A rare case of primary seminoma of the small bowel with lymph node involvement

INTRODUCTIONOne thousand four hundred new cases of testicular cancer are diagnosed annually in the UK, with peak incidence in men aged 25-35 years old. Seminomas account for over 40% of cases. The involvement of the gastrointestinal tract with seminoma is unusual. CASE DESCRIPTIONWe present a rare case of primary seminoma of the small bowel with lymph node involvement in a 30-year-old man who presented with iron deficiency anaemia and non-specific postprandial abdominal pain. A computed tomographic scan revealed small bowel wall thickening and mesenteric lymphadenopathy. Laparoscopic jejunal resection was performed and subsequent histology confirmed the diagnosis of primary seminoma of the small bowel. The patient also received three courses of cisplastin-based chemotherapy with good therapeutic outcome. DISCUSSIONThe possible anatomical origins of the seminoma include: the small bowel itself, a result of anomalies during embryogenesis, location of the lymphatic drainage of the testis, an occult testicular metastasis or a viable metastasis from a primary testicular lesion which had already regressed. CONCLUSIONThe investigation of unexplained iron deficiency anaemia in a young male patient requires full investigation of the entire gastrointestinal tract.