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Mechanism of unusual presentation of testicular tumour: case study and literature review- Angela Yan- Whittington Health NHS Trust - UCL Medical School
Testicular cancer is an increasingly prevalent cancer especially amongst young and middle-aged men. Most commonly it presents as a painless mass but atypical presentations are wellknown and have been reported in the literature. A 45-year-old male presented with acute periumbilical pain. After an unremarkable clinical examination of the abdomen and genitalia, an abdominal computerised topography (CT) scan showed a solitary enlarged para-aortic lymph node (30 mm) and ultrasound scan (USS) showed a 15x6x11 mm left-sided testicular lesion. Tumour markers were normal. CT-guided biopsy of the para-aortic lymph node revealed metastatic deposits from classical seminoma. We hereby discuss possible mechanisms of an enlarged para-aortic lymph node causing periumbilical/abdominal pain with reference to the normal anatomical structures present in the vicinity of the para-aortic lymph nodes in the retroperitoneum. We also present our findings of a litreature review of similar case presentations and discuss the comparison between those cases and the index case. We conclude that clinicians should undertake careful assessment of the genitals routinely when assessing men presenting with acute abdominal pain, and consider a testicular USS to exclude impalpable lesions, particularly when the clinical presentation is inconsistent with acute abdominal visceral pathology.
Angela Yan, Zhi Yang Low, Dhili Arul and Sudhanshu Chitale