We report the case of a 37-year-old man with a history of right orchidopexy failed due to inguinal testis in childhood and who came to the emergency department for inguinal discomfort, of approximately one month of evolution.
Physical examination revealed a left testicle with normal characteristics and an inguinal right testicle with an indurated region in its upper pole.
The rest of the examination showed no changes of interest.
The suspicion of a tumor was decided to perform an ultrasound, in which the undescended right testicle was objectified, in the inguinal duct, normal size and regular contours of testicular neoplasia, an image suggestive of solid testicular neoplasia.
The left test is found in the saccade and shows no abnormalities. Ultrasound examination of the abdominal cavity does not show retroperitoneal adenopathy or liver lesions.
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Once the findings were identified, the patient was admitted to hospital and a radical inguinal orchiectomy of the cryptorchidic test was performed.
During the procedure, a small visible lymphadenopathy was observed in the subcutaneous cellular tissue that was removed, as well as the skin with the scar from the previous surgery.
Preoperative tumor markers (LDH, alpha-fetoprotein and b-HCG) were normal.
During the postoperative period an extension study using abdominal CT scan seems to be performed, which does not show significant lymphadenopathy or space occupying lesions at any level, except for a small scar-nodular image on the left lung base
The result of the pathological study of the piece is testicular seminoma with testicular germ cell recurrence compatible testis, respecting tunica albuginea and epididymis cryptorchidism and with intralymphatic invasion (pT2), histological and parenchymal
The surgical margin (coron is persistent) is tumor-free.
A granulomatous histiocytic reaction with tumor cells isolated in the breasts and in one of the lymphatic vascular spaces is found in the lymph node removed. A immunohistochemical study is performed to determine the presence of alkaline phosphatase CD17 cells.
The case is presented in a joint meeting of the uro-oncological tumor committee, where it was decided to perform treatment with polychemotherapy.
