title: Synchronous bilateral seminoma.
abstract: OBJECTIVE
  To present a case of synchronous bilateral seminoma and perform a bibliographic review about this rare presentation of testicular neoplasia, with important physical and psychological consequences.
  
  
  METHODS
  25-year old man with bilateral multifocal testicular neoplasias and azoospermia. We performed a bilateral inguinal radical orchiectomy, with the pathologic exam diagnosing bilateral seminoma. Adjuvant lumbar-aortic radiotherapy was initiated. More than a year after the surgery the patient is asymptomatic and without evidence of disease, although dependent of testosterone supplement.
  
  
  RESULTS
  Germ cell testicular neoplasias are more frequent in young men between 15 and 35 years old. There is a 2-3% incidence of bilateral neoplasm, either synchronous or metachronous. Bilateral radical orchiectomy remains as standard of treatment, rendering the patient infertile and depending on exogenous androgens, which causes several psychological problems. However, a testis-sparing surgery could be performed in selected cases; our patient, having multiple bilateral neoplasias, was not eligible for this procedure. With a great incidence of carcinoma in situ on spared testicular parenchyma, scrotal radiotherapy is indicated. In spite of infertility, this treatment presents very good oncological results with androgen independence and consequent physical and psychological advantages.
  
  
  CONCLUSIONS
  Bilateral orchiectomy still remains as "gold-standard" treatment for bilateral seminoma. However, there are other possibilities of treatment, such as partial orchiectomy, feasible in selected cases of small volume testicular tumours in solitary testis / bilateral tumour in men without preoperative androgen deficiency and who could be object of close clinical and imaging follow-up. This way you could avoid additional loss of quality of life, without any prejudice on oncological results.
authors.affiliation: Urology Department, Hospital Pedro Hispano Unidade Local de Saúde de Matosinhos, EPE, Matosinhos Portugal. ricardosoares81@gmail.com
authors.forename: Ricardo
authors.initials: R
authors.lastname: Oliveira Soares
authors.forename: Tiago
authors.initials: T
authors.lastname: Pinto Correia
authors.forename: André
authors.initials: A
authors.lastname: Cardoso
authors.forename: Artur
authors.initials: A
authors.lastname: Oliveira e Silva
authors.forename: Manuel
authors.initials: M
authors.lastname: Cerqueira
authors.forename: Frederico
authors.initials: F
authors.lastname: Carmo Reis
authors.forename: Martinho
authors.initials: M
authors.lastname: Almeida
authors.forename: Rui
authors.initials: R
authors.lastname: Prisco
mesh_terms: D000328:Adult; D000728:Androgens / Q000627:therapeutic use; D053713:Azoospermia / Q000209:etiology; D003131:Combined Modality Therapy; D004632:Emergency Medical Services; D020249:Hormone Replacement Therapy; D006801:Humans; D008297:Male; D009919:Orchiectomy; D012611:Scrotum / Q000000981:diagnostic imaging; D018239:Seminoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D013736:Testicular Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D014463:Ultrasonography
chemical_list: D000728:Androgens