|LETTER TO THE EDITOR
|Year : 2016 | Volume
| Issue : 3 | Page : 376
Seminoma of solitary testis: A case report
I Rana, A Lukram
Shija Hospitals and Research Institute, Imphal, Manipur, India
|Date of Web Publication||24-Feb-2017|
Shija Hospitals and Research Institute, Imphal, Manipur
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rana I, Lukram A. Seminoma of solitary testis: A case report. Indian J Cancer 2016;53:376
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. Serum tumor markers are critical in the assignment of prognosis and the management of treatment as well. 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. Partial orchiectomy followed by radiotherapy can be advocated in small testicular tumor of solitary testis with favorable histopathology; 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.
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Conflicts of interest
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