A 33-year-old male with no relevant medical or surgical history was admitted from the emergency room in the traumatology ward with a diagnosis of back pain refractory to home treatment.
Endocrine consolidation was performed in the pelvic cavity, in which a large retroperitoneal mass (paraaortic) was observed, which continued with the iliac axis at the left side and the iliac chains (9 mainly the external iliac cm).
The tumor is solid with small areas of necrosis.
The cervicothoracic TAC was normal.
1.
Puncture biopsy of the mass was performed and the pathological result was a seminoma type germ cell tumor.
Bilateral testicular examination was normal and testicular ultrasound reported multiple punctiform echogenic images in both testicles (but striking and extensive in the left testicle), but without a clear mass.
A bilateral testicular biopsy was performed.
In both tests the testicular biopsy revealed a pattern of "Sertoli cells only" syndrome, tubular hyalinization and microlithiasis.
1.
A LDH of 1903 and b-HCG of 23.8 with normal α-fetoprotein were noteworthy in the blood tests performed on the patient.
The patient was started on chemotherapy CTEP (Cisplatin and Etoposide).
After 4 cycles a control CAT scan was performed without achieving total disappearance of the retroperitoneal mass, leaving only two left paraaortic adenopathies and another in left iliac chain of approximately 3 cm each patient.
1.
In order to remove the remaining tumor mass after chemotherapy, a midline laparotomy was performed with resection of the lymph nodes and bilateral orchiectomy.
The study of the adenopathies reported fibrous tissue with lymphoid infiltration and necrosis without observing tumor.
The anatomopathological study of the testicles reported a single cell syndrome of Sertoli, with tubular important, hyaline calcifications and microlithiasis without observing a tumor.
After twelve months of follow-up, the patient is clinically asymptomatic with hormone replacement therapy and no radiological or analytical recurrence.
