The patient is a forty-one-year-old man with an unremarkable medical history presented with a two-month history of scrotal swelling and discomfort. He denied a history of mal-descent, and there was no family history of testicular cancer. Physical exam was pertinent for an enlarged, nontender left testicle. An ultrasound revealed well-circumscribed hypo-echoic, heterogeneous lesions in both testicles (). The left testicular mass measured 3.0 × 2.6 × 4.3 cm, while the mass in the right testicle measured 2.1 × 3.1 × 0.5 cm. Doppler was suggestive of normal blood flow. Pertinent labs included (AFP) alpha fetoprotein 6.2 µg/L, (beta HCG) beta human chorionic gonadotropin <3 IU/L, (LDH) lactase dehydrogenase levels 572 U/L, and serum testosterone 375 ng/dL, and all prognostic markers are within normal limits. CT of the chest, abdomen, and pelvis was negative for evidence of metastatic disease or lymphadenopathy.\nHe underwent bilateral inguinal orchiectomy. Final pathology () revealed classical seminoma in both specimens. Both right and left tumors exhibited invasion of the rete testis. There was possible angiolymphatic space invasion noted within the left testicular mass. There was no tumor extension through the tunica albuginea, epididymis, or spermatic cord. Surgical margins were free. Both tumors were pathologically staged IA.\nThe patient did not have concerns regarding fertility and declined to consider an organ preserving approach. Our patient was uncomfortable with surveillance as an option. He declined medical oncology referral for discussion about systemic therapy and was therefore treated with external beam radiotherapy. He received 2550 cGy in 17 fractions at 150 cGy per fraction via 6 MV/18 MV photons with AP/PA fields. Field borders () included superior border at T10/11 interspace, inferior border at L5/S1 interspace, and lateral borders of vertebral transverse processes (field width approximately 10 cm). The patient did not have a history of previous pelvic surgery, and only the paraaortic lymph nodes were targeted. He tolerated treatment well, experiencing grade I nausea (as per Common Terminology Criteria for Adverse Events, version 3.0). He is currently disease-free, 18 months from completion of radiation therapy. His serum testosterone levels fell to 248 ng/dL after treatment, and he uses testosterone gel for hormone replacement.
A 29-year-old man developed a painless testicular lump, detected in auto-exam, and immediately sought medical assistance. An ultrasound examination showed a right testicle hypoechoic mass. AFP was above the superior limit of the normal value, and there was no evidence of metastatic disease in imagiological exams. Right inguinal radical orchiectomy was performed one day later, and histological exam revealed a teratoma with a low grade immature component. Pathological staging of pT1N0M0S0 – IA was done, and a surveillance program was implemented. Seven years later, during a routine scrotal ultrasound exam, a hypoechoic nodule of 11 mm was found. The patient was asymptomatic. Tumor markers were normal, as was the thoraco-abdomino-pelvian CT scan. A left inguinal radical orchiectomy was done. Histological exam revealed a TGCT with invasive classic seminoma with TIN component. He was staged as pT1N0M0S0 – IA, and a single carboplatin AUC7 session was done. 12 months later the patient remains disease free.