Spinal cord compression as the initial presentation of de novo metastatic testicular seminoma: A rare and complex case

Abstract

We report a 43-year-old man with de novo metastatic testicular seminoma complicated by paraplegia from spinal cord compression due to retroperitoneal lymphadenopathy. Urgent retroperitoneal biopsy confirmed seminoma and, after the patient declined neurosurgical intervention, systemic chemotherapy was promptly initiated prior to delayed orchidectomy. Post-chemotherapy orchidectomy histology revealed minimal viable tumour and serial imaging showed a residual retroperitoneal mass with low-grade uptake on FDG-PET. The mass was deemed unresectable, and surveillance was favoured over immediate salvage. This case highlights the importance of timely diagnosis, multidisciplinary care, and guideline-informed flexibility in managing advanced seminoma with rare complications such as spinal cord compression.