Large intra-abdominal seminoma in a left undescended testicle complicated by torsion

Abstract

A 39-year-old man presented with a 2-day history of worsening constant, dull diffuse lower abdominal pain with associated constipation and known history of left undescended testicle. He was evaluated at an outside hospital where a non-contrasted CT scan revealed a 20 cm well-circumscribed soft tissue mass within the pelvis.He was referred and further imaging revealed a 12 cm heterogeneous mass with foci of air that appeared to be contiguous with the left spermatic cord. This constellation of findings could represent torsion of undescended left testicle with infarction or underlying malignancy. Tumour markers were only significant for elevated lactate dehydrogenase of 1445. A subsequent ultrasound-guided biopsy of the mass demonstrated seminoma.Surgical resection revealed a large intra-abdominal mass emanating from the left spermatic cord with 270° of torsion. There appeared to be a left atrophic remnant testicle at the base of the mass with final pathology confirming the diagnosis of classic seminoma.

Keywords: urological cancer; urological surgery.

Figure 1

Axial view of mass on CT (A). Coronal view of mass on CT (B). Sagittal view of mass on CT (C).

Figure 2

MRI of mass.

Figure 3

CT chest. Arrow shows small 3 mm pulmonary nodule.

Figure 4

Gross pathology of retroperitoneal mass.

Figure 5

Sections of the tumour show ghost outlines of necrotic tumour cells.

Figure 6

Necrotic tumour cells that are reactive for placental alkaline phosphatase by immunohistochemistry.