Unusual seminoma revealed by bone metastasis

We report a first case of primitive mediastinal seminoma revealed by bone metastasis without testicular tumor. In a 24-year-old patient with a 6-month history of isolated right hip pain, having normal X-ray and blood tests, we discovered a clinically silent chest mass being diagnosed as seminoma on needle biopsy. Etoposide–ifosfamide–cisplatin chemotherapy was chosen because of the presence of multiple lesions and its lesser toxicity. Germ cell tumors are a rare cause of bone metastases and need to be known to rheumatologists because of their excellent prognosis when recognized and treated early. We discuss new diagnostic (CT, MRI and PET-Scan) and treatment (chemotherapy and radiotherapy) strategies applied to our patient.