Successful Treatment of an Atypical Presentation of Disseminated Retroperitoneal Seminoma: A Case Report

Background: Testicular seminoma is the most common malignant tumor of the testis. It occurs at a rate of 5 per 100 000 men, primarily between the ages of 15 to 34. While seminomas typically occur in the testis, other primary sites include the mediastinum, the retroperitoneum, or other extra-gonadal sites. Due to the curable nature of the malignancy (5-year survival rate > 95%), detection at early stages of the disease is key. This case presentation explores the delayed diagnosis and treatments of an atypical presentation of disseminated seminoma.

Case presentation: We present the unusual case of a 56-year-old male who had abdominal pain secondary to a 3.6 × 3.3 × 3.8 cm aortocaval mass. After 3 unsuccessful endoscopic/percutaneous biopsies, the patient consented to an open surgical biopsy that revealed disseminated seminoma abutting the inferior vena cava. The patient subsequently underwent a right radical/inguinal orchiectomy and started on 3 cycles of bleomycin, etoposide, and cisplatin. A positron emission tomography/computed tomography (PET/CT) scan at a 6-month follow-up appointment after treatment showed near complete resolution of the initial aortocaval mass and the interval improvement of accompanying lymphadenopathy. Previously elevated β-human chorionic gonadotropin and lactate dehydrogenase tumor markers are within normal limits to date.

Conclusion: Retroperitoneal masses range from primary neoplasms to solid organ neoplasms to metastatic disease. The challenge with these masses is accurate and prompt diagnosis. Treatment varies for each retroperitoneal mass. A painless lump in the testicle is the most common sign of testicular cancer. Symptoms related to the site of the metastases (ie, back/flank pain) can sometimes occur, making early diagnosis exceedingly challenging. Radical orchiectomy is the mainstay of treatment for seminomatous testicular tumors. Management following surgery is dependent upon staging. Surveillance following treatment requires frequent office visits as well as abdomen/pelvis CT scans and/or serum tumor markers.