CASE 803: GERMINOMA METASTASE, Dr PHAN THANH HẢI, Dr PHẠM HUỲNH BẢO TRÂN, Dr LÝ VĂN PHÁI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

A 42 year-old man with LLQ pain and  defecation troubles and some left neck lymph nodes for one week. He lost # 2kg. He denied to ask doctor his swollen right scrotum as ashamed of it.

Abdominal  and neck ultrasound detected some lymph nodes ( most big size # 51mm) into abdomen and retroperitoneum which were hypoechoic pattern maybe due to lymphoma infiltration.

Some 9-21 mm lymph nodes at left posterior triangular neck.

Lab data result has beta2 microglobulin elevated.

Histopathological biopsy result of the subclavian  node was lymphoma big cell. But histoimmunochemostaining was a germinoma metastase to lymph node.

Fuĺl body MSCT performed to evaluate the lymph nodes

But MSCT detected a # 46x58 mm right testicular tumor with metastase lymph nodes in the abdomen and retroperitoneum, at the groins and the subclavian region and left neck.

Scrotal ultrasound later confirmed a # 76x66x36 mm right testicular tumor and inguinal and pelvic lymph nodes metastase.

Surgery removed the right testicular tumor and 

planning of chemotherapy management. The patient remains well and ceases GI tract trouble.

Germinoma in elderly patient is rare entity and the ashamed feeling of his big scrotum was one dramatic cause for a difficult diagnosis.