Primary еxtragonadal seminoma of the urinary bladder presenting with spontaneous hemoperitoneum and hemorrhagic shock: A rare case report

Introduction. Extragonadal seminomas are rare germ cell tumors that most often occur in the mediastinum and retroperitoneum. Primary localization in the urinary bladder is extremely rare and represents a diagnostic challenge. Acute presentation in the form of intra-abdominal bleeding and hemorrhagic shock has so far been extremely rarely described. Case report. The case of a 36-year-old man who was admitted due to severe abdominal pain, with a clinical picture of acute abdomen and hemorrhagic shock, is presented. Laboratory analyses showed anemia (hemoglobin 58 g/L) and a pronounced inflammatory reaction (CRP 314.8 mg/L). Ultrasound examination of the abdomen revealed a large amount of free intraperitoneal fluid, while native radiography of the abdomen showed several hydroaeric levels without signs of pneumoperitoneum. Due to hemodynamic instability and signs of peritoneal irritation, an urgent exploratory laparotomy was performed. Intraoperatively, a massive hemoperitoneum was verified with the presence of a large tumor with a diameter of about 25 cm, which originated from the wall of the urinary bladder and was actively bleeding. After controlling the bleeding, a complete excision of the tumor mass was performed. Pathohistological and immunohistochemical analysis confirmed the diagnosis of extragonadal seminoma. Clinical examination and evaluation of the testes revealed no abnormalities, thus confirming the primary extragonadal localization. Conclusion. Primary extragonadal seminoma of the bladder wall is an extremely rare condition that can manifest with massive hemoperitoneum and hemorrhagic shock. In hemodynamically unstable patients, urgent surgical exploration plays a key role in controlling bleeding and establishing a definitive diagnosis.