CASE 599: TESTICULAR CANCER MIMICKING TESTIS TORSION , Dr PHAN THANH HẢI, Dr NGUYỄN MINH THIỀN, Dr MAI BÁ TIẾN DŨNG, MEDIC MEDICAL CENTER, HCMC VIETNAM

Male patient 31 yo, with sudden pain at left scrotum for 2 months had been treated as epidydimitis but treatment failed. He came to Medic for reexamination because swollen scrotum and testicular pain.

Ultrasound at Medic Center detected swollen left testis  with edema of epidydimis and hypervacularization. Testicular axis turned horizontally and left testis was inhomogenous with cystic necrosis and no vascular signal mimicking a left testicular torsion.

MRI of left testis #  60x85mm, inhomogenous signals that existed fluid and blood inside but captured a few of contrast. Edema of epidydimis and spermatic cord. No spermatocele.

Lab results showed no sign of inflammation, beta HCG, AFP, LDH raising that lead to think about a testicular  tumor non seminoma.

Operation removed left testis. It looks like tumor on macroscopic view. Histopathologic result is testicular embryonic carcinoma.

Post surgery one day,  blood tests dropped=  AFP, Beta HCG and LDH   ( AFP= 62, beta HCG= 8.9, LDH= 419). Normal. Chest XRray .  

DISCUSSION= Diagnosis of left testicular tumor based on patient history, age, beta HCG, LDH and AFP raising. No hypervascularizing of left testicular tumor maybe due to thrombosis of vessels in spermatic cord that could make mistake for ultrasound and MRI.