High Inguinal Orchiectomy Research Articles

Testicular mesothelioma disguised as hydrocele: a case report

BackgroundTesticular tumors have many different manifestations. The majority of these cases are presented as an incidental finding during hydrocelectomy. Malignant mesotheliomas are uncommon tumours that can arise from the coelomic epithelium of the pleura, peritoneum, pericardium, and tunica vaginalis.Case presentationWe present a 51-year-old South Asian (Indian) male patient with a rare case of mesothelioma, presenting with right hydrocele, to whom a right hydrocelectomy was performed. Any history of trauma or asbestos exposure was not present. Histopathological and immunohistochemistry reports revealed a malignant mesothelioma of tunica vaginalis. There was no invasion of the tumour to the epididymis and spermatic cord. Imaging studies showed no signs of metastasis. 1 month later, a high inguinal orchidectomy was performed. The patient underwent adjuvant chemotherapy thereafter and is still on follow-up.ConclusionAlthough hydrocele is common, detailed evaluation is mandatory to rule out certain rare tumours-testicular and paratesticular variants.

Malignant Mesothelioma of Tunica Vaginalis of Testis: Revisiting A Rare Entity

Introduction: Malignant mesothelioma is a rare tumour. Tunica vaginalis as the primary site is even rarer. Approximately, 300 cases have been reported to date in the literature. Its prevalence is 0.2 per million. Case Presentation: 67-year-old male, came with complaints of painless swelling in left hemiscrotum for 5 months. On examination, he had an enlarged left hemiscrotum. Ultrasound showed an enlarged left testis with hydrocele, with multiple deposits in tunica vaginalis with increased vascularity. Preoperative tumour markers and metastatic workup were within normal limits. He underwent a left high-inguinal orchidectomy. Microscopy showed intra-cystic papillae with a fibro-vascular core lined by stratified columnar cells with eosinophilic cytoplasm and marked atypia. IHC was positive for calretinin, WT-1, D2-40, and negative for PAX 8, CK 5/6, and vimentin. Biopsy suggestive of malignant mesothelioma of the tunica vaginalis. His follow-up PET scan was normal.

Liposarcoma of the testis: A case report

Liposarcoma of the testis is a rare genitourinary tumor. Liposarcoma commonly arises in the spermatic cord and rarely arises in the testis. We describe the case of a 60-year-old man who presented with complaints of swelling, associated with pain, in the right testicular region for 3 weeks. The scrotal ultrasound showed a heterogenous, hyperechoic lesion measuring 10 × 7 cm on the right. The testicular lesion appeared irregularly marginated with heterogeneous echotexture, with a central hyperechoic area and peripheral hypoechogenicity. Contrast-enhanced computed tomography of the abdomen showed no intra-abdominal mass or lymphadenopathy. Tumor markers including alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase were normal. A right high inguinal orchiectomy was performed, and the postoperative histopathologic examination showed features of liposarcoma of the testis with components of myxoid liposarcoma and well-differentiated liposarcoma. There was no evidence of recurrence up to 4 years post-surgery. Thus, misdiagnosis is common in liposarcoma testis due to the rarity and vague presentation. Ultrasound and tumor makers are often negative. A high index of suspicion is required in cases of tumor marker-negative testicular masses. The treatment of choice is high inguinal orchiectomy; evidence for the utility of chemotherapy and radiotherapy is limited.

Treatment results of Para-Testicular Rhabdomyosarcoma (PT-RMS) using radiation as an alternative to retro-peritoneal nodal dissection: A single Institution experience.

Para-testicular Rhabdomyosarcoma (PT-RMS) has a favorable treatment outcome adopting multidisciplinary management; resection, namely high inguinal orchiectomy ± retro-peritoneal lymph node dissection (RPLND) followed by standard or intensive chemotherapy ± adjuvant radiation therapy. This is a retrospective study including all patients with pathologically proven PT-RMS, presented to the National Cancer Institute, Cairo University, during the period from 2005 to 2020. Endpoints included overall survival, disease free survival and patterns of failure of different treatment modalities. Forty one patients were identified. Median age in our cohort was 15 years (range: 2-54 years). After a median follow up of 26 months (range, 3-75 months) ,two and five years OS were 100% and 91.7% respectively and median survival was not reached. Patients who underwent retro-peritoneal nodal dissection had a 5-year DFS rate of 100% versus 73% for those who received radiation to para-aortic nodes (p = 0.185). Limitations include retrospective nature and deviation from COG protocol. This study shows promising results suggesting that less aggressive local treatment modalities including radiation to para-aortic chain could be an option in PT-RMS, given the excellent results of this subtype. However further validation in a prospective study is warranted.

Testicular tumours in children: a single-centre experience.

Testicular tumours in childhood have diverse characteristics for different age ranges. This study aimed to describe the pattern, presentation and outcomes of primary testicular tumours in a paediatric population. A retrospective study was conducted from January 2010 to December 2020 on children (≤18 years) with a diagnosis of primary testicular tumour. Baseline demographics, clinical characteristics, pathology, treatment and outcomes of these patients were analysed. The data were entered into IBM SPSS Statistics version 20.0. Chi-square test and Fisher's exact test were applied to find the statistical significance, which was set at P value ≤ 0.05. The study included 115 males, with 85 (73.9%) patients in the prepubertal age range with a mean age of 2.53 ± 2.06 years and 30 (26.1%) patients in the postpubertal group with a mean age of 15.73 ± 1.25 years. Yolk sac tumour was the most common (62.6%) histological subtype. Majority (46.1%) of patients had stage I disease on presentation, while 29.6% had stage IV disease. All patients underwent upfront high inguinal radical orchiectomy, which was followed by platinum-based adjuvant chemotherapy in 67% of the patients. The five-year event-free survival and overall survival for all patients were 75% and 91%, respectively. Primary testicular tumours follow a bimodal age distribution pattern. Majority of patients can be cured with platinum-based chemotherapy despite having advanced disease at presentation.

Management of testicular tumours in patients with undescended testes- a challenging but rewarding task: experience from a tertiary care cancer centre in India.

Primary objective: To study patients' clinical profile and outcomes with germ cell tumours developing in undescended testes. Case records of patients enlisted in the prospectively maintained 'testicular cancer database' at our tertiary cancer care hospital from 2014 to 2019 were retrospectively reviewed. Any patient who presented with testicular germ cell tumour with a documented history/diagnosis of undescended testes, whether surgically corrected or not, was considered for this study. The patients were managed along the standard lines of treatment for testicular cancer. We evaluated clinical features, difficulties and delays in diagnosis and complexities in management. We evaluated event-free survival (EFS) and overall survival (OS) using the Kaplan-Meier Method. Fifty-four patients were identified from our database. The mean age was 32.4 years (median age 32, range: 15-56 years). Seventeen (31.4%) had developed cancer in orchidopexy testes, and 37 (68.6%) presented with testicular cancer in uncorrected cryptorchid testes. The median age at orchidopexy was 13.5 years (range: 2-32 years). The median time from symptom onset to diagnosis was 2 months (1-36 months). There was a delay in the initiation of treatment of more than 1 month in 13 patients, with the longest delay being 4 months. Two patients were initially misdiagnosed as gastrointestinal tumours. Thirty-two (59.25%) patients had seminoma, and 22 (40.7%) patients had non-seminomatous germ cell tumours (NSGCT). Nineteen patients had metastatic disease at presentation. Thirty (55.5%) patients underwent orchidectomy upfront while in 22 (40.7%) patients, orchidectomy was done after chemotherapy. The surgical approach included high inguinal orchidectomy, exploratory laparotomy or laparoscopic surgery per the clinical situation. Post-operative chemotherapy was offered as clinically indicated. At a median follow-up of 66 months (95% CI: 51-76), there were four relapses (all NSGCT) and one death. The 5-year EFS was 90.7% (95% CI: 82.9-98.7). The 5-year OS was 96.3% (95% CI: 91.2-100). The tumours in undescended testes, particularly those without prior orchiopexy, often presented late and with bulky masses, requiring complex multidisciplinary management. Despite the complexity and challenges, our patient's OS and EFS matched that of patients with tumours in normally descended testes. Orchiopexy may help in earlier detection. In the first such series from India, we show that testicular tumours in the cryptorchid are also as curable as the germ cell tumours developing in the descended testis.A multidisciplinary disease management group with expertise in managing complex cases is crucial for a favourable outcome in these groups of patients. We also found that orchiopexy done even later in life confers an advantage in terms of early detection in a subsequently developing testicular tumour.

Stage I seminoma: outcome of different treatment modalities & changes in patterns of care: A single institution experience.

The mainstay for management of stage I seminoma is high inguinal orchiectomy with post-orchiectomy therapeutic options including active surveillance, chemotherapy or radiation therapy. To analyze different post-orchiectomy treatment modalities outcomes of stage I seminoma patients presented to NCI, Cairo University in the period from 2005-2019. A retrospective review of all patients' records with clinical stage I seminoma who presented to our institute in the period from 2005-2019 was done. Adjuvant treatment details were extracted and we compared overall survival (OS) and disease free survival (DFS) for different modalities and changes in patterns of care over this period. Thirty five patients were identified with thirty three patients eligible for analysis. Median age was 35 years (range, 19-52). Fourteen patients were kept under active surveillance, eleven patients received adjuvant carboplatin and eight patients received adjuvant radiation to para-aortic chain. Five-year OS was 100% for all patients regardless post-operative approach. Five-year DFS was 100% for patients who received adjuvant chemotherapy or radiotherapy versus 93% for patients who were kept under active surveillance (p=0.03). Clinical stage I seminoma is a favorable disease entity with favorable disease related outcomes regardless post-operative approach. Active surveillance is reasonable and safe given equal survival to active treatment.

Paraneoplastic Hypercalcaemia as a Cause of Unexplained Renal Impairment in a Patient With Seminoma: A Case Report

A 44-year-old otherwise healthy male who had undergone left high inguinal orchidectomy, with histopathology suggestive of classical seminoma, was referred to the authors’ oncology centre for evaluation of persistently deranged renal function tests and initiation of chemotherapy. They had a large retroperitoneal mass encasing their left kidney and their creatinine was 4.2 mg/dL. Even 1 week after double J stenting, they had persistently elevated creatinine of 3.1 mg/dL, which was precluding their curative chemotherapy with bleomycin/cisplatin/etoposide regimen. In a desperate situation, to prevent further progression of disease, pre-phase chemotherapy with carboplatin and etoposide was considered. In anticipation of tumour lysis syndrome, considering the large mass and compromised renal function, a tumour lysis profile was requested, which revealed elevated serum calcium levels (15.4 mg/dL, which goes against the tumour lysis syndrome). Considering the large retroperitoneal lymph nodal mass, suppressed parathyroid hormone levels (4.1 pg/mL) and vitamin D3 being within normal range, a paraneoplastic cause of hypercalcaemia was considered. Correction of hypercalcaemia with medical measures as well as treatment of seminoma was instituted, which led to normalisation of renal function tests within the next 10 days. Here, the authors report a rare case of testicular seminoma with persistently deranged renal function, likely due to paraneoplastic hypercalcaemia, which improved after successful chemotherapy along with anti-hypercalcaemic measures, including aggressive hydration, diuretics, calcitonin, dexamethasone, and denosumab. This report shows that it is important to treat the cause along with medical management in this oncologic metabolic emergency. It also highlights the value of pre-phase chemotherapy with carboplatin and etoposide in the setting of acute renal impairment.

A Case of Adult Granulosa Cell Tumour of the Testis Masquerading as Hernia with Hydrocele

Granulosa cell tumours are extremely rare and very few cases of adult type have been reported till date . Granulosa cell tumours can broadly classified into juvenile and adult types. They are known to occur more commonly occurs in females (in ovaries) than in males (in testis) . We here reported here a case of 39 year old man who was diagnosed with testicular adult granulose cell tumour with no metastasis . A High Inguinal radical Orchidectomy was performed with histology demonstrating no invasion of the tunica albuginea , epididymis , spermatic cord and no lymphovascular invasion . The aim of the present report is to document another case of AGCT to summarize the knowledge regarding this rare tumour.

Leiomyosarcoma presenting as unilateral painless testicular mass in a septuagenarian: a case report with review of the literature

BackgroundPrimary testicular leiomyosarcoma has a rare occurrence and the diagnosis is uncertain on pre-operative assessment. It is often seen in the background of chronic inflammation, radiotherapy, and the use of high-dose anabolic steroids.Case presentationWe report a case of a painless testicular lump in a septuagenarian with pre-existing diabetes mellitus and hypertension but without any oncological risk factors. The primary workup did not reveal any elevation of serum tumour markers or any signs of metastatic disease on contrast imaging. The patient underwent a high inguinal orchiectomy due to a suspicion of germ cell tumor, and histopathology and immunohistochemistry confirmed the diagnosis of leiomyosarcoma.ConclusionTesticular leiomyosarcoma in the elderly is a rare malignancy and usually occur without any pre-existing risk factors. Early treatment provides long-term curative oncological control.

Primary DLBCL of testis: Presenting as a case of testicular mass

Primary testicular non-Hodgkin’s lymphoma (NHL) is a rare, clinically aggressive form of extranodal lymphoma and constitutes 1% of all NHL and 5% of all testicular neoplasms. The vast majority of primary testicular lymphomas (PTLs) are diffuse large B-cell lymphoma (DLBCL); however, Burkitt’s lymphoma, anaplastic lymphoma, or Hodgkin’s lymphoma may primarily involve the testis but it is less common. High inguinal orchiectomy, along with chemotherapy with or without radiotherapy, is the current treatment of choice for these tumors. Here, we present the case of primary testicular NHL in a 72-year-old male.

Primary testicular T cell Non Hodgkin Lymphoma with unusual histomorphology: A rare case

Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal lymphoma presentation, constituting 1-2% of all lymphomas. Majority are of B-Cell type, with very few cases being primary T-Cell phenotype. A 28 years male presented with painless, unilateral testicular swelling with elevated serum LDH levels, beta HCG and AFP serum levels were within normal limits. Gross evaluation of high inguinal orchidectomy specimen showed an enlarged homogenous, grey white lobulated mass with adjacent entrapped testicular parenchyma. Microscopy showed diffuse sheets of medium sized, monomorphic atypical lymphoid cells with sparing of adjacent seminiferous tubules. A panel of Immunohistochemistry markers done were suggestive of T-Cell Non-Hodgkin Lymphoma. Testicular T cell NHL are extremely rare amongst the testicular lymphomas, constituting for 5% of all testicular tumours. This case is being presented for its rarity in literature, especially in young age group and the unusual histomorphology.

Optimal surgical treatment for paratesticular leiomyosarcoma: retrospective analysis of 217 reported cases

BackgroundParatesticular leiomyosarcoma (LMS) is a rare tumor. Conventionally, tumor resection by high inguinal orchiectomy is performed as the preferred treatment approach for paratesticular sarcoma. On the other hand, testis-sparing surgery has recently attracted attention as a less-invasive treatment option for paratesticular sarcoma. However, the prognostic predictors and optimal treatment strategy for paratesticular LMS remain unclear because of its rarity. In this study, we systematically reviewed previously reported cases of paratesticular LMS to evaluate the prognostic factors and establish the optimal treatment strategy.MethodsA systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular LMS published between 1971 and 2020 in English. The final cohort included 217 patients in 167 articles. The starting point of this study was the time of definitive surgical treatment, and the end point was the time of local recurrence (LR), distant metastasis (DM), and disease-specific mortality.ResultsPatients with cutaneous LMS had a slightly better LR-free survival, DM-free survival, and disease-specific survival than those with subcutaneous LMS (p = 0.745, p = 0.033, and p = 0.126, respectively). Patients with higher grade tumors had a significantly higher risk of DM and disease-specific mortality (Grade 3 vs Grade 1 p < 0.001, and Grade 3 vs Grade 1 p < 0.001, respectively). In addition, those with a microscopic positive margin had a significantly higher risk of LR and DM than those with a negative margin (p < 0.001, and p = 0.018, respectively). Patients who underwent simple tumorectomy had a slightly higher risk of LR than those who underwent high inguinal orchiectomy (p = 0.067). Subgroup analysis of cutaneous LMS demonstrated that the difference in LR between simple tumorectomy and high inguinal orchiectomy was limited (p = 0.212). On the other hand, subgroup analysis of subcutaneous LMS revealed a significant difference in LR (p = 0.039).ConclusionsOur study demonstrated that subcutaneous LMS and high-grade tumors are prognostic factors for paratesticular LMS. For subcutaneous LMS, tumorectomy with high inguinal orchiectomy should be the optimal treatment strategy to achieve a negative surgical margin.

Clinical Study of Testicular Leiomyosarcoma: Our Experience

Introduction: Leiomyosarcoma is malignant soft tissue tumor of mesenchymal origin arising from undifferentiated smooth muscle cells. Thera are two types of Leiomyosarcoma of scrotum namely para-testicular and intra-testicular. The Intra testicular tumor is relatively rare. Blood vessels or contractile cells of the seminiferous tubules is believed to be the origin of this rare tumor which is of mesenchymal origin. Objective: Prospective clinical evaluation of testicular leiomyosarcoma with retroperitoneal mass and metastasis to para-aortic and retro-caval lymph nodes. Material &amp; Methods: All 21 consecutive patients who were diagnosed as testicular mass on evaluation from August 2018 to July 2021 were included in study after fulfillment of eligibility criteria. Prior to surgery all patients were evaluated. All patients operated with standard method of radical high inguinal orchidectomy, followed by chemo or radio therapy as and when required on further evaluation and histopathology checked. Patients demographic, clinical-pathological, testicular tumor parameters and tumor markers with perioperative data, metastatic parameters recorded prospectively and analysed. Outcome measures were demographic data, tumor response, perioperative data, complications and follow-up at 12 months. Results: In our study out of 21 patients, 13 patients (61.9%) were found to be in stage 1,4 patients (19%) were in stage 2 and another 4 patients (19%) were in stage 3 according to IGCCCG. Only 5 patients (23.8%) were found with retroperitoneal paraarotic and paracaval Lymphadenopathy. Metastasis to liver, lung, brain and major visceral organs were present in 4 of our patients (19.8%). Conclusion: As less cases have been reported so far, clinical and biological behavior of this tumor difficult to predict. Based on the literature review, the treatment of choice for an intratesticular leiomyosarcoma is a radical orchidectomy and clinico-radiological surveillance in cases at stage I. As there are no available data regarding the management of stage II or Stage III disease post radical orchidectomy.

Testicular non-Hodgkin’s lymphoma – a rare tumor

Primary lymphoma of the testis is an exceedingly rare disease. We present a case of a 65 years old gentleman who presented with a brief history of testicular pain. Imaging studies and serum tumour markers indicated a testicular lesion of suspicious aetiology. High inguinal orchidectomy was performed. Histopathology and immunohistochemistry revealed diffuse large B-cell lymphoma. Positron emission tomography (PET) scan revealed a metabolically active retroperitoneal lymph node in aortocaval location. Subsequently he underwent chemotherapy with Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen plus intravenous Methotrexate, following which PET scan showed disappearance of the previously detected metabolically active lesion.

Outcome of testicular non-seminomatous germ cell tumours: report from a tertiary cancer centre in eastern India.

Non-seminomatous germ cell tumour (NSGCT) is a rare but highly curable malignancy. The literature on the management and outcomes of NSGCT is scarce from India. Here, we report the demography and treatment outcomes of NSGCT treated at our centre. This is a retrospective analysis of testicular and retroperitoneal NSGCT patients treated from March 2011 to December 2019. Patients were staged appropriately with imaging, pre- and post-operative tumour marker. Patients received stage adjusted adjuvant treatment after high inguinal orchiectomy. Patients with advanced disease were risk stratified as per International Germ Cell Cancer Collaborative Group (IGCCCG) classification. A total of 100 patients were treated with a median age of 28 years (Range: 18–51). Primary site was testis in 92 and retroperitoneum in 8 patients. Testicular violation was present in 17 (18%) patients. The stage of the disease was I in 32, II in 19 and III in 49 patients, respectively. IGCCCG risk groups were good in 29 (46%), intermediate in 13 (21%) and poor in 21 (33%) patients. Eleven patients (24%) underwent retroperitoneal lymph node dissection amongst 45 with post-chemotherapy residual disease. After a median follow-up of 26.6 months (range: 2.2–100.7), 3-year event-free survival and overall survival (OS) were 70.7% ± 5.6% and 78.2% ± 5.4%, respectively. S3 tumour marker (p = 0.01) and non-pulmonary visceral metastasis (p < 0.001) emerged as independent poor prognostic factors for OS in multivariate analysis. To conclude, testicular NSGCT has very high cure rate. Two-third patients present with advanced disease and one-third of them had poor risk disease. S3 tumour marker and non-pulmonary visceral metastasis are poor risk factors for OS.

Technical illustration of Volumetric arc conformal radiotherapy planning in a case of paratesticular sarcoma

AbstractIntroduction:Paratesticular sarcoma are extremely rare malignant tumours. Unlike other sites, they tend to be lower grade and have higher propensity of lymphatic spread. They tend to fail locally and occasionally in the regional lymph nodes. In the absence of target volume delineation guidelines and technical illustration of conformal planning, we have made an attempt to illustrate conformal planning methodology and define target volume based on current evidence in a case of paratesticular sarcoma.Methods:We are presenting a case of 62-year-old male who presented with 15-cm scrotal swelling and underwent high inguinal orchidectomy with ligation of spermatic cord. Histopathology presented a well-differentiated leiomyosarcoma of epididymis. Post-operative radiotherapy target volume included the tumour bed, ipsilateral inguinal nodes and lower pelvic nodes as the clinical target volume.Conclusion:Adjuvant radiotherapy using advanced delivery technique such as volumetric arc technique can provide good dose distribution with good sparing of organs at risk. The downside of conformal radiation delivery is that it is a resource-intensive and has no established target volume delineation guidelines.

Clinicopathological characteristics, prognostic factors and treatment outcomes of seminomatous germ cell tumours from a tertiary cancer centre in eastern India.

. Seminomatous germ cell tumour (SGCT) is a rare but curable malignancy of young adults. The literature on management and outcome of SGCT is scarce from India. We report the demography and treatment outcome of SGCT at our centre. . We did a retrospective analysis of patients with SGCT treated from March 2011 to December 2018. Patients were staged appropriately with imaging, and pre- and postoperative tumour markers. High inguinal orchiectomy was performed in all with a testicular primary and received subsequent stage-adjusted adjuvant treatment. Patients were monitored for metabolic syndrome during follow-up after completion of treatment. . We treated 85 patients with a median age of 37 (range 20-68) years. The primary site of the tumour was the testis in 80 (94%) and mediastinum in 5 (6%) patients. Cryptorchidism was present in 20 (25%) patients and testicular violation was present in 11 (14%) patients. Stage of the disease was I in 61, II in 13 and III in 6 patients. Adjuvant treatment in stage I disease was single-agent carbo-platin (area under the curve ×7) in 38 (62%), surveillance in 20 (33%) and radiotherapy in 3 (5%) patients. Five patients in the surveillance group relapsed. The 7-year mean (SD) relapse-free survival and overall survival were 83.1% (8%) and 98.7% (1.3%), respectively. Thirty-one patients (n = 52, 60%) had features of metabolic syndrome. . SGCTs have a high cure rate. Long-term follow-up is essential for monitoring toxic effects. Early diagnosis, avoidance of testicular violation and multidisciplinary management are the key features for better long-term outcome in SGCT.

Testicular choriocarcinoma in a case of inguinal hernia: a rare subtype of non-seminomatous mixed germ cell tumour with a misleading presentation requiring a unique treatment approach

Testicular choriocarcinoma is a rare and aggressive variant of non-seminomatous germ cell tumor (NSGCT) with early metastatic spread and dismal prognosis. Early recognition of the diagnosis by elevated β-human chorionic gonadotropin (β-HCG) levels in a young male improves his chances of survival following a radical orchiectomy, which establishes the diagnosis and staging. We report a case of a 21-year old young male presenting with a right groin swelling for 2 months. The clinical history was that of a right inguinal hernia but examination findings suggested a testicular tumor, which was confirmed with an ultrasonograhy and contrast enhanced computed tomography (CECT) of abdomen and scrotum and an elevated β-HCG of 23,559 IU. The metastatic workup was clear and so the patient was taken up for immediate right high inguinal orchidectomy and Lichtenstein tension-free mesh repair. HPE of the postoperative specimen proved a mixed germ cell tumor with choriocarcinoma predominance. Semen analysis and sperm banking were done and the patient was started on chemotherapy and sequential normalization of β-HCG levels was observed. Choriocarcinoma is an aggressive variant of NSGCT with inherent invasive and metastatic potential rapidly metastasizing to the liver, lung, brain, etc. So a thorough knowledge of the varied clinical manifestations of the choriocarcinoma syndrome ensures early detection even when the presentation is misleading. Treatment is directed towards confirming the diagnosis and staging with histopathology examination and postoperative chemotherapy for persistent normalization of the tumor markers.

Testicular Tumor Presenting as Scrotal Abscess

We present a case of an 18-year-old male with a scrotal swelling which initially appeared to be a ruptured scrotal abscess but rapidly grew into a fungating mass after initial exploration. Investigations revealed Embryonal Carcinoma of testis with paraaortic and inguinal lymph nodal involvement. High inguinal orchidectomy and local excision of scrotum was followed by chemotherapy. Later the patient made complete recovery. Involvement of skin in case of testicular cancer is rare.