Solid Testicular Mass in a 44-Year-Old Man

Abstract

Figure 1. Ultrasound image of the left testicle showed a heterogenously low echogenic tumor within the left testis and normal left epididymis. Ahad noticed 6 months earlier. He reported left scrotal pain for a week before the visit but denied scrotal trauma or frank pain. He also denied voiding symptoms, gross hematuria, penile discharge, fever, or weight loss. His urologic history was insignificant, and his medical and surgical histories were significant only for hypertension. He also denied smoking. On physical examination, the patient had a firm, round, motile left scrotal mass with mild tenderness. Complete blood cell count and serum biochemistry tests revealed no significant abnormality. Serum lactic dehydrogenase (185 IU/L [normal reference range, 124-226 IU/L]), a-fetoprotein (6.9 ng/mL [normal reference value, <15 ng/mL]), b-subunit of human chorionic gonadotropin (<0.1 ng/mL [normal reference value, <0.2 ng/mL]), and C-reactive protein (0 mg/dL [normal reference value, <0.2 mg/dL]) were not elevated. A tuberculin skin reaction was slightly positive, suggesting no active tuberculosis infection. Ultrasound imaging revealed a heterogeneously hypoechoic and hypovascular lesion 3 cm in diameter within the left testis (Fig. 1), with apparently intact epididymis separated from the tumor. Multiple cystic lesions were also observed to the left side of the prostate. The left kidney was not visualized. A computed tomography (CT) scan also showed a solid, weakly enhanced mass in the left scrotum, and multiple cystic masses on the left seminal vesicle, a highly hypoplastic left kidney, and no retroperitoneal lymphadenopathy (Fig. 2).