Abdominal pain is a common complaint in children and adolescents and one of the main reasons to seek medical attention. It is nevertheless one of the most non-specific symptoms.
We describe the case of a fifteen-year-old boy who presented in the emergency room with a 48 hour right low abdominal pain, nausea and fever, without any other complaint. The anamnesis revealed a 2 year history of nocturnal enuresis and an episode of not feeling well eliciting right testicular pain after trauma in the past year. He had right low abdominal tenderness and the Blumberg sign was positive; no abdominal masses were felt. The testicles were asymmetrical (right one smaller). There were no other abnormalities on physical examination. Laboratory studies were normal except for a raised C reactive protein and lactate dehydrogenase on blood samples. Tumoral markers (beta-human chorionic gonadotropin and alpha-fetoprotein) levels were normal. The abdominal ultrasound and the computed tomography scan revealed a 55 mm retroperitoneal paraaortic mass with central necrosis. Scrotal ultrasound showed a smaller, heterogenic right testicle, with calcifications. A retroperitoneal mass biopsy was performed and revealed a seminoma. The right testicle biopsy was negative. Staging did not show any metastasis.
Chemotherapy was started (cycles of carboplatin, etoposide and bleomycin) and a good response was noticed: more than 50% reduction after 2 cycles. Surgery is planned.
Extragonadal seminomas are rare, but when treated have a good prognosis; the authors stress the importance of an early diagnosis of cancer in children and adolescents.