A 25 year old patient was referred to our clinic after an ultrasound study revealed a hypoechoic mass suggestive of neoplasia in the left teste.
The patient consulted the speciality centre because he had noticed a painless enlargement of the left testicle for some days.
His personal history included having suffered from a right testicular lift in childhood. At the age of 9 months, he suffered a case of meningitis that left him with a permanent neurological deficit and residual seizures. In addition, appendectomy and tenotomy of the Achilles in infancy.
At our clinic, she was asked for a new ultrasound scan, tumour markers and an extension study using computerised axial tomography. The results of the tests showed a beta-HCG of 5.7 mIU/ml, with normal lactate dehydrogenase and alpha-fetoprotein. Ultrasound showed an 8 cm mass in the left teste with multiple hypoechoic nodules compatible with a testicular tumour, as well as microcalcifications in the right testicle. No adenopathies or metastases were seen in the thoraco-abdomino-pelvic CT scan.
He underwent radical left orchiectomy via the inguinal route and the pathological anatomy analysis reported classic seminoma that did not infiltrate the albuginea or the cord, nor was there any vascular or lymphatic invasion.
With the diagnosis of classic Stage I Seminoma, conservative treatment was chosen.
At 10 months, a control ultrasound study revealed a hypoechoic nodule in the right testicle suspicious of neoplasia. Physical examination and tumour markers were normal.
A radical right orchiectomy was performed and the pathological anatomy study reported a classic type of seminoma with foci of Intratubular Germ Cell Neoplasia measuring approximately 4.5 cm. Vascular tracts, albuginea and spermatic cord free of tumour. Hormone replacement therapy was also started.
Three months later, an increase in beta-HCG of up to 4.5 mIU/ml was detected, with the rest of the tumour markers normal, and a new thoraco-abdominal-pelvic CT scan was requested, which revealed a retroperitoneal mass measuring 3 cm x 8 cm para-aortic below the left renal artery, extending to the iliac bifurcation. Another 2 cm x 2 cm nodular image with a necrotic centre and peripheral contrast uptake is also seen more anteriorly.
With the diagnosis of abdominal adenopathic relapse of classic seminoma, treatment began with 4 cycles of Etoposide and Cisplatin.
He has now been disease-free for approximately 7 years.