|Year : 2012 | Volume
| Issue : 2 | Page : 122-123
Primary extragenital retroperitoneal seminoma in an HIV positive man
Babji Korukonda, Bhavani R Reddi
Department of General Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
|Date of Web Publication||11-Jul-2012|
Bhavani R Reddi
Associate Professor of Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Germ cell tumors in the male usually present as a swelling in the testis. Approximately, 1-2% of germ cell tumors arise in extragonadal locations. These tumors often grow to a considerable size before symptoms arise. A mass of primary extragenital retroperitoneal seminoma in the hypogastric region causing intestinal obstruction is rare. Though intracranial primary seminoma in an HIV person reported before, we believe this is the first case of retroperitoneal primary seminoma reported in an HIV positive man.
Keywords: HIV positive, primary retroperitoneal seminoma, germ cell tumours
|How to cite this article:|
Korukonda B, Reddi BR. Primary extragenital retroperitoneal seminoma in an HIV positive man. J NTR Univ Health Sci 2012;1:122-3
| Introduction|| |
Germ cell tumors in the male are usually present as a swelling in the testis. Approximately, 1-2% of germ cell tumors arise in extragonadal locations. Though intracranial primary seminoma in an human immunodeficiency virus (HIV) person reported before, we believe this is the first case of primary extragenital retroperitoneal seminoma reported in an HIV positive man.
| Case Report|| |
A 30-year-old man arrived with colicky abdominal pain and a lump in lower abdomen of 1 month duration. He was constipated for the last 2 days. Clinical examination revealed an ill-defined large, irregular, fixed mass in the hypogastric region. Both testes appeared normal.
Plain abdominal radiograph showed few fluid levels. He was tested positive for HIV. Abdominal ultrasonography revealed a well-defined solid mass in the infraumbilical region measuring 110 mm × 115 mm. It is compressing ureter causing mild hydronephrosis, suggesting its retroperitoneal position. The cause for subacute intestinal obstruction was revealed at the rectosigmoid junction in the form of extrinsic pressure. Subsequent CT scan confirmed the ultrasonic findings. FNAC suggested a germ cell tumor.
Blood tumor markers revealed a raised LDH, mildly raised β HCG, and normal alpha feta protein levels. The CD4 count was 465 cells/mm 3 . Staging investigations showed no evidence of metastases. The patient underwent exploratory surgery in view of the subacute intestinal obstruction. [Figure 1] and [Figure 2] Peroperatively, the mass was noticed in the lower abdomen, with adhesions between bowels and the tumor. Tumor was excised, thus relieving the pressure over the rectosigmoid junction. Biopsy demonstrated the features of seminoma. The patient has been treated with 4 cycles of etoposide and cisplatin, from which he had a good response. At 1 year follow-up, the patient remains disease free.
| Discussion|| |
Most of the extragonadal germ cell tumors arise either in the retroperitoneum or in the mediastinum. , One case of primary germ cell tumor was reported in the intracranial location in an HIV patient.  This paper presents what appears to be the first case report of a primary germ cell tumor in an HIV patient at retroperitoneal site.
Extragonadal germ cell cancer usually presents as a bulky tumor, which has a tendency to wrap around and invade the surrounding vessels. ,, The extragonadal origin is now accepted, although with clinically normal testes occult or spontaneously-regressed testicular primary tumors may be difficult exclude. 
As only few cases of extragonadal seminoma with intestinal obstruction have so far been reported, no definite conclusion has been reached regarding the optimal therapy for advanced stage or for bulky local disease. Etoposide and cisplatin chemotherapy instituted postoperatively. ,
| Acknowledgement|| |
Dr. Maithili, Dr. Vijaya Prasad
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[Figure 1], [Figure 2]