Presentation
Painless left scrotal swelling for one month. Now he presented with acute left testicular pain. No dysuria, fever, anorexia or weight loss.
Patient Data
Well defined heterogeneous mixed echogenicity mass lesion containing cystic components, calcifications and increased vascularity is seen occupying the upper and mid pole of the left testis. The contralateral right testis is normal in size and echogenicity. Two tiny cysts are seen in the right epididymal head.
Heterogeneous left testicular mass, as seen on the previous ultrasound examination.
A few left retroperitoneal necrotic lymph nodes, the largest one measuring 14 x 18 mm below the level of the left renal vein. No hepatic or osseous metastasis.
Histopathology showed mixed germ cell tumor (teratoma 95% and embryonal cell carcinoma 5%).
Case Discussion
Heterogeneous mixed echogenicity left testicular mass lesion likely representing a non seminomatous germ cell tumor, which was later proven to be a mixed germ cell tumor.
Laboratory investigations showed normal tumor markers {AFP= 2.9 ng/ml (normal: ~8), Beta-HCG=2.9 IU/L (normal: 0-5), LDH=210 U/L (normal: 125-220)}.
Staging workup showed left para-aortic lymphadenopathy. After left inguinal orchiectomy, the patient was referred to the medical oncologist for further management.