Presentation
Right inguinal pain and fullness.
Patient Data
Enlarged right testis, exhibiting heterogeneous echogenicity, with loss of normal echotexture. Spermatic cord appears thickened.
No axillary, mediastinal or hilar lymphadenopathy.
Case Discussion
Complained of right inguinal pain and bulging. No fever, nausea, vomiting, diarrhoea or dysuria.
History notable for smoking 1-2 packs a day for 16 years and drinking 2 vodka bottles a week. He had an appendicectomy 3 years prior.
Physical examination ruled out an inguinal hernia.
Ultrasound interrogation showed a large right testicular mass. CT chest-abdomen-pelvis showed several lung nodes and retroperitoneal lymphadenopathy.
Beta-HCG 0.57 mIU/ml (normal 0-3 mIU/ml), alpha fetoprotein 43.46 ng/ml (normal 0-15 ng/ml).
Histopathology report:
Embryonal carcinoma, 7 cm in greatest diameter. The tumour focally involves the rete testis and invades the tunica albuginea. Vascular invasion also present.
Immunostains:
Positive: CD30, OCT 3/4, patchy PLAP, pankeratin. Focally positive alpha fetoprotein.
Negative: CD117, EMA, vimentin.
Intratubular embryonal carcinoma. Surgical margins and spermatic cord free of tumour.
Underwent right orchidectomy and received chemotherapy, recovered fully.
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