Empty hemiscrotum and a giant abdominal mass case report

Jan K. Rudzinski, Hunter R. Carlock, Benjamin B. Beech, Kamran Zargar-Shoshtari, Pranav Sharma, Timothy Kim, Philippe E. Spiess


Testicular germ cell tumors are the most common adult male malignancy among men 20–35 years, having a favorable prognosis when detected at early stages. Testicular teratomas are derived from embryonic tissue within gonads and tend to exhibit locally invasive and chemo resistant behavior. Cryptorchidism is a significant risk factor for the development of testicular germ cell tumors, therefore, patients with undescended testicles should be closely monitored. Pre-pubertal orchiopexy should be considered to reduce the risk of germ cell tumors and improve its early detection. We report a 26-year-old male with an empty hemiscrotum who incidentally presented with a large intraabdominal mass after being evaluated for a broken jaw. He was lost to follow-up and re-presented with a 19 cm intraabdominal mass and alpha-fetoprotein of 5,310 ng/mL, beta-human chorionic gonadotrophin of 0.5 MIU/mL, and a lactate dehydrogenase of 846 U/L. After completion of four cycles of paclitaxel, ifosfamide, and cisplatin chemotherapy, he underwent a left orchiectomy, bilateral full template retroperitoneal lymph node dissection, and a partial cystectomy. Final pathology revealed a malignant mixed germ cell tumor consisting of 75% immature teratoma, 25% mature teratoma, and involvement in zero of twenty-three retroperitoneal lymph nodes. The patient recovered well with no signs of recurrence. This case highlights the importance of proper genitourinary assessment during routine physical examinations and close follow-up of adult patients with cryptorchidism.