Click an information source below to view the case history.
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.
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.
CT thorax/abd/pelvis: R periaortic lymphadenopathy
Alpha-Fetoprotein 1.7 ng/ml (normal) LDH total 344 U/L (range 150-250)
From clinic notes hCG normal <2.0.
Orchiectomy w/cord: very large tumor R hemiscrotum.
Lymph node dissection: several large lymph nodes removed, wall of colon injured and repaired.
R radical orchiectomy: 7.0cm mixed germ cell tumor: 90% embryonal; 10% yolk sac, extends into tunica albuginea and epididymis. Positive spermatic cord margin.
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.
Surgery: R inguinal exploration and R radical orchiectomy.
Para-aortic lymph node dissection.
Chemotherapy: Chemotherapy started: BEP (Cisplatin, etoposide, bleomycin).