Giant intra-abdominal seminoma.

T susceptibility to malignancy of an undescended testis is well established. We report a 56-year old patient with giant intraabdominal seminoma of right undescended testis with no lymph node or distant metastasis, and normal left testis. The tumor was completely excised. The late presentation and size of the tumor were discussed. The patient is now 40 months postoperatively with no evidence of local recurrence or metastasis. A 56-year-old man, smoker one pack/day for 40 years, carpenter, married for 2 wives with kids. He was admitted with right upper quadrant and right loin pain of 4 weeks duration. The pain was colicky in nature, mild in severity, radiates to right groin, and is associated with attacks of urinary frequency, and dribbling. He has no hematuria, no fever, chills or rigors, and no history of weight loss or change in appetite. On examination the patient was healthy looking, his head and neck exam were within normal limits, and there was no lymph node enlargement. Chest exam showed no pathology. Abdominal examination showed a pelviabdominal mass 24cm x 18cm, directly beneath the skin, extending above the umbilicus, hard in consistency, and mobile in horizontal axis, there was no hepatosplenomegally, no inguinal hernias or lymph node enlargement. Scrotal examination showed absence of the right testis and normal scrotum Figure 1.1 Investigation showed elevated alkaline phosphatase (10 times the normal), and B-HCG (4 times the normal). Sperm analysis was within normal limits, alpha feto protein, prostate specific antigen, and carcino emberionic antigen was within normal limits. The CT scan shows a huge solid mass arising from the pelvis and reaching the upper abdomen with calcification, no liver lesions or para-aortic lymph node enlargement. Intravenous pyelogram: Pelvi-abdominal mass causing lateroposterior deviation of both ureters. Angiogram identified a feeding vessel as a branch from internal iliac artery. Fine needle aspiration was carried out transabdominally and showed a germ cell tumor that was most likely seminoma.The abdomen was explored under general anesthesia through a midline laparotomy, the mass was solid, not adherent to any intra abdominal structure, and the pedicle was identified and divided. The mass was approximately 1850 gram