A 30-year-old patient with no family or toxic history of interest.
The pathological antecedents included ulcus, exploratory laparotomy for stab wounds, gonorrhea urethritis HBVmo (+), and left varicocelectomy Palotype at 18 years old.
He consulted due to an increase in size of the left testicle of one year of evolution.
Examination revealed normal right testis and left hydrocele, which made it difficult to explore the testicle.
An ultrasound was requested to demonstrate a solid hypoechoic lesion of 17 mm of larger diameter located in the lower pole of the left test.
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Serum tumor markers (LDH; beta-HCG; alpha-AFP) were normal.
The chest X-ray and abdominal-pelvic CT were negative for metastasis.
An exploratory inguinotomy was performed with a left test perioperative biopsy. The pathological result was classic seminoma with areas of yolk sac tumor focally located in the tunica albuginia without exceeding it.
This diagnosis was later confirmed by immunohistochemical study.
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After performing left inguinal orchiectomy and being a tumor in stage T1N0M0 was decided conservative treatment and periodic controls every 3 months with physical examination, determination of tumor markers, CT and X-ray.
In one of these controls and 11 months after surgery, the patient reported recent testicular discomfort similar to those that motivated her initial consultation.
The ultrasound showed three hypoechoic nodular lesions of 16, 13 and 6 mm in diameter depending on the upper pole of the right test.
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The case was referred as a second multifocal testicular neoplasm and any type of conservative treatment on the testicle was ruled out, performing a new radical orchiectomy.
The patient refused cryopreservation of semen.
The histological study confirmed the presence of a classic seminoma with peritumor CIS zones without invasion of albuginia.
It was again a T1N0M0 germ cell tumor.
The patient is currently under regular monitoring every 3 months after starting hormone replacement therapy.
14 months later the patient is asymptomatic and without evidence of tumor disease.
