Testicular Seminoma After Testicular Torsion Presenting With a Contralateral Inguinal Lymph Node Metastasis: A Case...

We report the case of an adult male developing a right lymphadenopathy 18 months after being diagnosed with seminoma of the left testis and with a prior history of torsion of the left testis. This is a rare presentation of metastasized germ cell tumor, making it even more exceptional due to the contralateral localization and preceding testicular torsion. A 44-year-old male was diagnosed with non-metastatic seminoma of the left testis, after having a detorsion and bilateral orchiopexy for torsion of the left testis four years earlier. Eighteen months after an inguinal orchiectomy, he presented with a swollen mass in the right inguinal region. No other lesions were visible on computed tomography (CT) thorax-abdomen and magnetic resonance imaging (MRI) of the brain at the time of presentation. Resection and histopathological examination revealed an inguinal lymph node metastasis of the seminoma. In the meantime, the patient developed four subcutaneous nodules on the abdominal wall, but an additional biopsy was negative. Postoperatively, a curative treatment with three cycles of bleomycin, etoposide, and cisplatin (BEP) was suggested. Contralateral lymph node metastases from seminoma are extremely rare but may be explained by altered lymphatic drainage following prior scrotal or inguinal surgery. We therefore advise including a bilateral inguinal clinical examination within this specific patient population. Although no association has been established between a history of testicular torsion and the risk of developing germ cell tumors, clinicians should consider potential testicular malignancy in elderly male presenting with a testicular torsion.