An inguinal hernia that was not meant to be: a female with seminoma

Abstract

Complete androgen insensitivity is a rare X-linked disorder characterised by a female phenotype in a chromosomally male individual. It usually presents at puberty with primary amenorrhoea or as an inguinal mass in a female infant. Treatment includes bilateral orchidectomy and hormone replacement therapy. We present the case of a 31-year-old female with complete androgen insensitivity and a presumed inguinal hernia. We discuss the importance of early diagnosis, emphasise the consequences of misdiagnosis, and raise the question of whether such patients have been appropriately managed in the past.

Complete androgen insensitivity syndrome with concomitant seminoma and Sertoli cell adenoma: an unusual combination

“…Siminas et al 14 presented a case of CAIS associated with bilateral Sertoli cell adenomas and paratesticular leiomyomas. Seminomas are well documented in CAIS including a case with an inguinal hernia in a 31-year-old woman 15. In our case both seminoma and Sertoli cell adenoma were detected simultaneously but in different gonads.…”

Testicle in Inguinal Canal of a 62 Year Old Woman with Strangulated Hernia

“…When the literature is examined, patients who have surgery because of inguinal hernia, whereupon a testis is discovered, are almost always children or young patients (Arikan 2003, Papanastasopoulos 2009). In 2008, Costopoulos and colleagues diagnosed a patient (aged 31) with testicular tumor formation like that of the other patients found in the literature (Costopoulos 2008,Kim 2011. When evaluated from this perspective, our patient is the second only to the 67-yearold patient who was reported by Schindler and colleagues in 1978. One of the problems is the late discovery.…”

Pure seminoma in the setting of androgen insensitivity syndrome treated with surgical resection and para-aortic radiation: A case report and review of literature

“…This is a rare clinical scenario with significant health implications. There have been sporadic reports in the literature but all reviewed cases presented as a hernia, [8] incidental findings on laparoscopy, and routine orchiectomies for AIS patients, or unreported presentations. This is the first case to our knowledge of a patient presenting with pelvic pain.…”

“…We recommend that post-pubertal patients with complete insensitivity should be assessed for possible orchiectomy because of the aggregate risk for testicular malignancy. [1] 31-year-old female with 46XY karyotype with no evidence of mosaicsm…Androgen Insensitivity -right gonadal mass 10x13x8cm revealed seminoma -treated with RT for Stage I -total dose: 2000cGy to pelvic and para-aortic lymphatic in 10 fractions Costopoulos, et al [8] 31-year-old female with complete androgen insensitivity and presumed inguinal hernia on right -histology confirmed testis with evidence of lowgrade seminoma (pT1) and no involvement of the retes testis -no postop RT or chemo was given Chantilis, et al [7] 20 year female with complete androgen resistance -46 XY; underwent prophylactic laparoscopic gonadectomy -left gonad had an occult 8-mm seminoma as well as bilateral Sertoli cell hamartomas -unknown post-op treatments Collins, et al [9] "young woman" with testicular feminization syndrome and developed seminoma in an undescended intrapelvic testis -post op treatment unknown Hurt, et al [10] 14-year-old girl with complete androgen insensitivity syndrome and metastatic seminoma -treated with bilateral adnexectomy, removal of paraaortic lymph nodes, postoperative radiation, and estrogen replacement therapy -"she represents the fourth case of gonadal malignancy to be reported in a teenage patient with androgen insensitivity syndrome" …”