Testicular tumor in young adult

A 26 year old gentleman presented with left hemiscrotal swelling .The swelling was acute in onset and was not preceded with trauma/ pain.There was no history of lower urinary tract symptoms or fever.

On examination the swelling was hard and mild tenderness could be elicited .We sent his routine hematological and hematological profile and USG doppler scrotum.The ultrasound of the scrotum revealed 3.5 cm heterogenous mass in the left testis.The mass vas vascaular.

Suspecting it to be a neoplastic lesion we sent for staging work up- testicular tumor markers and CT scan abdomen and chest .

The tumor markers- Beta HCG and alpha fetoprotein were raised but LDH levels were normal( 125 and 60 ng/ml).

As the tumor markers were elevated and the mass was seen on USG testis ; we went ahead directly with Radical High Inguinal Orchidectomy.

In cases were the tumor markers are not raised there comes the dilemma.In such case scenario; there are two options- FNAC of the lesion or performing the Chevassu maneuver during the orchidectomy. 

Chevassu maneuvre is preferred thing as it prevents any tumor seedlings with the biopsy.The procedure involves the isolation of the spermatic cord in inguinal region and clamping it .Followed by sending the mass biopsy for the frozen section.Scrotal hypothermia cold saline irrigation can prevent ischemic and re perfusion injury.

We performed the orchidectomy and on scrutinising the specimen we found a 4 cm mass heterogenous with necrotic areas in the testis.We sent the testis with spermatic cord for histopathological examination.

The further plan is wait for 1 month and repeat the testicular tumour markers and decide for further management either Chemotherapy/radiotherapy or Laparoscopic RPLND.