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TheScientificWorldJOURNAL (ISSN 1537-744X) |
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Title: |
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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 |
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Authors: |
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Vaidyanathan, Subramanian ; Hughes, Peter L; Mansour, Paul ; Soni, Bakul M. |
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Journal: |
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TheScientificWorldJOURNAL |
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Year: |
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2008 |
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Volume: |
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8 |
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Page Range: |
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149-156 |
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Article Type: |
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Case Study |
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Handling Editor: |
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Vikram Dogra |
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Domains: |
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Urology
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Pathology
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Medical Care
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Neurology
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Imaging
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Surgery
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Medicine
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Clinical Images
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DOI: |
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10.1100/tsw.2008.30 |
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Keywords: |
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spinal cord injury, testis |
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Abstract |
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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. |
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