Intra-Abdominal Seminoma Testis in Adult: Case Report

Carlotto, Jorge Roberto Marcante; Colleoni-Neto, Ramiro; Shigueoka, David Carlos; Neto, Ricardo Artigiani; Filho, Gaspar de Jesus Lopes

doi:10.1590/s0102-6720201500030021

Cited by 5 publications

(5 citation statements)

References 5 publications

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“…They can originate from either endocrine or non-endocrine neoplasms (Pelosof & Gerber, 2010). Endocrinology's most common paraneoplastic syndromes are hypercalcemia, SIADH, Cushing syndrome, hypoglycemia, acromegaly, ectopic beta-hCG production, ectopic gonadotropin production, and hypoaldosteronism (Dimitriadis et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic and management problems of hyperthyroidism in a patient with testicular seminoma

Febrianto

Novida

2022

CIMRJ

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Patients with thyroid dysfunction are well represented in the general population. Hyperthyroidism can develop as a paraneoplastic syndrome in germ cell tumors. Testicular seminoma as a form of germ cell tumors, can express human chorionic gonadotropin (hCG). Beta-hCG strongly resembles TSH. A 26-year-old male with a history of cryptorchidism, came to Dr. Soetomo Hospital with the complaints of palpitation, diarrhea, weight loss, fatigue, nervousness, excessive sweating, and heat intolerance. He also complained of enlarged breast and a palpable mass in lower abdomen for 4 months. From the TSH and FT4 examinations, patient’s symptoms were in accordance with thyrotoxicosis. Anti-TPO and thyroid USG examination were within normal limits. Patient was treated with beta-blocker and thiamazole. Histopathology of abdominal mass showed a testicular seminoma. After surgery and chemoterapy, the clinical symptoms of hyperthyroidism gradually improved. Administration of beta-blocker and thiamazole was stopped in 4 months after surgery. Many of germ cell tumors in male are associated with cryptorchidism, half of them being testicular seminoma. Seminoma expresses hCG. At very high levels, hCG can stimulate the TSH receptors, causing hyperthyroidism or thyrotoxicosis. TSH and FT4 measurement were needed in patient with suspected hyperthyroidism. Anti-TPO test is performed to exclude autoimmune cause of thyroid disease. Symptomatic management of beta-hCG induced hyperthyroidism is not different from hyperthyroidism in general, namely administration of beta-blocker and anti-thyroid drugs. However, the definitive treatments are surgery and chemotherapy. Hyperthyroidism in germ cell tumors almost all responds well to surgery and chemotherapy.Patients with thyroid dysfunction are well represented in the general population. Hyperthyroidismcandevelopasaparaneoplasticsyndromeingermcelltumors.Testicularseminomaasaformofgermcelltumors,canexpresshumanchorionicgonadotropin(hCG). Beta-hCGstronglyresemblesTSH.A26-year-oldmalewithahistoryofcryptorchidism,cametoDr.SoetomoHospitalwiththecomplaintsofpalpitation,diarrhea,weightloss, fatigue, nervousness, excessive sweating, and heat intolerance. He also complained ofenlargedbreastandapalpablemassinlowerabdomenfor4months.FromtheTSHandFT4examinations,patient’ssymptomswereinaccordancewiththyrotoxicosis.Anti-TPOandthyroidUSGexaminationwerewithinnormallimits.Patientwastreatedwithbeta-blocker andthiamazole.Histopathology ofabdominal massshowedatesticularseminoma.After surgery andchemoterapy,theclinicalsymptomsofhyperthyroidismgraduallyimproved. Administration ofbeta-blockerand thiamazolewasstoppedin 4monthsaftersurgery.Many ofgermcelltumorsin maleareassociatedwith cryptorchidism,halfofthembeing testicular seminoma.SeminomaexpresseshCG. At veryhighlevels,hCGcanstimulatetheTSH receptors, causing hyperthyroidism or thyrotoxicosis. TSH and FT4 measurement were neededin patientwithsuspectedhyperthyroidism.Anti-TPOtestisperformedtoexclude autoimmunecauseof thyroiddisease. Symptomaticmanagementof beta-hCGinduced hyperthyroidismisnotdifferentfromhyperthyroidismingeneral,namely administrationof beta-blocker and anti-thyroid drugs. However, the definitive treatments are surgeryand chemotherapy.Hyperthyroidismingermcell tumorsalmostall respondswelltosurgery and chemotherapy.

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Section: Discussionmentioning

confidence: 99%

“…The cryptorchidism results from abnormalities in the formation and testicular descent during the embryonic period. The most common malignant transformation of an undescended testicle is testicular seminoma (Carlotto et al, 2015). Research Center, 2018).…”

Section: Discussionmentioning

confidence: 99%

Diagnostic and management problems of hyperthyroidism in a patient with testicular seminoma

Febrianto

Novida

2022

CIMRJ

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“…Radiologic and pre-operative diagnosis of these tumors are often difficult, as the history of the undescended testis is not usually provided and imaging features are non-specific mimicking more commoner lymphadenopathy and sarcoma. 8,9 In our case also, the patient presented with a history of pain abdomen and abdominal fullness and didn't give the history of undescended testis initially considering it not to be relevant. In our case, tracing feeding and draining vessels of the lesion pointed towards the gonadal origin of the lesion, which led to an assessment of the right inguinoscrotal region.…”

Section: Discussionmentioning

confidence: 73%

“…2 The peak age of cancer development in undescended testis is in the third to fourth decade of life, similar to that in scrotal testis. 8 Intraabdominal testicular tumor is often asymptomatic, and when symptomatic may mimic appendicitis, ureteric colic and symptoms related to mass effect in gastrointestinal and genitourinary tracts. Radiologic and pre-operative diagnosis of these tumors are often difficult, as the history of the undescended testis is not usually provided and imaging features are non-specific mimicking more commoner lymphadenopathy and sarcoma.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Seminoma in Undescended Testis: A Case Report

et al. 2022

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Testicular seminoma needs to be considered as a differential diagnosis for intra-abdominal mass in the male patient if there is a history of undescended testis. The risk of developing seminoma in an undescended testis is about 4-7.5 times greater than in a normally located testis.The risk of seminoma in undescended testis is increased even after orchidopexy.The identification of the draining gonadal vein can play a key role in the diagnosis of the testicular tumor in undescended intra-abdominally located testis. We report a case of seminoma in the retroperitoneal undescended testis in 50 years old male admitted for abdominal pain and distension

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“…There have been numerous cases of metastatic seminoma arising from undescended testis described in the literature, describing young males aged in their 20s and 30s presenting with painless masses variably located in the abdominopelvic cavity and inguinal region [30–33]. In two of the cases, the patients underwent FDG-PET/CT as part of the staging process [30, 31] whilst the others were staged with conventional anatomical imaging and exploratory laparotomy.…”

Section: Discussionmentioning

confidence: 99%

The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball!

et al. 2019

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Background Testicular germ cell tumour is the commonest malignancy affecting males aged between 15 and 35, with an increased relative risk amongst those with a history of cryptorchidism. In patients presenting with locoregional metastatic disease, retroperitoneal and pelvic soft tissue masses are common findings on ultrasound and computed tomography, which has several differential diagnoses within this demographic cohort. On staging 18 F-FDG-PET/CT, understanding the typical testicular lymphatic drainage pathway facilitates prompt recognition of the pathognomonic constellation of unilateral absence of testicular scrotal activity, and FDG-avid nodal masses along the drainage pathway. We describe the cases of three young males presenting with abdominopelvic masses, in whom FDG-PET/CT was helpful in formulating a unifying diagnosis of metastatic seminoma, retrospectively corroborated by a history of testicular maldescent. Case presentations In all three cases, the patients were males aged in their 30s and 40s who were brought to medical attention for back and lower abdominal pain of varying duration. Initial imaging evaluation with computed tomography and/or ultrasound revealed large abdominopelvic soft tissue masses, with lymphoproliferative disorders or soft tissue sarcomas being high on the list of differential diagnoses. As such, they were referred for staging FDG-PET/CT, all of whom demonstrated the pathognomonic constellation of, 1) unilateral absence of scrotal testicular activity, and 2) FDG-avid nodal masses along the typical testicular lymphatic drainage pathway. These characteristic patterns were corroborated by a targeted clinical history and examination which revealed a history of cryptorchidism, and elevated β-hCG in two of three patients. All were subsequently confirmed as metastatic seminoma on biopsy and open resection. Conclusion These cases highlight the importance of clinical history and examination for the clinician, as well as a sound knowledge of the typical testicular lymphatic drainage pathway for the PET physician, which would assist with prompt recognition of the characteristic imaging patterns on FDG-PET/CT. It further anecdotally supports the utility of FDG-PET/CT in evaluating undiagnosed abdominopelvic masses, as well as a potential role in the initial staging of germ cell tumours in appropriately selected patients.

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Intra-Abdominal Seminoma Testis in Adult: Case Report

Cited by 5 publications

References 5 publications

Diagnostic and management problems of hyperthyroidism in a patient with testicular seminoma

Diagnostic and management problems of hyperthyroidism in a patient with testicular seminoma

Retroperitoneal Seminoma in Undescended Testis: A Case Report

The role of 18F-FDG-PET/CT in evaluating retroperitoneal masses -Keeping your eye on the ball!

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