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  Table of Contents  
LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 3  |  Page : 376
 

Seminoma of solitary testis: A case report


Shija Hospitals and Research Institute, Imphal, Manipur, India

Date of Web Publication24-Feb-2017

Correspondence Address:
I Rana
Shija Hospitals and Research Institute, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.200667

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How to cite this article:
Rana I, Lukram A. Seminoma of solitary testis: A case report. Indian J Cancer 2016;53:376

How to cite this URL:
Rana I, Lukram A. Seminoma of solitary testis: A case report. Indian J Cancer [serial online] 2016 [cited 2017 Sep 20];53:376. Available from: http://www.indianjcancer.com/text.asp?2016/53/3/376/200667


Sir,

Diagnosis and treatment of tumor mass in solitary testis is a challenging situation because there is possibility of permanent infertility and patient often suffers from significant psychological distress. We report a case of 27-year-old man who presented with painless scrotal swelling for the last 2 years. He had solitary testis (left side) from birth. History of infertility was present (married for the last 5 years with no child). On clinical examination, a hard left testicular mass was palpable. No testis was palpable on the right side. Testicular sensation was decreased. There was no palpable inguinal lymph node. Ultrasonography of the scrotum detected the left testicular mass 8 cm × 6 cm × 5 cm. Fine needle aspiration cytology (FNAC) of testicular mass revealed seminoma of testis. His blood test detected raised placental alkaline phosphatase level, but alphafetoprotein, human chorionic gonadotropin, and lactate dehydrogenase levels were normal. Chest X-ray was normal. Abdominopelvic contrast-enhanced computed tomography (CECT) scan showed no inguinal and retroperitoneal lymphadenopathy. After taking written informed consent, high inguinal orchiectomy was performed under spinal anesthesia. Histopathology report was suggestive of classical seminoma confined to left testis without lymphovascular and perineural invasion. Tumor node metastasis staging was – pT1pNoMoLoVoRo, Stage 1 (AJCC 7th edition, 2010). His risk status was “Good Risk” according to International Germ Cell Consensus Classification. There is no evidence of tumor recurrence after 1-year follow-up.

Testicular ultrasound is sensitive and has important role in determining whether a mass is intra- or extra-testicular. FNAC is considered if a suspicious intratesticular abnormality is identified in ultrasound.[1] Serum tumor markers are critical in the assignment of prognosis and the management of treatment as well.[2] Chest X-ray and abdominopelvic CECT scan are important for staging purpose. Initial management of pure seminoma involves a high inguinal orchiectomy. For Stage 1 pure seminoma, the standard management options after orchiectomy include close surveillance with or without adjuvant therapy. In patients of reproductive age, sperm banking must be discussed before undergoing any therapeutic intervention that may compromise fertility.[3] Partial orchiectomy followed by radiotherapy can be advocated in small testicular tumor of solitary testis with favorable histopathology;[4] however, in our case, it was not possible as the tumor mass replaced almost whole testis.

The management of testicular tumor in solitary testis requires a good communication between patient and surgeon. Opinion of spouse should be considered for final decision making. Early diagnosis and treatment of such cases has good outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kim W, Rosen MA, Langer JE, Banner MP, Siegelman ES, Ramchandani P. US MR imaging correlation in pathologic conditions of the scrotum. Radiographics 2007;27:1239-53.  Back to cited text no. 1
    
2.
Klein EA. Tumor markers in testis cancer. Urol Clin North Am 1993;20:67-73.  Back to cited text no. 2
    
3.
Saito K, Suzuki K, Iwasaki A, Yumura Y, Kubota Y. Sperm cryopreservation before cancer chemotherapy helps in the emotional battle against cancer. Cancer 2005;104:521-4.  Back to cited text no. 3
    
4.
Bazzi WM, Raheem OA, Stroup SP, Kane CJ, Derweesh IH, Downs TM. Partial orchiectomy and testis intratubular germ cell neoplasia: World literature review. Urol Ann 2011;3:115-8.  Back to cited text no. 4
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