A 39-year-old man presented with a 2-day history of worsening constant, dull diffuse lower abdominal pain with associated constipation and known history of left undescended testicle. He was evaluated at an outside hospital where a non-contrasted CT scan revealed a 20 cm well-circumscribed soft tissue mass within the pelvis.
He was referred and further imaging revealed a 12 cm heterogeneous mass with foci of air that appeared to be contiguous with the left spermatic cord. This constellation of findings could represent torsion of undescended left testicle with infarction or underlying malignancy. Tumour markers were only significant for elevated lactate dehydrogenase of 1445. A subsequent ultrasound-guided biopsy of the mass demonstrated seminoma.
Surgical resection revealed a large intra-abdominal mass emanating from the left spermatic cord with 270° of torsion. There appeared to be a left atrophic remnant testicle at the base of the mass with final pathology confirming the diagnosis of classic seminoma.
- urological cancer
- urological surgery
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Contributors ER was responsible for conception of the idea, acquisition of surgical/operative documentation, planning for case report and contributed to the production of the manuscript. DK assisted with the planning and conception of the project as the lead surgeon completing this case and contributed to the interpretation of the information presented. He also gave final approval for the version published. GD performed literature reviews and assisted in the organisation and procurement of data for the case including figures presented. EG was responsible for assisting with the conception and design, acquisition of data or analysis and interpretation of data as well as drafting the article and revising it critically for important intellectual content.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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