Tumor in undescended intrapelvic testis revealed by supraclavicular lymphadenopathy: a case report and literature review
- Mohammed Fadl Tazi†1, 2Email author,
- Omar Riyach†1,
- Mustapha Ahsaini†1,
- Youness Ahallal1,
- Abdelhak Khallouk1,
- Mohammed Jamal El Fassi1 and
- Moulay Hassan Farih1
© Tazi et al.; licensee BioMed Central Ltd. 2013
Received: 24 August 2012
Accepted: 25 March 2013
Published: 26 April 2013
Testicular cancer is a rare disease. The incidence of testicular cancer in undescended testicles is of 3 to 48 times greater than in the general population. In the developed countries, the existence of undescended testicles in the adult population is rare, due to systematic practice of elective orchidopexy before the second year of life and orchiectomy in post adolescent males with undescended testicles. Despite these prevention measures, there are still some isolated cases of intra-abdominal testicular tumors in adults. We report a case of testicular cancer in cryptorchid testis revealed by supraclavicular lymphadenopathy.
We report a case of a 46 year old fertile man with a history of unilateral cryptorchidism who presented with a palpable left supraclavicular mass and absence of the right testicle. On investigations an intrapelvic testis tumor was diagnosed. Laparotomy and complete excision was carried out. The possible association between the undescended testis and cancer transformations is briefly discussed.
Testicular cancer in undescended testicles should not be ignored. Only early diagnosis and lower of testis in scrotumprevent such clinical forms.
Cryptorchidism (testicular maldescent), the most common congenital anomaly of the genitourinary tract in males, is encountered in 1% of boys. The incidence increases in subjects with deficiencies of androgen function . Such an organ is at high risk of torsion, trauma, infertility, and malignancy. A tumor of an intra-pelvic testis in a fertile patient revealed by supraclavicular lymphadenopathy is reported in this case.
The testicular cancer represents 1-2% of all male malignant tumors and 4% of the urogenital ones. It is the more frequent solid neoplasia in young men between 20-35 years meaning the 1-2% of total tumors  There are many etiological proposed factors in the development of testicular cancer: traumatisms, testicular atrophy, and gonadal dygenesis, being cryptorchid and the history of tumor in the contralateral testicle the most significant [2, 3]. In cryptorchidic testicles the incidence of testicular cancer is considered between 3 to 48 times greater than in the general population [4, 5]. Approximately a 10% of all the testicular tumors appear on an undescendent testicle [4, 5].
Cryptorchid affects 0, 4% of male. The non-palpable testicles correspond to a 20% of the cryptorchidic testicles. Of the non-palpable testicles, only in 20% of the cases it is absent, the rest is in the abdomen or the inguinal canal. Between undescended testicles, abdominal testicles present a higher rate of malignity than the ones located in the groin inguinal . The abdominal testicles develop cancer in 30% of cases .
The tumors in undescendent testicles are rare. The histopathology of the undescendent testicle tumors in the adult depends on location, being the proportion of pure seminoma of 93% when it is in intra-abdominal situation, 63% if it is inguinal and 28% in normotopic testes . The prognosis will depend on initial stage and tumor histology.
In the developed countries, the existence of undescended testicles in the adult population is rare, due to systematic practice of elective orchidopexy before the second year of life, to prevent cancer and infertility. Orchidopexy does not eliminate cancer risk but allows an early diagnosis being testicle accessible to exploration [8, 9].
There are many studies published on cryptorchidism and cancer in undescendent testicles. There is no long series of intra-abdominal testicular tumors in the literature. The majority of them corresponds to a case reports. Searching in PubMed, they are approximately 42 clinical cases of seminomas in intra-abdominal testicles published. In a 1930 article, a 8% incidence of Supra-calavicular lymphnodular metastasis have been recorded. In an article from Kenyata, an incidence of 17.91% has been recorded . The greatest part was between the decade of 50 and 80. Afterwards, there were less published cases due to advances in investigation on the evolution of undescendent testicles, its relation with cancer and the prevention actions taken. In the last 20 years there were less published cases, which would be explained by the progressive reduction due to the prevention of tumors incidence in abdominal testicles .
The abdominal variant of cryptorchid testis is rare and carries a high risk of malignant transformation. Very rarely they can be revealed by a supra-calavicular node. Early diagnosis and treatment of cryptorchidism can dramatically reduce the risk of testicular cancer and probably preserve the fertility, as well as, the virility of the patient.
Written informed consent was obtained from the patient for publication of this manuscript and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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