SHM Converge Scientific Abstract ePoster Gallery-Testicular Cancer Presenting as Retroperitoneal Lymphadenopathy: Seminoma

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This case describes a 40-year-old man who presented with acute back, flank, and abdominal pain with nausea/vomiting, low-grade fevers, left CVA tenderness, and mild left testicular asymmetry. Imaging revealed bulky retroperitoneal lymphadenopathy with a large paraaortic mass causing mild left hydronephrosis, along with splenomegaly and gynecomastia. Laboratory findings showed mildly elevated beta-hCG and LDH, with normal AFP and negative blood cultures.<br /><br />Further evaluation with scrotal ultrasound and orchiectomy pathology confirmed a pure seminoma limited to the left testis, measuring 4.4 cm. The preliminary stage was T2 cN3 cM0, Stage II. Because staging for seminoma depends on post-orchiectomy tumor markers, treatment began before those results were finalized due to the extent of retroperitoneal disease.<br /><br />The standard treatment for Stage II seminoma is BEP chemotherapy for 3 cycles or EP for 4 cycles in Stage IIc disease. In this patient, the plan was 3–4 cycles of BEP (bleomycin, etoposide, and cisplatin), with the first cycle given inpatient. He developed mild liver enzyme elevation after chemotherapy initiation. Radiation therapy was not recommended because the retroperitoneal mass was bulky, measuring 14 cm, whereas RT is generally reserved for non-bulky disease.<br /><br />Post-treatment plans include PET imaging to assess for residual masses, as well as post-orchiectomy labs and semen analysis.<br /><br />The case emphasizes that testicular cancer may present not with classic testicular symptoms, but with symptoms from metastatic spread, especially to retroperitoneal lymph nodes. It also highlights the importance of ruling out testicular cancer in men with retroperitoneal lymphadenopathy before biopsy, due to the risk of biopsy tract seeding and because seminoma can mimic other malignancies such as lymphoma.

Asset Subtitle

Hannah R. Ray

Meta Tag

Author List Brian Quinn, Hannah R. Ray

Category Clinical Vignettes

Concept Seminoma

Concept Stage II Seminoma

Concept Retroperitoneal Lymphadenopathy

Concept Stage II Disease

Concept BEP Chemotherapy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Hannah R. Ray

Track Adult

Keywords

seminoma

testicular cancer

retroperitoneal lymphadenopathy

paraaortic mass

BEP chemotherapy

beta-hCG

orchiectomy

hydronephrosis

gynecomastia

PET imaging

Seminoma

Stage II Seminoma

Retroperitoneal Lymphadenopathy

Stage II Disease

BEP Chemotherapy