SHM Converge Scientific Abstract ePoster Gallery-A Diagnostic Challenge in a Rare Rapidly Enlarging Neck Mass: Isolated Cervical Seminoma Without Testicular or Mediastinal Primary

A Diagnostic Challenge in a Rare Rapidly Enlarging Neck Mass: Isolated Cervical Seminoma Without Testicular or Mediastinal Primary

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This case report describes a 34-year-old man with a rapidly enlarging, painful right cervical neck mass. Initial CT imaging showed necrotic level II cervical lymph nodes without any visible primary tumor in the pharynx or mediastinum. An outside biopsy suggested a poorly differentiated carcinoma, possibly seminoma, but interpretation was limited by necrosis and crush artifact. PET-CT showed FDG-avid right cervical and supraclavicular lymph nodes, while testicular ultrasound and tumor markers (AFP, β-hCG, LDH) were normal. Based on concern for an occult germ cell tumor, empiric bilateral orchiectomy was recommended.<br /><br />The patient sought a second opinion after worsening pain. At the second hospital, a multidisciplinary team recommended repeat biopsy and direct laryngoscopy. Repeat CT showed interval growth of the lymph node. Laryngoscopy found no head and neck primary. FNA and core biopsy revealed malignant cells with clear cytoplasm and prominent nucleoli. Immunohistochemistry was positive for SALL4, OCT3/4, and SOX17, and negative for cytokeratin, EMA, and CD30. FISH demonstrated gain of iso(12p), confirming seminoma.<br /><br />The final diagnosis was stage IIIB extragonadal seminoma confined to the cervical lymph nodes. The patient was treated with BEP chemotherapy (bleomycin, etoposide, cisplatin). The report emphasizes that seminoma should be considered even in atypical locations such as isolated cervical lymph nodes, despite normal testicular imaging and tumor markers. It also highlights the importance of a structured evaluation of adult neck masses, early multidisciplinary collaboration, and molecular testing in difficult diagnostic cases. Accurate diagnosis prevented an unnecessary orchiectomy and guided appropriate treatment.

Asset Subtitle

Nikita L. Jhangiani

Meta Tag

Author List Gloria Mensah, Joanna Song, Nikita L. Jhangiani, Saivaroon Gajagowni, Sergio Villegas De Leon, Son Viet Nguyen

Category Clinical Vignettes

Concept Neck Mass

Concept Extragonadal Seminoma

Concept Malignancy

Concept Biopsy

Concept Lymphadenopathy

Distinguished Non-Finalist

Presenter Organization Baylor College of Medicine, MD Anderson Cancer Center Track

Presenting Author Nikita L. Jhangiani

Track Adult

Keywords

extragonadal seminoma

cervical lymph node mass

neck mass

SALL4

OCT3/4

SOX17

iso(12p)

BEP chemotherapy

testicular ultrasound

multidisciplinary diagnosis

Neck Mass

Extragonadal Seminoma

Malignancy

Biopsy

Lymphadenopathy