitoneal tumors [1].
Many studies demonstrate the association between diffuse bilateral testicular microlithiasis (TM) and gonadal and extragonadal germ cell tumors [2,3].

A 39 year-old man with a six month history of lumbar pain came to our hospital to perform a MRI in order to rule out a lumbosacral hernia. The MRI images showed no slipped discs, but unfortunately detected a voluminous retroperitoneal solid mass (Fig. 1). Therefore we decided to perform a total-body CT to better characterize the mass and its relationship with adjacent structures. CT images showed a large heterogeneous retroperitoneal mass with curvilinear calcification and a marked inhomogeneous ehancement after intravenous contrast-medium injection, due to the presence of necrotic-colliquatives areas. This lesion displaced the left renal vein cranially, the abdominal aorta anteriorly and toward the right, and infiltratated the inferior vena cava, the left renal vein and the left psoas muscle (Fig. 2,3).