Primary paratesticular seminoma

Maurizio Carrino1, Luigi Pucci1, Roberto Campese1, Riccardo Giannella1, Clemente Meccariello1, Maurizio Fedelini1, Riccardo Riccio1, Paolo Fedelini1
  • 1 AORN A. Cardarelli - U.O.S. Andrologia Chirurgica (Napoli)

Objective

Paratesticular tumors are rare in the older male with an incidence of 15% of all intrascrotal tumors and very rare in the children. About 20-25% are malignant with an high prevalence of rabdomyosarcomas arising from spermatic cord and its contents, epidydimis and epidydimal and testicular appendages. We describe a case od paratesticular seminoma that in our research appears to be the third published. In this study we report the case of a patient who came to our observation in second care. A 52 years old men presented with about two months history of painfull right-sided scrotal swelling already treated with antibiotics and various antiinflammatory drugs with no results.

Methods and results

Patient showed us scrotal ultrasound with a 24mm solid lesion of epidydimis and normal testis. Clinical examination confirmed a non tender mass in right paratesticular region. CT scan of thorax, abdomen and pelvis not revealed metastatic disease and serum tumor makers alpha phetoprotein, beta human chorionic gonadotrophin and LDH were normal. The patient underwent inguinal exploration that revealed a solid 25 mm mass in the right mid-epidydimis with normal testicular size and structure. The mass was easily excissed due to total absence of infiltration and send for hystologic evaluation. Histopatology confirmed a classic type seminoma without evidence of lynfovascular invasion and no extension to ink surgical margin of the specimen. Also according to the patient we have not performed a radical orchidectomy and opted for wathfull waiting.

Discussion

25% of paratesticular mass are malignant tumors but primary extratesticular seminoma is very rare. C.M. Dowling and coll. Reported in “International Journal of Surgical Case Report” in 2012 the second case described using a pubmed research with keywords “paratesticular tumors and seminoma”. At our knowledge this is the third case described. As noted we have not perfomed radical orchidectomy for various reasons, surely the absence of lesion at ultrasound and clinical examination of testis, but also the desire of patient. We have considered; the paratesticular seminoma like extragonadal classical seminoma in wich the terapy gives excellent results (more than 95% alive at five years). We follow the patient with three months ultrasound and after six months there isn’t evidence of disease. In the Dowling already cited paper they perfomed orchidectomy with no evidence of testicular seminoma, but Dutckievicz et al. Describe a case of paratesticular tumor with micro-foci of seminoma in the testis (burnt tumor). We continue to follow the patient hoping our opinion is correct.

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