The rare quadruplet: seminoma, microlithiasis, epididymal cyst and varicocele: a case report
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Abstract
Background: Seminomas account for nearly one-third of testicular germ cell tumors and are highly curable, with survival rates approaching 98% in early stages. The incidence of classic seminoma is rising in Pakistan. While the typical presentation is a painless testicular mass, diagnosis can be challenging when patients present misleading histories, such as scrotal trauma. Moreover, the coexistence of multiple testicular pathologies in a single patient is uncommon, further complicating the diagnostic process.
Case Presentation: We report the case of a 29-year-old male with a prior history of blunt scrotal trauma who presented with persistent swelling and ecchymosis. Ultrasound revealed multifocal hypoechoic intratesticular lesions with internal vascularity, alongside tubular ectasia of the rete testis, epididymal cysts, microlithiasis, and a left-sided varicocele. Tumor markers were largely within normal ranges. Frozen section during surgery suggested a neoplastic lesion, and left radical orchidectomy was performed. Histopathology confirmed multifocal classic seminoma (pT1a), limited to the testis with rete testis invasion, negative margins, and no lymphovascular invasion. Immunohistochemistry was positive for PLAP, CD117, and OCT3/4, supporting the diagnosis.
Conclusion: This case represents an uncommon scenario of multiple concurrent testicular pathologies coexisting with multifocal seminoma, initially masked by a history of trauma. It highlights the critical role of ultrasound as the first-line imaging modality, with definitive confirmation through histopathology and immunohistochemistry. Early surgical intervention remains the cornerstone of management, ensuring accurate diagnosis and favorable outcomes.
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