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28-year-old male felt a hard area on his R testis since last month with no other symptoms. Firm nodule R testis palpable on exam. Normal inguinal canal. No nodes. L testis normal.
Testicular US: heterogenous 2.8cm mass involving R testicle, very suspicious for neoplastic process. L testicle is WNL.
CT scan: periaortic adenopathy, presumably metastatic, largest lymph node 3 cm.
Chest X-Ray negative.
AFP, hCG negative. LDH: ordered, results not in record.
R testis 4cm embryonal carcinoma, tumor focally invades into but not through tunica albuginea, multiple foci throughout testis and extends adjacent to but does not invade epididymis. Sections of spermatic cord negative.
Surgery: Right radical orchiectomy.
Chemotherapy: PEB Chemo started.
Consult obtained – given small LN size, no LN dissection at this time.