Fitzgerald Mark, Kamath Sheshang
Department of Paediatric Surgery, Division of Surgery, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia 5006, Australia.
Department of Surgery and Critical Care, Royal Darwin Hospital, 105 Rocklands Drive, Tiwi, Northern Territory 0810, Australia.
Int J Surg Case Rep. 2024 Dec;125:110502. doi: 10.1016/j.ijscr.2024.110502. Epub 2024 Oct 23.
Testicular tumours can present outside the testis in about 5 % of cases, including as a primary lesion within the retroperitoneal space. These arise insidiously and can be hard to detect. Salmonella is an uncommon cause of abscess formation and the subtype of bovismorbificans, arising from geckos, only scarcely reported to cause an abscess. We describe a case in line with SCARE Criteria where a retroperitoneal non-seminomatous germ cell tumour presented with a salmonella bovismorbificans abscess and subsequent bacteraemia.
A 37 year old male presented unwell with fevers and right flank pain suggestive of pyelonephritis. He had a salmonella bacteraemia on initial blood cultures, subsequently isolated to be salmonella bovismorbificans, and a CT scan demonstrate a large 7.7 cm retroperitoneal mass with surrounding lymphadenopathy.
An initial attempt at tissue sampling failed as the lesion was filled with purulent material requiring a pig tail drain to remain in place. He progressed slowly with resolution of fevers and bacteraemia however the lesion did not reduce in size despite adequate antibiotic treatment for two weeks. A repeat core biopsy and aspiration after 19 days revealed ongoing salmonella infection with a yolk sac tumour and seminoma. His AFP markers at this time were elevated at 3330kIU/L.
A underlying malignancy should be consider when a retroperitoneal abscess fails to resolve with adequate treatment especially when a organism unknown to cause abscess is isolated.
睾丸肿瘤约5%的病例可出现在睾丸外，包括作为腹膜后间隙内的原发性病变。这些肿瘤隐匿起病，难以检测。沙门氏菌是脓肿形成的罕见原因，源自壁虎的牛型致病亚种仅鲜有报道会引起脓肿。我们描述了一例符合SCARE标准的病例，一名腹膜后非精原细胞瘤性生殖细胞肿瘤患者出现牛型致病沙门氏菌脓肿及随后的菌血症。
一名37岁男性因发热和右侧腰痛不适就诊，提示肾盂肾炎。初始血培养显示有沙门氏菌菌血症，随后分离出牛型致病沙门氏菌，CT扫描显示一个7.7厘米的巨大腹膜后肿块及周围淋巴结病。
最初的组织采样尝试失败，因为病变充满脓性物质，需要留置猪尾引流管。患者发热和菌血症消退，病情进展缓慢，但尽管接受了两周的充分抗生素治疗，病变大小并未缩小。19天后重复进行的芯针活检和穿刺显示持续存在沙门氏菌感染，并伴有卵黄囊瘤和精原细胞瘤。此时他的甲胎蛋白标志物升高至3330kIU/L。
当腹膜后脓肿经充分治疗仍未消退，尤其是分离出未知的引起脓肿的病原体时，应考虑潜在的恶性肿瘤。
