Case Report
A 26-year-old man noticed a painless enlargement of right scrotum and visited the urology department at a nearby hospital. In childhood, he was diagnosed with a cryptorchidism and underwent a test laparotomy, but his left testis was not confirmed. Later, he was diagnosed with a left testicle defect. The right testis was swollen to a diameter of 5 cm without pain. Ultrasonography revealed a 5 cm hypoechoic mass in the right testis. Simple CT scan revealed a uniform mass of about 5cm inside the scrotum and no obvious metastasis. A laboratory examination showed almost normal levels. HCG-β level 0.46 ng/ml, HCG level 16.6 mIU/ml, AFP level 2.3 ng/ml, LH level 2.1 mIU/ml, FSH level 4.7 mIU/ml, and testosterone level 470 ng/dl.
He was not married but had a fiancé, and he wanted to cryopreserve the sperm. A semen test was performed at ART Clinic to preserve fertility, but he was diagnosed as azoospermia. His karyotype and chromosome Y were normal and without microdeletions. He was referred to our hospital, and Onco-TESE and radical inguinal orchiectomy were scheduled to be performed at the same time. Surgery was performed and most of the testicles were occupied by gray-white mass without bleeding or necrosis (Fig 1). Despite the tumor occupying most of the right testis, normal seminiferous tubules were detected on the head side of the testis and normal sperm were collected when microscopically collected (Fig 2). They were cryopreserved.
Histopathological examination revealed tumor cells containing lymphocytes and clear cytoplasm, and the diagnosis was pure seminoma, pT1N0M0 (Fig 3). In a portion of normal seminiferous tubules, spermatogenesis was confirmed (Fig 4). A small number of sperm was found in the seminiferous tubule, and the Johnson score was 8.
His postoperative course was uneventful, no adjuvant therapy was performed, and close follow-up with imaging was undertaken. No obvious tumor recurrence has been observed so far, and the patient have been receiving continuous testosterone supplementation due to low testosterone levels after orchiectomy.
Later, he married, the wife visited gynecology for underwent detailed examinations such as hysteroscopy, transvaginal ultrasound, and blood tests, and she was diagnosed as normal. They were performed ICSI using frozen sperm, and his wife became pregnant and a healthy child was born on gestational week 39 + 3. The newborn was a boy, born at a weight of 3060g and healthy without TDS syndrome.