Case #2

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Expand Physical Exam


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.

Expand X-Rays & Scans


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.

Expand Laboratory


Alpha-Fetoprotein 2.2 (normal) Chorionic Gonadotropin <2 (normal). Elevated LDH 280 (range 150-250).

Expand Operative Findings


R radical inguinal orchiectomy of undescended testicle – large mass in R inguinal canal, hydrocele removed, then right testis removed. No obvious mass, testicle infarcted.

Expand Pathological Reports


R testicle: seminoma with secondary infarction. Negative involvement tunica albuginea, epididymis or vas deferens. Negative vascular involvement. Tumor about 4cm.

Expand Treatment


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.