Presentation
For the evaluation of asymmetric testicular size observed during a physical examination.
Patient Data
The right testicle shows two well-defined hypoechoic lesions, with calcification and minimal detectable vascularity, the largest seen in the lower portion, measuring about 1.2 x 1.1 x 1 cm.
The right testicle appears relatively hypoechoic and small in size (10 mL) and shows microlithiasis.
Case Discussion
This patient underwent a total orchiectomy and was sent for histopathology, which revealed a testicular seminoma as follows:
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seminoma, classic type, extent of invasion:
primary tumor: pT1 - tumor limited to the testis without lymphovascular invasion
No evidence of an invasive tumor was observed in the rete testis, epididymis, spermatic cord, or tunica vaginalis
additional pathologic findings: atrophy, and a few tubules with intratubular germ cell neoplasia
Seminoma is considered the most common testicular tumor, affecting people between 30 and 40 years old.
Risk factors for seminoma include; family history, undescended testes and infertility.
In this case, the patient has declined any history of the previous risk factors. However, the patient had an asymmetric small testicle, which itself might be a consequence of an undescended testicle during childhood that the patient was not aware of. Therefore, one should always be aware of the possibility of underlying malignancy where a small testicle is found during examination, despite the fact that the direct relationship between small testicular size and testicular tumor is not well established.
The relationship between microlithiasis and seminoma is controversial. Although microlithiasis could occur in normal individuals, some authors suggest that microlithiasis is a risk factor for seminoma.
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