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.
An 18-year-old man, without any known risk factor for testicular malignancy, presented to our hospital with a painful right testicular mass with 1 month of evolution. Physical examination detected a small lump, confirmed by testicular ultrasound as a hypoechoic nodule. A CT-scan revealed no metastatic disease. α-fetoprotein (AFP) and lactate dehydrogenase (LDH) were above the normal limit. A right inguinal orchiectomy was performed and the histological exam revealed a mixed germ cell testicular tumor (composed by embrionary carcinoma and mature teratoma). Tumoral markers normalized after surgery, and the tumor was staged as pT1N0M0S0 - IA, according to the American Joint Committee on Cancer guidelines. The patient remained under surveillance. Twelve years later he developed bilateral gynecomastia and a high human chorionic gonadotropin (HCG). CT-scan found a 1cm lateroaortic adenopathy and a PET-scan revealed hyperfixation in the referred adenopathy and left testicle. At that time a scrotal ultrasonography was done, and a voluminous testicle of 5 x 5 x 3 cm with hypoechogenic and hypervascularized areas were found. This was followed by a left radical inguinal orchiectomy with testicle prosthesis introduction. Histological exam revealed a mixed TGCT (with seminoma, embrionary carcinoma and immature teratoma components) and a pathological stage pT2N1M0S1 – IIA. Chemotherapy was started with BEP protocol (bleomycin, etoposide and cisplatin), administered every 21 days for 3 cycles. Retroperitoneal adenopathy disappeared, HCG normalized and a surveillance program was initiated. The patient was disease-free in the 5 months after having finished his treatment.