Male patient aged 29 years. He was referred to our department to complete the study because, after the appearance of a painless tumour in his left testicle for a month, an ultrasound scan revealed a hypogenic left testicle of reduced size, and a right testicle with heterogeneous parenchyma suspicious of neoplasia.
He had no other urological symptoms, no asthenia, no weight loss. He also had no personal history of interest.
Physical examination revealed a hypotrophic left teste and a slightly enlarged right teste. Both were painless, of normal consistency and regular surface. Epididymis and cords with no pathological findings.
Laboratory tests showed haemostasis, biochemistry and haemogram within normal parameters, and an alpha-fetoprotein of 2.7ng/ml with a beta-hCG of 4.2mIUI/ml.
On admission, a new Doppler flow ultrasound was performed and revealed: a right teste measuring 49mm x 36mm x 26mm with a hypoechoic lesion, with lobulated edges, heterogeneous, occupying practically the entire testicle, and with increased Doppler flow. And a 32mm x 22mm x 20mm hetrogenic left teste with a slightly hypoechoic focal lesion of approximately 9mm with subtle Doppler flow. In addition, bilateral testicular microlithiasis.
A chest X-ray was also performed, which showed no pathological findings, and a thoraco-abdominal-pelvic CT scan with contrast, where no adenopathies or metastases were identified in any of the territories visualised.
With the diagnosis of bilateral testicular tumour, a bilateral orchiectomy via the inguinal route was performed and she was prescribed hormone replacement therapy.
The pathological anatomy reported: atrophic left testicle with multiple microscopic foci of classic seminoma associated with large areas of intratubular germ cell neoplasia (IGCT) with no tumour infiltration in the albuginea, rete testis, epididymis or vascular infiltration. The right testicle presents tumour with characteristics of classic seminoma that occupies practically the entire parenchyma, associated with foci of intratubular germ cell neoplasia (IGCT) and foci of atrophy in the remaining testicle. Tunica albuginea, rete testis, epididymis and surgical edge free of tumour.
Treatment was completed with two cycles of chemotherapy with carboplatin according to hospital protocol.
He has now been in complete remission for more than three years.

