Incidental Diagnosis of a Burned-out Testicular Tumor in a Pediatric Trauma Patient

Burned-out testicular tumors are rare in pediatric patients. Patients usually present with metastatic retroperitoneal lymphadenopathy and occult-scar-like calcific lesion in the testis. We report a 16-year-old male patient who presented to the emergency department with abdominal pain after blunt trauma to the epigastric region. An abdominal ultrasound (US) performed to rule out solid organ injury revealed incidental necrotic retroperitoneal lymphadenopathy and right paratracheal nodular opacities on posteroanterior chest radiography (PACR). A scrotal US performed to rule out a possible primary testicular neoplastic process showed a subcentimetric irregularly contoured calcified lesion with scattered microcalcifications in the right testicle. Biochemistry tests revealed elevated levels of alpha-fetoprotein, lactate dehydrogenase and ß-human chorionic gonadotropin. Differential diagnosis considered a burned-out testicular tumor and metastatic lymphatic spread. A biopsy of abdominal lymph nodes confirmed the diagnosis of a non-seminomatous germ cell tumor. When incidental retroperitoneal lymphadenopathy is detected during an abdominal ultrasound, including a testicular neoplastic process in the differential diagnosis and conducting a simultaneous scrotal ultrasound can help reduce delays in diagnosis and treatment.