Intra-scrotal testicular torsion of a classical seminoma in an elderly patient: a case report and literature review

Abstract

Intra-scrotal testicular torsion of a seminoma is extremely rare and has been reported scarcely in literature. On the other hand testicular torsion by itself is rare in old age as well. We report a 63-year-old male who was presented to our Emergency Department with a right scrotal swelling and pain for 1 week. The patient had intra-scrotal testicular torsion of a seminoma which was overlooked initially by Doppler ultrasound, progression of symptoms led to a computed tmomgraphy scan which showed a testicular torsion. Intra-operative findings showed a torsed right testis with completely engorged cord. Right radical orchiectomy was done and indecently histopathology revealed a classical seminoma. Urologist should be aware and more vigilant of testicular torsion as a presentation of malignancy in old age especially with the presence of diagnostic limitations.

Figure 1:

Right testicular Doppler US showing hypo-echoic areas with heterogeneous echo-texture.

Figure 2:

A coronal cut of and enhanced abdominal CT scan showing enlarged right spermatic cord and areas of decreased right testicular enhancement suggesting torsion.

Figure 3:

An intra-operative photo showing torsion areas (black arrows).

Figure 4:

Testicular histopathology. Sections from testis show extensive hemorrhage with an area showing sheets of large round cells with clear cytoplasm. (Inset left) High power of cells show prominent nucleoli and vacuolated clear cytoplasm. (Inset right) Immunohistochemical staining of placental alkaline phosphatase (PLAP) confirms the diagnosis of classical seminoma.