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39-year-old male found a hard area in the L testicle. On exam L testicle firm and tender, R testicle normal, no adenopathy
Ultrasound of scrotum revealed a 2.2 cm heterogenous L intratesticular mass compatible with neoplasm.
Chest X-Ray negative.
CT abdomen/pelvis showed no adenopathy. Lung bases clear.
Elevated levels of hCG 2628 mIU/ml and AFP 63 ng/ml. LDH WNL.
No unusual findings.
Testis, L radical orchiectomy – mixed germ cell tumor, approx 35% teratoma, 25% embryonal carcinoma, 25% yolk sac tumor and 15% choriocarcinoma. Spermatic margin free of tumor, focus suspicious for vascular invasion identified.
L retroperitoneal LND: 26 nodes negative for malignancy.
Surgery: Left radical orchiectomy.
Nerve sparing L side retroperitoneal lymph node dissection .