Blunt testicular trauma results in rupture of testicular cancer

Sallami Sataa |

La tunisie chirurgicale - 2019 ; Vol 2019

Resumé

Testicular trauma revealing testicular cancer is extremely rare with exceptional citations in the literature .The review of clinical features in a series of 73 patients with germ-cell testicular cancer revealed only 2 cases that were found after testicular trauma .

Mots Clés

Traumatisme fermé, testicule, cancer

Introduction :

Testicular trauma revealing testicular cancer is extremely rare with exceptional citations in the literature (1).The review of clinical features in a series of 73 patients with germ-cell testicular cancer revealed only 2 cases that were found after testicular trauma (2).

In such condition, clinical examination is often limited because of scrotal pain and swelling, and may lead to the misdiagnosis of an eventual associated condition (3).

Ultrasonography with Doppler flow is the investigation of choice in evaluating the integrity of scrotal contents and to detect any scrotal abnormalities (4).

Early surgical treatment of serious scrotal trauma is recommended (4). However, no general agreement exists regarding how to manage intrascrotal rupture of a testicular cancer and what to do in post-orchidectomy (3). Capelouto et al. suggest that scrotal incision does not significantly worsen the overall prognosis with current multimodal therapy (5).

 

Herein, we report a new case of incidental testicular cancer diagnosed after surgical exploration for testicular blunt trauma.

 

Article

CASE REPORT:

27-year-old male presented, to the emergency department, with acute right testicular pain after being kicked in the scrotum by an aggressor. He reported being aggressed 2 hours earlier with gradual swelling of the right testis.

On clinical examination, the right testis was tender, irregular, firm, enlarged and triple in size compared to the contralateral side with multiple ecchymosis around the scrotal skin towards the base of the penis and the right groin. The left testis was normal.

The Doppler ultrasonography showed a large heterogeneous echo-texture with very little vascularity in the right testicle consistent with a hematoma and serious testis damage (fig. 1).

 

Urgent surgical exploration was performed through the scrotal approach, using a midline incision. During surgery, he was found have an unsalvageable right testis with large hematocele thus an orchidectaomy was performed. The postoperative course was uneventful and the patient was discharged home the day after surgery without complications.

 

Unpredictably, histology revealed an incidental ruptured classical seminoma with teratoma and Yolk sac tumour (Figure 1 and 2). Secondary, we performed an ipsilateral scrotal excision.

 

The patient was referred to the Oncology Department for further management. A staging computed tomography scan showed multiple ipsilateral pelvic retroperitoneal lymph-nodes.

Serum α-fetoprotein, lactate dehydrogenase and human chorionic gonadotropin levels were within normal limits on postoperative day 8.  

After 4 cycles of BEP (bleomycin, etoposide and cisplatin) at the 38 months follow-up, there were no signs of recurrence of his primary disease or metastasis and tumour markers were within normal limits.

 

CONCLUSION:

We point on, through this observation, the importance of keeping a certain index of suspicion for co-existing neoplastic pathology for any blunt injury to the scrotum that may result in testicular rupture. Moreover, even in the presence of accurate diagnostic tools, a testicular cancer may be masked by the damaged testicular parenchymal tissue.

Figure 1: Seminoma with pronounced infiltration of mymphocytes (25XHE).

Figure 2: Yolk sac tumour. A : endodermal sinus pattern (40XHE). B: solid pattern (40XHE). Insert : weak expression of α-Foeto-protein (40ximmunohistochemistry)

Références

  1. Luchey A, Rogers A, Saunders SE, Williams HJ, Fooks HJ, Zaslau S. Blunt testicular trauma results in rupture of mixed germ cell tumor. Can J Urol. 2009;16:4955-7.
  2. Fernández Gómez JM, Guate Ortiz JL, Martín Huescar A, et al. Clinical presentation of testicular germinal cancer. Arch Esp Urol. 2002;55:915-22.
  3. Lunawat R, Craciun M, Omorphos S, Weston PMT, Biyani SC. Seminoma presented as testicular rupture: Case report and literature Review. Can Urol Assoc J. 2014;8:749-51.
  4. Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol. 2006;175:175-8.
  5. Capelouto CC, Clark PE, Ransil BJ, Loughlin KR. A review of scrotal violation in testicular cancer: Is adjuvant local therapy necessary? J Urol. 1995;153:981-5.