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.