No abstract

Unilateral renal agenesis is usually asymptomatic and may be found incidentally during examination for other causes. The incidence of testicular tumors arising from cryptorchidism is well established, but if it is coexistent with ipsilateral renal agenesis, the diagnosis and management becomes a challenge. Only three cases of such association have been reported in literature so far. This association has to be kept in mind when dealing with a case of testicular tumor arising from abdominal cryptorchidism, so that the function of the other kidney can be assessed before surgery, and protection given to it in the event of using radiotherapy in an adjuvant setting.Keywords Seminoma . Intra-abdominal cryptorchidism . Unilateral renal agenesis Case ReportA 43-year-old man presented with the history of a progressively increasing lump in the left side of the abdomen for 4 months. On examination a 20×15 cm large, hard, intraabdominal lump was found involving the left hypochondrium, lumbar, and iliac fossa. The left testis was absent and the scrotum was poorly developed on the left side.Ultrasonography of the whole abdomen revealed a large, heterogeneous mass measuring 16×12 cm in the region of the left kidney. The right kidney and the ureter were normal. Contrast-enhanced computerized tomography (CECT) of the whole abdomen revealed a large variegated mass in the left lumbar region. No normal renal parenchyma and ureter could be identified. The right kidney and the ureter were normal. CECT findings were suggestive of a renal neoplasm, possibly renal cell carcinoma (Fig. 1a).Keeping in mind the possibility of the neoplasm arising from an abdominal cryptorchidism, tumor markers were done. Serum LDH (939 units/l) and β-HCG (10.43 mIU/ml) were raised, while serum AFP (3.25 ng/ml) was within normal limits. Thus, the diagnosis was further confounded, as the normal renal parenchyma and ureter were not visualized at all in either the normal or any ectopic position. A decision was taken to do a radionuclide renogram using Tc-99 m-DTPA. This confirmed the absence of the left kidney and ureter (Fig. 1b). Cystoscopy findings also failed to reveal the ureteric orifice on the left side further confirming absence of the left ureter.An exploratory laparotomy was performed. A huge mass was found arising from the retroperitoneum and adherent to surrounding structures (sigmoid colon and mesocolon). Instead of a definite vascular pedicle, leashes of vessels were seen all around the mass. The left kidney and ureter were not visualized separately. En bloc resection of the mass was done. No lymph nodes were seen.The resected specimen was 15.5 cm at its longest axis (Fig. 2a), with smooth surface and areas of necrosis (Fig. 2b). Histopathological examination gave the impression of a malignant tumor (seminoma) (Fig. 2c). The immunohistochemistry report revealed tumor cells expressing ckit (Fig. 2d) and PLAP. It was negative for CD 20 and CD 30. The final impression was that of testicular seminoma (pT2 pN0M0S2), stage IS.Postoperatively, t...