Department of Surgery, Texas Tech University Health Sciences Center, El Paso, TX 79905, USA.
Am J Med Sci. 2013 Jul;346(1):70-2. doi: 10.1097/MAJ.0b013e31827db3fd.
Most testicular neoplasms are germ cell tumors, the vast majority of which represent seminomas. Most seminomas present localized to the testis, whereas nonseminomatous germ cell tumors more often present with lymph node metastases. Psoas abscesses generally arise from a contiguous intra-abdominal or pelvic infectious process, an adjacent focus of osteomyelitis or septic emboli from distant infectious foci. In this study, the case of a 24-year-old man who presented with a right psoas mass presumptively diagnosed as an abscess secondary to fever and leukocytosis is presented. The patient had a history of right testicular seminoma, and normal serum levels of alpha-fetoprotein and human chorionic gonadotropin. Surgical exploration and biopsy demonstrated seminoma metastasis. This case represents an extremely unusual clinical presentation of metastatic germ cell tumor presenting as a psoas abscess. This unique case represents an unusual presentation of a recurrent germ cell tumor mimicking a psoas abscess. Awareness of possible metastatic testicular germ cell neoplasm as a psoas abscess could prevent diagnosis delay before retroperitoneal tumor debulking.
大多数睾丸肿瘤为生殖细胞肿瘤，其中绝大多数为精原细胞瘤。大多数精原细胞瘤局限于睾丸，而非精原细胞瘤生殖细胞肿瘤更常出现淋巴结转移。腰大肌脓肿通常源于相邻的腹腔或盆腔感染性病变、相邻骨髓炎病灶或来自远处感染灶的化脓性栓子。在本研究中，报告了 1 例 24 岁男性，因发热和白细胞增多而被误诊为脓肿的右侧腰大肌肿块。该患者有右侧睾丸精原细胞瘤病史，甲胎蛋白和人绒毛膜促性腺激素的血清水平正常。手术探查和活检显示为精原细胞瘤转移。该病例代表了一种极其罕见的转移性生殖细胞肿瘤的临床表现，表现为腰大肌脓肿。这种独特的病例代表了一种复发性生殖细胞瘤的罕见表现，类似于腰大肌脓肿。认识到可能的转移性睾丸生殖细胞肿瘤作为腰大肌脓肿可以防止腹膜后肿瘤减瘤术之前的诊断延迟。
