A 29 year old patient was referred to our clinic following pain in the right teste 3 months earlier, which subsided with anti-inflammatory treatment. One month later he had a new episode of pain in the right testicle which was diagnosed as orchiepididymitis but which did not resolve with medical treatment.
His only personal history was an allergy to sulphonamides. No urological history of interest.
Physical examination revealed a painless tumour in the posteroinferior pole of the right teste.
Suspicion of a testicular tumour led to a complete blood analysis with tumour markers and a testicular ultrasound scan, the results of which showed AFP 36.4 ng/ml and Beta-hCG 4.2 mIU/ml. The ultrasound showed a 23 mm tumour in the lower pole of the right testicle with non-cystic characteristics suspicious of neoplasia.
The patient underwent a radical right inguinal orchiectomy and the pathological anatomy revealed a 2 cm mixed germ cell tumour formed by embryonal carcinoma and foci of teratoma. No vascular or lymphatic invasion. Albuginea, spermatic cord and epididymis free of tumour.
As it was a Stage I Non Seminomatous Germinal Tumour, it was decided by mutual agreement with the patient not to receive adjuvant treatment with chemotherapy and to follow a strict observational control.
The patient underwent periodic check-ups according to our hospital protocol and remained free of disease in the imaging techniques, clinically and analytically for 7 and a half years until a control ultrasound study detected microcalcifications in the left testicle with a single hypoechoic nodule measuring 7 mm x 9 mm, also with calcifications and no increase in Doppler flow, which was compatible with a testicular tumour. A left varicocele was also observed.
Physical examination was unremarkable and tumour markers were normal.
After left inguinal orchiectomy, the pathological anatomy reports a 0.5 cm seminoma infiltrating the capsule of the atrophic testicle with extensive intratubular germ cell neoplasia. No vascular or lymphatic infiltration.
Treatment was completed with chemotherapy and hormone replacement therapy.
Currently she has been disease free for 4 years.