Asian Journal of Case Reports in Surgery

Aims: An individual with testicular malignancy can present with a large abdominal mass. Such mass can be secondaries in retroperitoneal lymph nodes (RPLN), a malignant cryptorchid testis itself, or both. This article aims to highlight the importance of thorough genitourinary examination in males presenting with abdominal masses and of vigilance at image interpretation and explorative surgery for multiplicity of masses.

Presentation of Case: We report a case of one adult male in his forties presenting with a large intra-abdominal mass. Examination revealed bilateral cryptorchidism; historical inquiry revealed a state of subfertility for nearly 10 years. Case has neither sought treatment for subfertility, nor was aware of emptiness of his scrotum. Computed Tomography (CT) revealed one retroperitoneal mass suspicious of malignant intra-abdominal testis. At laparotomy, we encountered two separate intra-abdominal masses connected through a pedicle, a RPLN mass, and a malignant intra-abdominal testis.

Discussion: Cryptorchid abdominal testis poses increased risk of malignancy. Cases as such present in interesting ways; an intra-abdominal mass is the commonest. Such a mass can contain either or both primary testicular tumor and enlarged RPLN which, CT can often clearly define. However, there are times when surgeon face intra-operative surprises, encountering two masses instead of one, as reported by the imaging.

Conclusion: This case reinstates the necessity of a thorough genito-urinary examination as a part of routine evaluation of males presenting with abdominal masses. Radiologist and operating surgeon need to be vigilant to look for multiplicity of masses, corresponding to primary testicular tumor and RPLN mass.