title: Seminoma of testis masquerading as orchitis in an adult with paraplegia: proposed measures to avoid delay in diagnosing testicular tumours in spinal cord injury patients.
abstract: Orchitis is common in adult male spinal cord injury (SCI) patients and, therefore, both health professionals and SCI patients themselves tend to attribute testicular swelling to orchitis, with a consequent potential delay in the diagnosis of testicular tumours. A 37-year-old man with paraplegia developed swelling of the right testis. With a presumptive diagnosis of acute bacterial orchitis, he was prescribed ciprofloxacin while awaiting an ultrasound scan. Ultrasound examination of the testis 4 weeks later showed a moderate hydrocele, enlargement and altered echogenicity of both the epididymis and testis, and features of mass-like lesions within the substance of the testis. As these changes might merely have represented a partly treated infection, a follow-up scan was carried out 2 weeks later, which revealed a lobulated mass of mixed echogenicity within the testis and a focal area of increased echogenicity indicative of calcification. A radical orchidectomy performed 19 days later revealed a seminoma. To prevent delay in the diagnosis of testicular tumours in SCI patients, we propose the following measures: (1) patients who develop swelling of the testis should consult a physician as soon as possible for clinical examination; blind antibiotic therapy should be avoided if possible; (2) if clinical examination reveals a hard swelling of the testis and the typical features of acute urinary infection are absent, an ultrasound scan of the scrotum should be performed as soon as possible; (3) in patients with equivocal ultrasound findings, ultrasound-guided, fine-needle aspiration cytology may allow an early diagnosis of testicular malignancy; (4) education of SCI patients and their caregivers is needed to implement these recommendations.
authors.affiliation: Regional Spinal Injuries Centre, District General Hospital, Southport, PR8 6PN, UK. S.Vaidyanathan@southportandormskirk.nhs.uk
authors.forename: Subramanian
authors.initials: S
authors.lastname: Vaidyanathan
authors.forename: Peter L
authors.initials: PL
authors.lastname: Hughes
authors.forename: Paul
authors.initials: P
authors.lastname: Mansour
authors.forename: Bakul M
authors.initials: BM
authors.lastname: Soni
mesh_terms: D000328:Adult; D003951:Diagnostic Errors / Q000517:prevention & control*; D006801:Humans; D008297:Male; D009920:Orchitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D010264:Paraplegia / Q000150:complications*; D018239:Seminoma / Q000175:diagnosis*; D013119:Spinal Cord Injuries / Q000150:complications*; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014463:Ultrasonography