SEER Logo

SEER Training Modules

Case #3

Click an information source below to view the case history.

Expand Physical Exam

05/18/XX

32-year-old male with 2-3 month history of increasing R scrotal size, pain during urination x 1 week. No hematuria. PE: Firm, tender enlarged R scrotum. Palpable abdominal node.

Expand X-Rays & Scans

05/18/XX

Ultrasound testicle – 5.9cm R testicular heterogenous mass, likely neoplastic

CT Abd/pelvis: enlarged hypodense paraortic nodes to level of renal vessels.

Chest X-Ray negative.

06/11/XX

CT thorax/abd/pelvis: R periaortic lymphadenopathy

Expand Laboratory

05/19/XX

Alpha-Fetoprotein 1.7 ng/ml (normal) LDH total 344 U/L (range 150-250)

06/12/XX

From clinic notes hCG normal <2.0.

Expand Operative Findings

05/19/XX

Orchiectomy w/cord: very large tumor R hemiscrotum.

06/22/XX

Lymph node dissection: several large lymph nodes removed, wall of colon injured and repaired.

Expand Pathological Reports

05/19/XX

R radical orchiectomy: 7.0cm mixed germ cell tumor: 90% embryonal; 10% yolk sac, extends into tunica albuginea and epididymis. Positive spermatic cord margin.

06/22/XX

Para-aortic lymph node dissection: 5/57 Lymph nodes positive. Largest metastasis 5cm LN replaced by embryonal carcinoma, extending into perinodal adipose tissue with extensive necrosis.

Expand Treatment

05/19/XX

Surgery: R inguinal exploration and R radical orchiectomy.

06/22/XX

Para-aortic lymph node dissection.

07/19/XX

Chemotherapy: Chemotherapy started: BEP (Cisplatin, etoposide, bleomycin).