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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 3  |  Page : 542-543
Retroperitoneal mass and burned out testicular tumor


Head of Urology Department, Yosef Al-Azmma Military Hospital, P.O. Box 125, Jaramana, Damascus, Syria

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Date of Web Publication26-Apr-2010
 

How to cite this article:
Jaber S. Retroperitoneal mass and burned out testicular tumor. Saudi J Kidney Dis Transpl 2010;21:542-3

How to cite this URL:
Jaber S. Retroperitoneal mass and burned out testicular tumor. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2020 Oct 27];21:542-3. Available from: https://www.sjkdt.org/text.asp?2010/21/3/542/62719
To the Editor,

We report on a 32-year-old male patient who presented with a retroperitoneal mass. He pre­sented with complaints of left loin pain and fever. He was diagnosed to have acute pyelo­nephritis and treated with antibiotics. However, his general condition deteriorated, he developed nausea, vomiting, chills and severe loin pain. An ultrasound scan of the abdomen was per­formed which showed normal kidneys but a large retroperitoneal mass measuring 17 Χ 8 cm at the level of the lower pole of the left kidney [Figure 1]. [1]

Physical re-examination revealed a small left testis which was located at the level of external ring; this was tender and it was difficult to exclude a small mass arising from it. An ultra­sound scan of the testis showed a small hypo­echoic area which raised the suspicion of a testicular tumor. [2] A CT scan of the abdomen confirmed the presence of the retroperitoneal mass measuring 17 Χ 8 cm located at the level of lower pole of the left testis [Figure 2].

The patient was admitted to the hospital; la­boratory testes showed increased white blood cell count, elevated ESR and alkaline phospha­tase. Tumor markers such as alfa feto protein and beta HCG were normal. He was treated symptomatically with intravenous antibiotics following which his general status improved and he underwent a left radical orchidectomy. [3],[4] Gross description revealed a white nodule mea­suring 1.5 Χ 1 cm; microscopic findings showed cellular loose collagenous tissue, hyalinized seminiferous tubules and collection of lympho­cytes and plasma cells. These findings were su­ggestive of a fibrous tumor and the differential diagnosis included testicular scar which may be seen in the presence of retroperitoneal mass (burned out testicular tumor). Surgical removal of the retroperitoneal mass was needed to exclude seminoma and other lesions.

Subsequently, the patent underwent retroperi­toneal exploration; a soft, capsulated mass ex­tending to the renal pedicle and infiltrating into the renal vessels and the lymphatic sac was found [Figure 3], [Figure 4] and [Figure 5]. In view of these fin­dings, a radical nephrectomy was performed. [5],[6] Histopathology of this mass could not confirm a seminoma; however, the immunohistobio­chemical staining for PLAP was positive and the diagnosis was compatible with seminoma.

In conclusion, seminoma and burned out testicular tumor is a rare occurrence and we present this case to draw the attention to the fact that not all testicular lesions have similar presentations.

 
   References Top

1.Vogelzang NJ, Scardino PT, Shipley WU, Coffey DS. Genitourinary oncology. Philadelphia: Lip­pincott, Williams and Wilkins; 1999.  Back to cited text no. 1      
2.Richie JP, Steele JS. From Neoplasms of the Testis. In Campbells urology. Volume 4. 8th edition. Edited by: Walsh PC et al. Philadelphia; 1997.  Back to cited text no. 2      
3.Bhala N, Coleman JM, Radstone CR, et al. The management and survival of patients with ad­vanced germ-cell tumours: improving outcome in intermediate and poor prognosis patients. Clin Oncol 2004;16:40-7.  Back to cited text no. 3      
4.Holtl L, Peschel R, Knapp R, et al. Primary lymphatic metastatic spread in testicular cancer occurs ventral to the lumbar vessels. Urology 2002;59:114-8.  Back to cited text no. 4      
5.Ohtani O, Gannon BJ. The microvasculature of the rat vas deferens: A scanning electron and light microscopic study. Br J Anat 1982;135: 521-9.  Back to cited text no. 5      
6.Spermon JR, Witjes JA, Kiemeney L. Difference in stage and morphology adjusted survival between young and elderly patients with a testicular germ cell tumour. Urology 2002;60: 889-93.  Back to cited text no. 6      

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Correspondence Address:
Salim Jaber
Head of Urology Department, Yosef Al-Azmma Military Hospital, P.O. Box 125, Jaramana, Damascus
Syria
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PMID: 20427889

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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