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38-year-old male with history undescended R testicle and 1 month history R groin mass. L testicle normal. No palpable lymph nodes. Impression: possible incarceration of inguinal testicle. Admit for groin exploration, hernia repair, possible orchiectomy.
Ultrasound testicle – large undescended R testicle, 5cm hypoechoic mass within R testicle worrisome for carcinoma, R inguinal hernia seen. L testicle WNL.
Chest X-ray normal.
CT Abd/pelvis: no enlarged nodes in abdomen or pelvis. No mets.
Alpha-Fetoprotein 2.2 (normal) Chorionic Gonadotropin <2 (normal). Elevated LDH 280 (range 150-250).
R radical inguinal orchiectomy of undescended testicle – large mass in R inguinal canal, hydrocele removed, then right testis removed. No obvious mass, testicle infarcted.
R testicle: seminoma with secondary infarction. Negative involvement tunica albuginea, epididymis or vas deferens. Negative vascular involvement. Tumor about 4cm.
Surgery: R inguinal exploration, R radical orchiectomy, R hernia repair.
Radiation: External beam radiation 2550 cGy in 15 fractions to the abdomino-periaortic lymph nodes using 18 MV X-ray, complete course given.