Problems in the management of testicular seminoma associated with a horseshoe kidney

Four patients with seminoma of the testis and coexisting horseshoe kidney are presented. Three patients had stage one disease, which would conventionally be managed by abdominal nodal irradiation. However, because of the risk of radiation nephritis, a surveillance policy was adopted with regular computed tomography (CT). Two of these three patients have relapsed and are disease free after chemotherapy. The fourth patient had Stage IIC disease which initially responded to combined radiotherapy and chemotherapy. This patient's disease relapsed and he died despite further treatment. Because of the altered retroperitoneal anatomy, CT interpretation must be made with special care.