Title : Very late isolated bladder recurrence of testicular seminoma 16 Years after orchidectomy: A rare case report
Abstract:
Background: Very late relapse of testicular seminoma is uncommon, particularly after a prolonged disease-free interval and at an atypical anatomical site. Recurrence involving the urinary bladder is exceptionally rare and may present a significant diagnostic challenge.
Case Presentation: A 52-year-old man presented with painless visible haematuria, 16 years after radical inguinal orchidectomy for stage I testicular seminoma. Cross-sectional imaging demonstrated a large infiltrative mass arising from the left posterolateral bladder wall, with extension into the prostate and distal ureter, causing severe hydronephrosis. Serum tumour markers, including alpha-fetoprotein, beta-human chorionic gonadotropin and lactate dehydrogenase, were within normal limits. Transurethral resection of the bladder tumour was performed. Histopathological examination, supported by immunohistochemistry, demonstrated features consistent with classical seminoma. Staging revealed locally advanced disease with regional lymph node involvement but no evidence of distant metastases. The patient was discussed at a multidisciplinary meeting and commenced on systemic platinum-based chemotherapy alongside urinary decompression.
Conclusion: This case highlights the potential for seminoma to relapse after an exceptionally long disease-free interval and at an unusual extragonadal site. Although primary extragonadal germ cell tumours may enter the differential diagnosis, the clinical history and pathological findings support late metastatic recurrence of testicular seminoma. Importantly, normal serum tumour markers do not exclude late relapse. Histopathological confirmation with appropriate immunohistochemistry remains essential when evaluating unusual masses in long-term survivors of testicular germ cell tumours. Awareness of atypical patterns of late recurrence may facilitate earlier diagnosis and appropriate multidisciplinary management.
