Metastatic testicular cancer presenting as lower back pain in a pilot.

Daniela J Bermudez, Jonathan Groh
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Abstract

Background: Lower back pain is ubiquitous in the helicopter community and testicular cancer is the most common solid organ tumor that affects approximately 1% of men ages 15 to 35. However, rarely is lower back pain caused by testicular cancer and, in an otherwise healthy male, it is generally low on the differential diagnosis. Literature review discovered the most recent case report where lower back pain was the presenting symptom for testicular cancer was in 1987.

Case report: A 26-yr-old male helicopter pilot presented to clinic complaining of lower back pain for greater than 1 yr for which conservative treatment had failed. The pain was so severe he was unable to sleep and had to remove himself from the flight schedule. The patient was seen by physical therapy and a chiropractor and treated with NSAIDs and other pain medications, including narcotics. After further investigation, it was discovered that the patient's lower back pain was a result of a retroperitoneal metastatic tumor originating from his right testicle.

Discussion: It is important to consider that, although most aviators in their twenties have been screened for chronic illness, they are still at risk for developing cancer. In this case, the patient never complained of testicular mass or pain and even denied symptoms during review of systems questioning. Proper education regarding the importance of self-examination and reporting of abnormalities is key to early detection and intervention. The 5-yr survival for metastatic testicular cancer is greater than 95%.

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一名飞行员的转移性睾丸癌表现为腰痛。
背景:下背部疼痛在直升机社区中普遍存在,睾丸癌是最常见的实体器官肿瘤,约占15至35岁男性的1%。然而,睾丸癌很少引起腰痛,在其他健康男性中,其鉴别诊断通常较低。文献回顾发现,最近的病例报告中,腰痛是睾丸癌的主要症状是在1987年。病例报告:一名26岁男性直升机飞行员到诊所主诉腰痛超过1年,保守治疗无效。疼痛非常严重,他无法入睡,不得不从航班时刻表中删除自己。患者接受了物理治疗和脊椎按摩师的治疗,并接受了非甾体抗炎药和其他止痛药的治疗,包括麻醉剂。经进一步检查,发现患者的下背部疼痛是源于右睾丸的腹膜后转移性肿瘤。讨论:重要的是要考虑到,尽管大多数20多岁的飞行员已经接受了慢性病筛查,但他们仍然有患癌症的风险。在本例中,患者从未抱怨睾丸肿块或疼痛,甚至在系统询问时否认症状。关于自我检查和报告异常的重要性的适当教育是早期发现和干预的关键。转移性睾丸癌的5年生存率大于95%。
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来源期刊
Aviation, space, and environmental medicine
Aviation, space, and environmental medicine 医学-公共卫生、环境卫生与职业卫生
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