Abstract
BackgroundThe route of local and metastatic spread of testicular seminoma is well recognised and accepted. The spread is via lymphatics to the paraaortic nodes.Case PresentationWe present a case report of testicular seminoma in a 56 year old man with previously unreported histological findings. In this case seminoma tumour cells did not appear to have spread by the expected lymphatic route. There was no involvement of retro-peritoneal para-aortic lymph nodes. The tumour appeared to have spread directly along the vas deferans in the sub epithelial plane to the mesenteric lymph nodes.ConclusionThis type of seminoma tumour spread has not previously been described and it is not a recognised route for metastasis by seminoma tumour. In this case the macroscopic clinical appearance was of a stage I tumour with normal tumour markers. However, the pathological stage of the tumour was surprisingly increased to stage III on the basis of histology and CT radiological findings. We present the unusual histological findings. In view of this unusual histological finding we reinforce the need for accurate staging and for resection of the spermatic cord close to the deep inguinal ring. Accurate staging is crucial in planning the treatment and follow up of seminoma and determines the prognosis.
Highlights
The route of local and metastatic spread of testicular seminoma is well recognised and accepted
This type of seminoma tumour spread has not previously been described and it is not a recognised route for metastasis by seminoma tumour. In this case the macroscopic clinical appearance was of a stage I tumour with normal tumour markers
We present the unusual histological findings. In view of this unusual histological finding we reinforce the need for accurate staging and for resection of the spermatic cord close to the deep inguinal ring
Summary
Accurate staging is important because it dictates the management of the disease. Inaccurate staging has been reduced to approximately 20% in T1 – T3, N0, M0 disease using modern staging techniques [2]. Spermatic cord involvement is normally seen within the main cord vasculature or grossly involving the cord In this case the seminoma cells appeared to be spreading along the spermatic cord by "creeping" along underneath the epithelial lining of the vas deferans. The prognosis and period of remission remains uncertain in this case This case reinforces the need for high spermatic cord ligation and excision at the deep inguinal ring and immediate CT staging. This should be performed even in patients who are thought to have low stage disease and when tumour markers are normal. CT – computed tomography, TNM – tumour, node metastais staging system, AJCC – American Joint Committee on Cancer
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
