We report the case of a 33-year-old man with progressive enlargement of the right testicle of three months duration.
She reported no urinary symptoms or pain.
There are no allergies or diseases of interest.
She had normal psychomotor development without a history of cryptorchidism or hydrocele during childhood.
She denied alcohol, tobacco or other drugs.
Physical examination revealed a diffuse increase in size and consistency of the right testicle with negative transmissivity.
The left testicle was normal.
Unknown in inguinal lymphadenopathy or other anatomy
There is no gynecomastia, visceromegaly or peritoneal irritation.
We decided to perform testicular ultrasound in Primary Care, observing a diffuse alteration of the echostructure without the presence of cysts or calcifications.
Complete blood tests with tumor markers, chest X-ray and preferential referral to the Urology Department were requested.
Blood count, basic biochemistry, AFP, Beta-HCG and LDH were strictly normal.
The chest X-ray was equally normal.
Given the long waiting time for the Urology consultation, we refer the patient to Hospital Emergency with a complete study conducted in Primary Care.
Testicular ultrasound was performed, confirming: "increased right testicular size with diffuse alteration of echogenicity, without calcifications, presents diffuse increase of vascularization.
Inflammatory process of the right orchitis type, however, given the time of evolution, a neoplasic process is not discarded".
She was admitted to the Urology Department and underwent right inguinal radical orchiectomy.
Pathological anatomy reports: "classic seminoma of greater diameter 8 cm, with no evidence of involvement of the tunica albugínea.
Testicular parenchyma remnants with intratubular germ cell tumor foci.
Epididymis and resection of the cord are persistent edge without evidence of malignancy".
Computed Tomography (CT) was performed to confirm the diagnosis of cryptococcal meningitis.
Right paracardiac adenopathy of 6 mm and micronodule of 4 mm in SCI.
No pathological retroperitoneal or pelvic lymphadenopathy was observed.
Bilateral inguinal lymphadenopathy with reactive appearance secondary to surgery is observed in panoramic radiographs.
Study challenge without findings".
The decision was made to perform adjuvant surveillance in cases without a pure diagnosis of stage I disease.
However, the small but clinically significant risk of recurrence supports the need for long-term monitoring and initiation of rescue cisplatin-based radiotherapy or chemotherapy.
Because recurrences occur mainly in the first 2 years, follow-up with CT is recommended every 3 months in the first year, every 4 months in the second and every 6 and 12 months in the following years.
Our patient has been followed for more than 3 years, with no relapse data.
The nonspecific findings present in the first CT scan and tumor markers remain negative to date.
