Incidental discovery of seminoma after simple orchiectomy in transgender individuals: A case series

Abstract

Introduction: Seminoma is a common malignancy reported in young, cisgender men. However, there is sparse literature describing cases of seminoma in the transgender and gender diverse patient population. Case Series: We present two cases of seminoma incidentally discovered after simple bilateral orchiectomy performed as part of genital gender affirming surgery. In both instances, patients had not reported any testicular firmness or abnormality prior to surgery. After a thorough literature review, only two other such cases have been reported. Herein, we discuss our two cases and their implications for surgical management of suspected testicular malignancy intraoperatively, a methodical inspection of testicles removed during gender affirming surgery and providing affirming care when navigating discussions of genitalia with transgender and gender diverse patients. Conclusion: Testicular malignancy such as seminoma may be found incidentally when transgender and gender diverse patients undergo genital gender affirming surgery. Thus, special attention is required to identify suspicious exam findings, adjust surgical techniques as indicated, and properly examine surgical specimens. As there is a significant paucity of literature surrounding testicular malignancies in the transgender and gender diverse patient population, it is crucial to continue to investigate how to provide affirming care in these situations.