A 25-year-old patient who presented to our clinic after finding a hypoechoic mass suggestive of neoplasia in the left testis on ultrasound.
The patient consulted in the specialty center for the painless increase of the left testicle for a few days.
His personal history included right testicle in elevator in childhood.
At 9 months she suffered from meningitis that left a permanent neurological deficit and residual seizures.
In addition, hysterectomy and tenotomy in childhood.
In our consultation, a new ultrasound, tumor markers and extension study by computerized axial tomography were requested.
Test results were a beta-HCG of 5.7 mIU/ml, with normal lactate dehydrogenase and alpha-fetoprotein.
Ultrasound showed an 8 cm mass in the left testicle with multiple hypoechoic nodules compatible with testicular tumor, as well as microcalcifications in the right testicle.
No lymphadenopathy or metastases were observed in the TAC-absent-pelvic.
She underwent left radical inguinal orchiectomy and the pathological anatomy analysis reported classic seminoma affecting the vasculature and cord, but there was no vascular or lymphatic invasion.
With the diagnosis of classic Seminoma in Stage I, conservative treatment is chosen.
A 10-month follow-up ultrasound showed a hypoechoic nodule in the right testicle suspected of malignancy.
Physical examination and tumor markers were normal.
Right radical orchiectomy was performed and the pathological anatomy study reported a classic seminoma with foci of intratubular neoplasms of the Germline Cells and vascular cords, approximately 4.5 cm.
Hormone replacement therapy is also started.
Three months later, beta-HCG levels increased up to 4.5 mIU/ml, with the rest of the tumor markers being normal. A new left iliac bifurcation was detected and the retroperitoneal mass was discovered at 8 cm.
Likewise, in a more anterior situation, another 2 cm x 2 cm nodular image is seen with a necrotic center and peripheral contrast uptake.
With the diagnosis of abdominal adenopathic relapse of classic seminoma, treatment begins with 4 cycles of Etoposide and Cisplatin.
Currently she has approximately 7 years free of disease.
