November 16, 2024

21-year-old male with soft, non-tender mass on the posterior aspect of the left testicle

By Med-Challenger · 2 minute read

A 21-year-old male presents to your office for a routine physical exam. He has no significant medical history and has no complaints. He had no major childhood illnesses, but states that he did have an orchiopexy at a very young age for a case of cryptorchidism.

He denies smoking, alcohol, or illicit drug use. He says he is sexually active with 1 partner. He has no known allergies, and he is not currently taking any medications except for a natural protein powder supplement.

On physical exam his temperature is 98.6o F; blood pressure is 118/72 mm Hg; pulse is 64/minute, and respirations are 14/minute. His cardiovascular, respiratory, and abdominal exams are unremarkable. Upon examination of the genitalia for a possible hernia, a soft, non-tender mass is felt on the posterior aspect of the left testicle.

Labs are drawn, and the patient is told to return in 1 week to discuss the results. Patient’s labs showed a normal basic metabolic panel, normal complete blood count, and a normal urinalysis. Levels of serum beta-human chorionic gonadotropin were increased, but alpha-fetoprotein levels were within normal limits. The additional metastatic workup findings were negative.

Ultrasound of the testicles showed the following:

image (21)

What is the most likely diagnosis?

seminoma
nonseminoma
yolk sac tumor
teratoma

The correct answer is:

seminoma

Germ cell tumors are the most common malignancy in men aged 15-35 years. Patients with a history of cryptorchidism have an increased risk of testicular cancer. Any elevation of alpha-fetoprotein (AFP) levels dictates a diagnosis of nonseminomatous germ cell tumor. The ultrasound showed a right testicle with hypoechoic solid masses compared to the homogeneous, more hyperechoic, normal left testicle--which is consistent with seminoma. Further, because the patient had normal levels of AFP, the other answer choices are ruled out.

References:

Swerdlow AJ. Epidemiology of Testicular Cancer. In: Raghavan D, Scher H, Leibel S, Lange P, eds. Principles and Practice of Genitourinary Oncology. Philadelphia, Pa: Lippincott-Raven; 1997.

Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T. Cancer statistics, 2008. CA Cancer J Clin. Mar-Apr 2008;58(2):71-96.

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