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|Year : 1983 | Volume
| Issue : 4 | Page : 261-2
Malignancy in an intra-abdominal testis with renal agenesis (a case report).
Chaudhary AA, Kohli PK
|How to cite this article:|
Chaudhary A A, Kohli P K. Malignancy in an intra-abdominal testis with renal agenesis (a case report). J Postgrad Med 1983;29:261
The susceptibility to malignancy of an undescended testis is well established. The present communication is a case report in which unilateral renal agenesis was also present, posing an additional problem in the management.
M.S., a 30 year old male, was admitted with pain in the left upper abdomen and weight loss (4 kg) of 2 months' duration. There were no urinary symptoms. His right testis was absent since birth.
On examination, there were two intra-abdominal lumps. One was in the right iliac fossa and hypogastrium, 4 cm X 2 cm in size, oval, hard, nodular and bimanually palpable per rectum. The second lump was in the left upper abdomen, g cm X 6 cm in size, irregular, hard and fixed. The right testis was absent and the scrotum was poorly developed on this side. There was no inguinal lymphadenopathy.
The relevant blood and urine investigations were normal. Chest X-ray was also normal. Plain X-ray of the abdomen showed a soft tissue shadow in the left upper abdomen. Even on a double dose I.V.P., the right kidney and the ureter could not be seen. The left ureter was dilated and pushed laterally in the lower part. There was a smooth impression on the dome of the bladder [Figure - 1]. The clinical impression was malignancy in an intra-abdominal testis with metastasis in para aortic nodes and non-functioning right kidney.
On exploration, there was a 7 cm X 3 cm tumour in the pelvis. Spermatic cord and testicular vessels were seen passing from this swelling. It was infiltrating the dome of urinary bladder and sigmoid colon [Figure - 2] and could be separated from the latter by sharp dissection but a portion of the bladder wall had to be excised with it.
Another mass, a group of lymph nodes, was present in the left para-aortic region sitting over the left kidney and aorta. The right kidney was absent and the right ureter could not be identified.
Excision of the primary tumour and biopsy from the unresectable para-aortic secondaries were performed. Suprapubic cystostomy was added after the repair of the bladder defect. Histologically, it revealed a well differentiated seminoma and the para-aortic nodes confirmed secondary deposits. Post-operative course was uneventful and the patient was discharged with advice to come for radiotherapy.
Radiotherapy posed a special problem in this patient as his right kidney was absent and the lymph nodal mass was sitting right over the solitary left kidney. Keeping in mind the lethal dose for kidney (1800-2000 rads) he was given whole abdominal irradiation initially. After receiving about 1200 rads, the tumour size reduced by 80 per cent and later the kidney was shielded before abdominal irradiation. No tumour could be felt at completion of the therapy. He had been put on chemotherapy after mediastinal irradiation.
The association of malignancy in undescended testis is well established. Undescended testis is about 20-48 times more prone to malignancy,,  intra-abdominal testis being 5 times more liable than inguinal. Stage-wise prognosis in these cases is no different. Overall prognosis, however, is relatively bad since these tumors, being inaccessible for examination, are noticed late and are apt to involve the surrounding vital structures before a diagnosis is made, as happened in the present case.
Congenital upper urinary tract anomalies occur in about 13 per cent of cases of undescended testis. Therefore, routine I.V.P. is recommended in all patients with undescended testis. Commonly encountered anomalies include ureteral duplication, uretero-pelvic junction obstruction, renal malrotation and renal agenesis. The last mentioned anomaly is reported to account for 30 per cent of all congenital urinary tract anomalies in association with undescended testis. Such patients need a careful treatment planning to avoid inadvertent damage to the solitary kidney. The present communication is aimed to bring awareness of such a condition in the routine management of testicular malignancy in undescended testis.
The authors would like to gratefully acknowledge the help and guidance of Dr. S. P. Kaushik in preparation of this manuscript and his permission to publish the case.
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