Metastatic seminoma from an undescended intra-abdominal testis: Case report and review of management

Abstract

Testicular germ cell tumors (TGCTs), particularly seminomas, are the most common malignancies in young males and are strongly linked to cryptorchidism. This case report describes a 44-year-old patient with metastatic seminoma originating from an undescended intra-abdominal testis. The diagnosis was confirmed through imaging, tumor marker analysis, and histopathology. Treatment involved orchidectomy followed by BEP chemotherapy, leading to complete remission with no recurrence at 18-month follow-up. This case highlights the importance of early detection and a multidisciplinary approach for optimal management of testicular seminomas.

Highlights

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Testicular germ cell tumors (TGCTs), especially seminomas, are strongly associated with cryptorchidism.
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We report a unique case of metastatic seminoma originating from an undescended intra-abdominal testis.
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Early diagnosis and a multidisciplinary approach are critical for effective treatment and achieving favorable outcomes.
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The patient achieved complete remission following surgery and chemotherapy, with no recurrence 18 months post-treatment.

1 Introduction

Testicular germ cell tumors (TGCTs) account for 1–2 % of all male malignancies, predominantly affecting young adults. Seminomas, the most common histological subtype, are highly radiosensitive and chemosensitive, with a favorable prognosis. While TGCTs typically arise in gonadal germ cells, they can rarely develop in extragonadal locations, particularly in patients with a history of cryptorchidism. This case underscores the challenges associated with seminomas arising from ectopic testes and emphasizes the need for early diagnosis and targeted treatment.

Cryptorchidism, also known as undescended testis, is a congenital anomaly affecting 2–8 % of full-term male neonates and is an important risk factor for the development of testicular germ cell tumors (TGCTs). The severity of ectopia correlates with the risk of malignancy, especially for intra-abdominal testes, which is also exacerbated by delayed or lack of surgical correction. Despite advances in the management of cryptorchidism, late presentations and associated complications, including malignancy, remain a clinical challenge.

We report the case of a 44-year-old man with metastatic seminoma originating from an undescended intra-abdominal testis. This case emphasizes the diagnostic and therapeutic challenges in seminomas occurring in ectopic testes and reinforces the necessity of timely diagnosis, targeted imaging and interdisciplinary management for successful outcomes.

2 Case presentation

A 44-year-old male patient, with no significant medical history, presented with bilateral lower back pain and a general decline in health. Clinical examination was normal, except for an empty left scrotum. An initial ultrasound revealed a large retroperitoneal mass of lymphadenopathy surrounding the vessels, along with a left-sided pelvic lesion measuring 83 × 54 mm, characterized by hypoechoic tissue structure with central vascularization on Doppler imaging ( Fig. 1 ).

A thoraco-abdomino-pelvic CT scan was subsequently performed, describing the left pelvic mass as a tissue lesion with low contrast enhancement, measuring 63 × 63 mm, with lobulated contours and exerting pressure on the left side of the bladder. Additionally, a heterogeneous conglomerate of retroperitoneal lymphadenopathy was noted, with some necrotic areas, encasing the aorta, renal arteries, superior mesenteric artery, and abutting the right border of the celiac trunk. This mass displaced the vena cava and renal veins anteriorly. The lymphadenopathy extended along the right iliac axis over a height of 180 mm on the right side and 110 mm on the left, measuring 135 × 63 mm transversely. It displaced the kidneys laterally, causing moderate dilation of the left renal cavities ( Fig. 2 ).

A CT-guided biopsy of the lymphadenopathy was performed, and histological analysis revealed cellular elements of indeterminate nature. Immunohistochemical studies were inconclusive due to insufficient material.

Tumor marker tests revealed elevated HCG levels at 635 IU/L, elevated LDH at 839.40 IU/L, and normal AFP at 3.91 IU/mL.

Following a multidisciplinary oncologic-urologic meeting, a testicular tumor in an ectopic testis was suspected, and an orchidectomy was decided and performed via a left iliac incision. The specimen was completely removed ( Fig. 3 ). Postoperative recovery was uneventful, and the patient was discharged the day after surgery.