Indian Journal of Urology
CASE REPORT
Year
: 2004  |  Volume : 20  |  Issue : 2  |  Page : 180--181

Seminoma arising in a true hermaph­rodite with normal male external genitalia


Abraham Kurien1, Kim Mammen1, Sunitha Jacob2,  
1 Department of Urology, Christian Medical College and Hospital, Ludhiana, India
2 Department of Pathology, Christian Medical College and Hospital, Ludhiana, India

Correspondence Address:
Kim Mammen
Department of Urology, Christian Medical College and Hospital, Ludhiana - 141 008
India




How to cite this article:
Kurien A, Mammen K, Jacob S. Seminoma arising in a true hermaph­rodite with normal male external genitalia.Indian J Urol 2004;20:180-181


How to cite this URL:
Kurien A, Mammen K, Jacob S. Seminoma arising in a true hermaph­rodite with normal male external genitalia. Indian J Urol [serial online] 2004 [cited 2022 Jul 5 ];20:180-181
Available from: https://www.indianjurol.com/text.asp?2004/20/2/180/20758


Full Text

 Case Report



A 24-year-old phenotypic man with bilateral cryp­torchidism presented with pain and mass in the right iliac fossa. On examination there was a right iliac fossa mass, an empty scrotum and a normal penis. Contrast enhanced CT scan confirmed a large retroperitoneal mass of 16 x 12 x 8 cm [Figure 1]. No metastatic disease was detected. A true-cut needle biopsy demonstrated seminoma. His se­rum b-HCG and LDH were elevated while the serum AFP levels were normal. With four cycles of platinum based chemotherapy there was a remarkable reduction in size of the mass. His serum levels of b-HCG and LDH came down to normal levels. A further CECT showed a residual mass in the pelvis. Laparotomy and histopathology revealed a rudimentary uterus with a pair of tubes extending on to a pair of ovotestes with no residual tumour. The uterus along with the gonads was resected [Figure 2]. Chromosomal analy­sis showed 46 XY karyotype. The follow up on him over two years has not revealed any recurrence.

 Comments



The presence of ovarian and testicular tissue in an indi­vidual, whether as a single tissue type gonad or an ovotes­tis, constitutes true hermaphroditism a rare form of intersex. The reported incidence of 46 XY karyotype in a true hermaphrodite is 7% and the incidence of gonadal malignancy in a true hermaphrodite is 4.6%. [1] The Y chromosome is implicated in the incidence of germ cell tu­mours in these patients. [2] The risk may reflect the ectopic location of the gonads in these individuals. The completely normal male external genitalia except for the empty scro­tum corresponded with a Luks type VI classification. [3] While genital ambiguity is the frequent finding in a true hermaphrodite, clinicians should suspect, although rare, the possibility of an intersex condition in a patient with bilateral cryptorchidism and normal external genitalia. To the authors' knowledge, this is the first reported case of seminoma occurring in a true hermaphrodite with normal male genitalia.

References

1Krob G. Braun A. Kuhnle U. True hermaphroditism: geographical distribution, clinical findings, chromosomes and gonadal histology. Eur J Pediatr 1994; 153: 2-10.
2Manuel M. Katayama PK. Jones HW Jr. The age of occurrence of gonadal tumours in intersex patients with a Y chromosome. Am J Obstet Gynecol 1976; 124: 293-300.
3Luks Fl. Hansbrough F, Klotz DH Jr. Kottmeier PK. Tolete-Velcek F. Early gender assignment in true hermaphroditism. J Ped Sure 1988: 23: 1122-6.