Metastatic testicular seminoma

Case contributed by Dr Amy Lam

Presentation

6 weeks of abdominal and lumbar back pain

Patient Data

Age: 35
Gender: Male
CT

There is evidence of nodal and distal metastatic disease to the lung and liver and the known large retroperitoneal mass anteriorly displacing the D3 segment of the duodenum with a small necrotic area on the anterior aspect of the mass containing small locules of gas immediately posterior to the duodenum which raised the suspicion of a localized duodenal perforation.

CT

Signs of contained perforation of the posterior part of the third part of the duodenum, due to the mass in the retroperitoneum

Ultrasound

Findings are highly suspicious for a primary left testicular malignancy

Case Discussion

A 35 year old male was referred to emergency by his GP with a 6 week history of abdominal and lumbar back pain with a CT abdomen/pelvis showing a large left paramedian retroperitoneal mass encasing the abdominal aorta, IVC and having a local mass effect on the small bowel. He did not have any significant past medical history or family history of malignancy. On examination, his abdomen was not peritonitic but was tender throughout and had a palpable left lower quadrant mass.

A CT Chest/Abdomen/Pelvis performed followed by a CT Abdomen/Pelvis with contrast revealed the abovementioned findings. The duodenal perforation was managed conservatively.

With regards to retroperitoneal masses in this patient population, the top differential would be testicular malignancy, with sarcoma and lymphoma less likely. An ultrasound of his scrotum and elevated B-hCG of 179,000 and AFP of 25 suggested a left testicular primary. Histopathology post radical orchiectomy confirmed a seminoma.

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Case information

rID: 63766
Published: 10th Nov 2018
Last edited: 14th Aug 2019
System: Oncology
Inclusion in quiz mode: Excluded
Institution: Townsville hospital

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