Case #4

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Expand Physical Exam


31-year-old male with painless progressive enlargement of L testicle. No GI or GU symptoms. Exam showed large L testicular mass firm and suspicious for malignancy. Remainder of exam normal. Family history positive for father with testicular cancer in his 30s.

Expand X-Rays & Scans


Scrotal sonography: marked enlargement and decreased attenuation of L testis, c/w malignancy.


CT chest/abd/pelvis: Two enlarged retroperitoneal nodes (2cm) seen, suspicious for metastasis.


PET scan: subtle increased activity anterior to the lumbar spine correlating with lymph node involvement seen on CT. Increased activity is also seen along the course of the L spermatic cord.

Expand Laboratory


AFP = 2.7 (< 9.0 ng/ml). B-hCG = <2 (< 5 mIU/ml). LDH 134 (100-200 U/L). Chart notes tumor markers all unremarkable.

Expand Pathological Reports


L orchiectomy: seminoma 5 cm. No extracapsular extension seen. Intralymphatic tumor in proximal spermatic cord sections. No tumor seen in spermatic margin of resection.

Expand Treatment


Surgery: L radical orchiectomy.


Radiation: Beam radiation started to pelvis plus periaortic nodes and involved lymph nodes.