Escalation of an Otherwise Curable Cancer: Retroperitoneal Mass Destruction Associated With Testicular Seminoma in a Psychiatric Patient

We report the case of a 31-year-old male patient with underlying psychiatric illness and substance abuse who presented to the emergency department with a chief complaint of abdominal pain. CT scan of the abdomen revealed a large retroperitoneal mass wrapping around the aorta and obstructing the left ureter causing hydronephrosis. Physical examination found a painless left testicular mass. The ultrasound revealed a left scrotal mass measuring 32 x 24 x 16 mm with evidence of increased vascularity and calcifications. The patient underwent ureteral stent placement and left testicular orchiectomy with the pathology evaluation revealing seminoma. Although follow-up care plans were made, the patient relapsed IV heroin abuse causing failure to attend oncological treatment appointments. Two months later upon readmission, a repeat of the CT scan of the abdomen and pelvis showed a persistent large left retroperitoneal mass with an increase in size and significant mass effect. The patient would be ultimately considered for hospice if lack of compliance were to continue for his chemotherapy, along with his comorbid underlying substance abuse and psychiatric illness. This case highlights the effect of mental illness on medical care and treatment, demonstrating how a treatable malignancy may result in greater morbidity and mortality in psychiatric populations.