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Medical City Weatherford
internal medicine, testicular neoplasms, pathology
Internal Medicine | Male Urogenital Diseases | Neoplasms | Pathology
It is exceedingly rare to find a case of bilateral synchronous germ cell testicular tumors of different histological types, and there have been only a handful of cases because of a lack of connections through lymphatic or vascular pathways between the testes. Here we present a unique case of a 43-year-old man who initially presented to the primary care physician for increasing right testicular swelling. He had a testicular sonogram that showed a large right testicular mass as well as a 1.7 cm left testicular mass suspicious of malignancy. Pre-surgical laboratories showed PSA 0.97, alpha-fetoprotein 1875, quantitative hCG 2508, and LDH 448. He proceeded with a right inguinal orchiectomy and the pathology revealed a 9-cm embryonal carcinoma limited to the testes. Negative lymphovascular invasion with clear margins, stage IS (pT1b N0 M0). Post-surgery, the tumor markers normalized. CT scan of the abdomen and pelvis showed postsurgical changes but no evidence of lymphadenopathy or metastatic disease. Chest x-ray showed no evidence of metastatic disease. This was subsequently followed by a left inguinal orchiectomy and the final pathology revealed a seminoma, negative margins, no invasion, stage IA (pT1a N0 M0). Because of the rarity of synchronous bilateral testicular neoplasm, treatment is unique and based on the tumor stage and managed separately with close surveillance in accordance with National Comprehensive Cancer Network guidelines.
HCA Healthcare Graduate Medical Education
Kim, Joseph; Page, Ray; Moses, Gregory; and Columbres, Rod Carlo, "An Exceedingly Rare Case of Bilateral Synchronous Germ Cell Testicular Tumors of Different Histological Types" (2023). North Texas Research Forum 2023. 25.