Presentation
The patient presented for an infertility workup. There has been mild swelling and pain of the right testis on and off for two years associated with heaviness. AFP 82.6 ng/ml (Normal <7), bHCG 22.6 mIU/ml (Normal <2).
Patient Data
A well-defined mixed echogenic predominantly hypoechoic intratesticular mass is seen at the lower pole of the right testis, occupying more than half of the testicular parenchyma. It measures 3.1 x 2.5 cm and shows coarse calcification and scanty blood flow on color Doppler. Right epididymis is normal. No hydrocele, spermatocele, or varicocele is seen. Overlying scrotal skin thickness is normal.
The left-sided testis is of normal size and echotexture. No focal lesion is seen.
Case Discussion
Seminoma is common in this age group and commonly presents with painless swelling of the testis and is the most likely diagnosis in this case, although pathological confirmation is not available. Sometimes mild discomfort is associated due to pressure effects. This patient does not have any risk factors, i.e. family history of germ cell tumors, undescended testis or immunosuppression.
The treatment may be radiation therapy is mainly used for patients with seminoma, which is very sensitive to radiation. Sometimes it is performed after orchiectomy. Prognosis is good for all stages with a greater than 90% cure rate.