Synchronous bilateral seminoma.

Area of Science:

• Urology
• Oncology
• Reproductive Medicine

Background:

• Testicular germ cell tumors are the most common cancer in young men aged 15-35.
• Bilateral testicular neoplasms, occurring synchronously or metachronously, have an incidence of 2-3%.

Observation:

• A 25-year-old male presented with multifocal bilateral testicular tumors and azoospermia.
• Bilateral inguinal radical orchiectomy was performed, with pathological diagnosis of bilateral seminoma.
• Adjuvant radiotherapy was administered, and the patient remained asymptomatic with no evidence of disease post-treatment.

Findings:

• Bilateral radical orchiectomy is the standard treatment, resulting in infertility and dependence on androgen supplementation, impacting physical and psychological well-being.
• Testis-sparing surgery is a viable option for selected cases, potentially avoiding androgen deficiency and associated quality of life issues.
• Scrotal radiotherapy is indicated for carcinoma in situ in the remaining parenchyma, offering good oncological outcomes.

Implications:

• While bilateral orchiectomy offers good oncological results, it leads to permanent infertility and potential psychological challenges.
• Partial orchiectomy in carefully selected patients may preserve fertility and quality of life without compromising oncological outcomes.
• Close clinical and imaging follow-up is crucial for patients undergoing conservative management of bilateral testicular tumors.