LAUSR

A 30-year-old male with no co-morbidities was referred from a regional hospital having presented to his general practitioner with abdominal bloating, fevers and weight loss for 1 month. On examination, a large abdominal mass along with a small left inguinal lump were palpable, as well as an empty scrotum. On further questioning, his scrotum had been empty since birth awaiting eventual testicular descent based on medical advice received in a developing country. Initial ultrasound examination demonstrated a large abdominal vascular mass measuring 16.3 × 15.8 × 9.96 cm, which was confirmed by computed tomography imaging (Fig. 1). The mass displaced the right kidney and ureter causing hydronephrosis, and compressed the gallbladder with para-aortic lymphadenopathy (>1 cm). An ovoid mass in the left groin and empty scrotum was also noted. Abnormally elevated serum tumour markers, specifically betahuman chorionic gonadotropin (100 IU/L) and lactate dehydrogenase (1740 U/L) and normal alpha-fetoprotein (2.7 μg/mL), accompanied with the clinical findings were suggestive of testicular neoplasm in an undescended testis. Laparotomy and right abdominal orchidectomy were performed in a tertiary urology unit. Intraoperatively, the tumour dimensions were 15 × 12 × 8 cm, and weighed 1.25 kg (Fig. 2). Formal histology demonstrated 100% seminoma (pT1), consistent with intraoperative frozen section diagnosis. His post-operative recovery was unremarkable followed by orchidopexy and biopsy of the left testis, which demonstrated absence of seminiferous tubules or sperm, consistent with preoperative azoospermia. Staging investigations performed 2 weeks’ post-orchidectomy showed normal serum tumour markers, retroperitoneal lymphadenopathy (<2 cm) and no other evidence of metastatic disease in the chest, abdomen or pelvis. This represented a Stage IIA pure seminoma (pT1cN1M0S0) and he went on to receive three cycles of bleomycin, etoposide and cisplatin.