Unusual case of classic testicular seminoma in a 90-year-old patient: a case report
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(2020) 14:182
CASE REPORT
Open Access
Unusual case of classic testicular seminoma in a 90-year-old patient: a case report Ahmad Al-Mousa1, Mohammad Nour Shashaa2* , Mohamad Shadi Alkarrash2, Mohamad Alkhamis2, Lina Ghabreau3 and Mouhsen Dandal1
Abstract Background: Seminoma is the most common subtype of testicular cancer and occurs most commonly in patients aged 30–49 years, but decreases to a very low level in men in their 60s or older. Case presentation: A 90-year-old Syrian man with a 6-year history of an increase in size of his right scrotum, presented to the urological clinic and, on clinical examination, the findings suggested testicular tumor. After orchiectomy and histology results based on microscopic and immunohistochemical examinations, a pure seminoma was diagnosed, so we describe in this case report the second-oldest patient with classical seminoma in the medical literature. Conclusion: This case report has been written to focus on the probability of any type of testicular tumor occurring at any age or decade; urologists should consider seminoma as a differential diagnosis with any testicular swelling even in elderly patients. Keywords: Seminoma, Testicular tumor, Scrotum
Background Testicular cancers account for approximately 1–1.5% of all cancers in men and 5% of urological tumors [1]. It commonly presents as a painless, nodular unilateral mass [2]. Testicular cancers include germ cell tumors (GCTs) 90–95% and non-germ cells tumors (NGCTs)10–15%. GCTs are mainly categorized into unclassified type; seminoma (pure or classic, syncytiotrophoblastic and spermatocytic), and non-seminomatous-type tumors include embryonal carcinoma; yolk sac tumor; choriocarcinoma; other trophoblastic tumors; teratoma (mature, immature, or malignant); and mixed tumors [3, 4]. Seminoma is the most common testicular germ cell neoplasm and accounts for about 50% of all GCTs, which occur most commonly in patients aged 30–49 years [5]. * Correspondence: [email protected] 2 Faculty of Medicine, University of Aleppo, Aleppo, Syria Full list of author information is available at the end of the article
Less than 20% of patients with stage I seminoma will have retroperitoneal lymph node metastatic disease [6]. In this case report, we describe a classic seminoma that was diagnosed in a 90-year-old patient, who is the second-oldest patient with this condition in the medical literature.
Case presentation A 90-year-old Syrian man with a 6-year history of an increase in size of his right scrotum, without pain presented to the urology clinic with enlargement of, and slight pain in, his right testis. He is a farmer with seven sons and has been smoking for 55 years. In his medical history, he had controlled hypertension and no history of testicular trauma or inflammation. A clinical examination showed the presence a painless, massive enlargement occupying his right scrotum, impermeable to light and with no inguinal lymph node palpable. His vital signs were within normal limits. A scrotal ultrasound scan showed a hypoech
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