Bilateral Seminoma in a Pediatric Patient With a History of Cryptorchidism: A Case Report

Synchronous bilateral testicular germ cell tumors (BTGCTs) are a rare subset of testicular germ cell tumors (GCTs) in pediatric patients. Cryptorchidism is a well-established risk factor for testicular cancer and markedly increases the risk of malignancy; thus, an early diagnosis is essential for effective management and prognosis. In this study, we discuss a case of a pediatric patient diagnosed with bilateral seminoma, treated surgically with bilateral orchiectomy. In this study, we describe a 16-year-old boy with a past medical history of bilateral cryptorchidism and orchidopexy, presenting with right testicular induration over the last month. Physical examination showed Tanner stage 3 genitalia with complete induration of the right testicle, but no palpable mass was detected in the left testicle. Scrotal ultrasound found heterogeneous nodules with increased vascularity, with microlithiasis involving bilateral testicles, prompting suspicion for a GCT. A bilateral orchiectomy with intraoperative biopsy was performed. Histopathological examination revealed bilateral seminoma, stage I, with the absence of any metastatic spread. Follow-up tumor markers and imaging study were unremarkable. In the pediatric population, bilateral seminoma is an extremely rare pathology with metachronous presentation more commonly described. The traditional risk factor of cryptorchidism remains important, highlighting the need for long-term follow-up of these patients. Diagnosis is based on clinical evaluation, imaging studies, and histopathological confirmation. Treatment usually consists of orchiectomy, with consequences for endocrine and fertility function. Due to the very low incidence of synchronous bilateral seminoma in this age group, a multidisciplinary approach is warranted with an emphasis on fertility preservation and hormonal follow-up. High-risk populations still require early detection via testicular ultrasound.