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Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 278-280
Seminoma of undescended testis presenting as acute abdomen

1 Department of Pathology, G.S.L. Medical College and General Hospital, Rajahmundry - 533 294, Andhra Pradesh, India
2 Department of Radiology, G.S.L. Medical College and General Hospital, Rajahmundry - 533 294, Andhra Pradesh, India
3 Department of Surgery, G.S.L. Medical College and General Hospital, Rajahmundry - 533 294, Andhra Pradesh, India

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How to cite this article:
Mohapatra M, Satyanarayana S, Mishra A, Rao K, Rao G B. Seminoma of undescended testis presenting as acute abdomen. Indian J Pathol Microbiol 2009;52:278-80

How to cite this URL:
Mohapatra M, Satyanarayana S, Mishra A, Rao K, Rao G B. Seminoma of undescended testis presenting as acute abdomen. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Jul 12];52:278-80. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/278/48948


An undescended testis is at a 3.5-5 times higher risk for development of testicular germ cell tumor, most commonly seminoma, compared with scrotal testis. Such a testis is also vulnerable to torsion due to rapid increase in tumor size and free mobility, which is a rare and difficult pre-operative diagnosis. Although there are a few case reports in the literature depicting such a rare complication, there is only one report from the Indian subcontinent ascribing such a complication. [1] Herein, we describe a case of a 29-year-old male who presented with acute abdomen and was subsequently diagnosed to be having seminoma of intraabdominal testis undergoing torsion on histopathological examination where the pre-operative diagnosis was not made.

A 29-year-old male presented with abdominal pain with a history of dragging pain in the right iliac fossa, radiating to the groin, of 3-4 weeks duration. The patient was febrile and revealed tenderness in the right iliac fossa on physical examination. Emergency sonography performed for presumed appendicitis showed a well-defined mixed echogenic mass in the pelvis. A contrast-enhanced abdominal computerized tomography scan demonstrated a well-defined iso to hyperdense mass of size 8.7cm × 8.5cm with air within the mass [Figure 1]. The mass was noted in the pelvis, superior and anterior to the bladder, which was suggestive of a solid mass/bowel mass. Diagnostic laparoscopy was planned for the patient. Pre-operative investigations showed a total leukocyte count of 12,900/cmm, serum bilirubin of 6.3mg/dL, with an indirect bilirubin level of 4.0mg/dL. While doing diagnostic laparoscopy, a mass was found in the hypogastrium extending into the anterior abdomen. Hence, immediate laparotomy was performed. Surgical exploration revealed a soft mass in the suprapubic region below the tip of the appendix measuring 9.0cm × 8.0cm × 3.0cm. The mass was excised.

On gross examination, it was a pear-shaped solid, reddish brown mass measuring 9.0cm × 8.0cm × 3.0cm. A cut section revealed a well-circumscribed soft mass with foci of hemorrhage, necrosis centrally and compressed firm tissue peripherally [Figure 2].

Microscopically, hematoxylin and eosin-stained sections showed a tumor comprising of round to polyhedral cells arranged in sheets, groups, cords and trabeculae separated by fine fibrocollagenous septae traversed by a good number of lymphocytes. These cells exhibited a distinct cell border with scanty amount of eosinophilic to clear cytoplasm, large round to oval pale nuclei having fine chromatin pattern and some showed prominent nucleoli. The stroma showed extensive areas of hemorrhage, necrosis, good number of congested thrombosed blood vessels and lymphocytic infiltration [Figure 3]. The case was diagnosed as torsion of seminoma of intraabdominal testis. Subsequent clinical examination revealed absence of testis in the right scrotal sac, which was missed clinically and in the imaging studies.

Undescended testes are seen infrequently with the incidence of one in 500 men but can be associated with complications like cancer, infertility and ischemia. [2] The peak age of cancer in undescended testis is similar to that in scrotal testes, generally the third to fourth decade of life. Clinical presentations of malignant intraabdominal testes can range from an asymptomatic mass to symptoms simulating appendicitis or retroperitoneal mass, incarcerated hernia, urinary frequency or dysuria from mass effect on bladder or acute abdominal pain due to torsion and hemorrhage. [3],[4],[5] Often, radiologic and pre-operative diagnosis of torsion of intraabdominal testicular tumor is rare and difficult because, usually, the history of cryptorchidism is not provided and the imaging features can be non-specific. However, a detailed history taking, thorough physical examination, meticulous inspection of radiological films and, above all, the awareness of such complication involving maldescended testis can enhance the diagnostic yield.

To conclude, we would emphasize that in any male patient with acute abdominal symptoms and absence of scrotal testis, a high index of suspicion for intraabdominal testicular torsion should be maintained.

   Acknowledgement Top

The authors are thankful to the staff of Pathology Department of G.S.L. Medical college, Rajahmundry for their help and cooperation.

   References Top

1.Surana SS, Dixit SM, Sharma VP. Intraabdominal torsion of seminoma testis. Indian J Cancer 1983;20:218-20.  Back to cited text no. 1    
2.Miller FH, Whitney WS, Steven WF, Miller EI. Seminoma complicating undescended intraabdominal testes in patients with prior negative findings from surgical exploration. AJR Am J Roentgenol 1999;172:425-8.  Back to cited text no. 2    
3.Chou YH, Chen CH, Huang CJ, Li HH, Huang CH, Huang TJ. Torsion of a malignant undescended testis. Kaohsiung J Med Sci 1998;14:308-10.  Back to cited text no. 3  [PUBMED]  
4.Frank RG, Gerard PS, Barbera JT, Lindsay K, Wise GJ. Torsion of an intraabdominal testis tumor presenting as an acute abdomen. Urol Radiol 1990;12:50-2.  Back to cited text no. 4  [PUBMED]  
5.Memon AS, Siddiqui FG. Cryptorchid testicular tumor presenting with torsion. J Coll Physicians Surg Pak 2003;13:118-9.  Back to cited text no. 5  [PUBMED]  

Correspondence Address:
Manisha Mohapatra
Department of Pathology, G.S.L. Medical College and General Hospital, NH- 5, Lakshmipuram, Rajahmundry - 533 294, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.48948

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  [Figure 1], [Figure 2], [Figure 3]

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