A case of spermatic cord teratoma in low-stage testicular cancer managed by surveillance.

BACKGROUND

A 25-year-old male presented to his local urologist with new-onset right testicular pain and swelling detected on self examination. A scrotal ultrasound scan showed a right testicular mass, suspicious for neoplasm. Serum levels of alpha-fetoprotein and human chorionic gonadotropin were found to be elevated at 920.2 microg/l and 637.4 U/l, respectively. The patient underwent right inguinal orchiectomy and was diagnosed with nonseminomatous germ cell tumor of the right testis, composed of yolk sac tumor, teratoma, and embryonal carcinoma with no evidence of metastatic disease. He opted to remain under surveillance rather than undergo primary chemotherapy or retroperitoneal lymph node dissection for his clinical stage I disease. Serologic relapse at 4 months after orchiectomy was successfully treated with bleomycin, etoposide and cisplatin (BEP) chemotherapy.

INVESTIGATIONS

Surveillance comprised regular clinic visits, measurement of serum levels of alpha-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase, chest X-ray and CT of the abdomen and pelvis. Pathology of the testicular mass was reviewed.

DIAGNOSIS

A 1.7 cm nodule anterior to the right psoas muscle suspicious for metastatic disease that was seen on CT 16 months after orchiectomy was pathologically confirmed as recurrent mature teratoma in the spermatic cord. Additionally, one of eleven interaortocaval lymph nodes showed evidence of teratoma.

MANAGEMENT

Bilateral nerve-sparing retroperitoneal lymph node dissection with complete excision of the right spermatic cord was performed. The patient has since remained disease-free, with normal levels of serum tumor markers and no evidence of metastasis on chest X-ray and abdominal CT.