American Journal of Dermatology and Venereology

2015;  4(1): 9-11


Case Report: Testicular Seminoma in Sudanese Patient

Anilkumar Mitani1, Mohamed A. Hameed2, Gamal O. Elhassan3, 4, Khalid O. Alfarouk5, Abdel Khalig Muddathir6, Adil H. H. Bashir6

1University of Bahri, Bahri, Sudan

2Omdurman Islamic University, Omdurman, Sudan

3School of Pharmacy, Uneiazah University, AL-Qassim, KSA

4Faculty of Pharmacy, Omdurman Islamic University, Omdurman, Sudan

5Alfarouk Biomedical Research, LLC, Tampa, Florida, USA

6University of Khartoum, Khartoum, Sudan

Correspondence to: Adil H. H. Bashir, University of Khartoum, Khartoum, Sudan.


Copyright © 2015 Scientific & Academic Publishing. All Rights Reserved.


A male, 22 years old young man presented with left testicular mass and pain along left leg and lower back for one year; the mass is totally excised and sends to histopathology to be confirmed as Seminoma.

Keywords: Testicular Seminoma, Sudan

Cite this paper: Anilkumar Mitani, Mohamed A. Hameed, Gamal O. Elhassan, Khalid O. Alfarouk, Abdel Khalig Muddathir, Adil H. H. Bashir, Case Report: Testicular Seminoma in Sudanese Patient, American Journal of Dermatology and Venereology, Vol. 4 No. 1, 2015, pp. 9-11. doi: 10.5923/j.ajdv.20150401.03.

1. Case Report

A male patient, laborer, 22 years old, single, resident in Al-Gezira, South of Khartoum. The patient was complaining of painfully hard swelling at left testicle one year ago, no increase in testicle size at the first three months, then gradually increased to reach a grapefruit size in almost eight months. Patient’s general condition was good within two years before a sense of hotness in the left testicle on and off. No loss of weight or appetite, as no fever or night sweating. The condition started with sudden onset and progressive course, where received treatment in the form of tablets and capsules with no response. Patient has been admitted to hospital for enteric fever at childhood.
Family history: Parents are first-degree relatives, as no similar condition in the family.
On examination: Patient has normal facial features and good general condition.
Lesions are skin colored and Firm on palpation.
Palms &soles: not detected.
Nails: No nail dystrophy.
Hair: No Abnormality Detected.
Eye: No abnormality is seen.
Oral mucosa & Lips: No abnormality is seen.
Genital Examination: Left testicle is large in size about 12X8 cm, freely mobile, slightly tender, smooth surface with palpable 2 nodules, testicle is hard in consistency, spermatic cord couldn’t be palpated, and noregional inguinal lymph nodes are palpable, as Para aortic lymph nodes.Scrotal skin shows an ulcer 3X4 cm punched out, indurated, with necrotic floor, penis and pubic hair look normal on examination. Right testicle shows no abnormality. No palpable regional or Para aortic lymph nodes.

2. Investigations Did

Ultra sonography of both testicles:
Gross multiple ectopic left testicular mass with left spermatocele.
Right testicular size and pattern looks normal.
Histopathology: Gross: Hard growth, 13X8 in size, regular, smooth, with ill-defined spermatic cord structure.

3. Discussion

Figure 1. Scrotal swelling and necrotic ulcer
Testicular seminoma is a pathologic diagnosis in which only seminomatous elements are observedinhistopathologic review after a radical orchiectomy and in which serum alpha-fetoprotein (AFP) is within the reference range (Figures 1-6). Seminomas account forone-thirdof testicular germ cell tumors (GCTs), which are the most common malignancy in men aged 15-35 years [1]. The risk of testis cancer is 10-40 times higher in patients with a history of cryptorchidism; 10% of patients with GCTs have a history of cryptorchidism. Treatment usually requires removal of one testis, but this does not affect fertility or another sexual functioning.
Figure 2. Spermatic cord of the swollen testes
Figure 3. Excision of the scrotal ulcer prior to removal of the testicular tumor
The typical presentation in testicular seminoma is a male aged 15-35 years presents with a painless testicular lump that has been noticeable for several days to months, the patients commonly have abnormal findings on semen analysis at presentation, and they may be subfertile [2] and sometimes presented with hydrocele, and scrotal ultrasonography may identify a nonpalpable testis tumor. Some cases of seminoma can present as a primary tumor outside the testis, most commonly in the mediastinum [3]. The preferred treatment for most forms of stage 1 seminoma is active surveillance. Stage 1 seminoma is characterized by the absence of clinical evidence of metastasis. Active surveillance consists of periodic history and physical examinations, tumor marker analysis, and radiographic imaging. Around 85-95% of these cases will require no further treatment. Modern radiotherapy techniques, as well as one or two cycles single-agent carboplatin, have been shown to reduce the risk of relapse, but carry the potential of causing delayed side-effects. Regardless of treatment strategy, stage 1 seminoma has nearly a 100% cure rate [4]. Stage 2 seminoma is indicated by the presence of retroperitoneal metastasis. Cases require radiotherapy or, in advanced cases, combination chemotherapy. Large residual masses found after chemotherapy may require surgical resection. Second-line treatment is the same as for nonseminomas [5].
Figure 4a. Removal of the testicular tumor
Figure 4b. Removal of the testicular tumor
Stage 3 seminoma is characterized by the presence of metastasis outside the retroperitoneum—the lungs in "good risk" cases or elsewhere in "intermediate risk" cases. This is treated with combination chemotherapy. Second line treatment follows nonseminoma protocols [5].
Figure 5. the testicular tumor is totally removed
Figure 6. The case after the operation


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