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Case 6-2007 A 28-Year-Old Man with a Mass in the Testis

 投稿者:February 22, 2007  投稿日:2007年 2月22日(木)10時37分47秒
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  A 28-year-old man was referred to this hospital for consultation on the management of an enlarging testicular mass.

One year earlier, he had noticed a small, nontender mass in the posterior aspect of the right testicle, which a physician, who was a relative of the patient, ascribed to epididymitis; the mass seemed to disappear, or at least the patient did not notice it again. One month before the consultation, the results of a routine annual physical examination were normal; no abnormalities were noted in the testicles. Ten days before the consultation, the right testicle became tender and began to enlarge rapidly. The patient did not have fever or constitutional symptoms. His primary care physician began treatment with levofloxacin. The results of laboratory studies  including urinalysis, complete blood count, platelet count, erythrocyte sedimentation rate, and liver-, renal-, and thyroid-function tests  were normal.

The testicular tenderness decreased, but the swelling persisted. One week later, an ultrasound examination performed at another hospital showed a complex testicular mass that was considered highly suggestive of cancer. The patient's physician recommended an immediate biopsy of the testis, but the patient decided to come to this hospital for a second opinion.

He felt well and had no constitutional, gastrointestinal, or urinary symptoms. He had been in excellent health, had no allergies, and took no medications. He had never had a urinary tract infection or epididymitis, and there was no history of inguinal hernia or sexually transmitted disease. He had never smoked; he occasionally drank alcohol. He had married 4 months earlier and had no children. A grandfather had died of pancreatic cancer, and a grandmother had cancer, but the patient did not know the primary site. There was no family history of testicular or other genitourinary cancer.

On physical examination, the patient appeared well, although anxious. His vital signs and the results of the general physical examination were normal; there was no tenderness of the breasts or gynecomastia. The left testis was normal; the right testis contained a firm, nontender mass, 4 cm in diameter. The epididymis was normal. A specimen of blood was drawn to test for tumor markers.

Later that day, a diagnostic procedure was performed.


Figure 1. Ultrasonographic Images of the Right Testis.
A transverse image through the right testicle (Panel A) shows a complex intratesticular mass with a cystic component (arrowhead) and a solid component (arrow). Normal testicular tissue is seen along the anterior aspect of the mass. A Doppler image (Panel B) reveals minimal vascularity in the solid component (arrow).

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