On today’s conference we discussed a case of young male patient with 3 month history of nonspecific (diffuse -> RUQ) abdominal pain who presented with acute sharp epigastric abdominal pain. After ruling out life threatening causes of abdominal pain, CT abdomen + pelvis showed bulky retroperitoneal lymphadenopathy. DDx for this includes infectious (bacterial, viral including HIV, mycobacterial, spirochete including syphillis and lyme), inflammatory (sarcoidosis, amyloidosis, castleman) and neoplastic (lymphoma, testicular cancer). Biopsy was not needed since patients bHCG and AFP were extremely high pointing to non-seminematous germ cell tumor (NSGCT).
Testicular cancer is common with a rising incidence and is highly curable. More information about the case here: abdominal pain – 12.9.2019
Take home points:
- Include less common etiologies in your abdominal pain schema
- Testicular cancers are mostly seminoma and NSGCT, seminomas are more indolent and sensitive to radiation
- Staging includes imaging, tumor markers and orchiectomy +/- RPLND without biopsy