Case Summary
A 40-year-old male presented to Rochester General Hospital in October 2021 with complaints of left leg swelling and pain. He had also noticed gradual non painful swelling of this scrotum over the last year with associated weight loss. Examination showed left sided scrotal swelling and left leg swelling. Doppler of the lower extremity showed left proximal DVT for which he was started on anticoagulation. A CT Abdomen and Pelvis was also ordered because of the left scrotal swelling. It showed a 30.1 cm (cranial caudal) lobulated mixed attenuating left lower pelvic retroperitoneal mass extending to the left hemiscrotum. Several pulmonary nodules measuring up to 1.9 cm were also seen. A subsequent CT Chest showed multiple pulmonary nodules as well as an extensive pulmonary embolus. Beta HCG was < 0.6 IU/ L (< 0.5 IU/ L) although AFP was raised to 74242.6 ng/mL (< 9 nm/mL) and LDH was raised to 1692 IU/L (100-190 IU/L). He subsequently underwent a needle biopsy of the retroperitoneal mass which showed histopathology most consistent with yolk sac tumor with tumor necrosis and sarcomatous pattern. It was also positive for chromosome 12p detection. He was diagnosed with stage III poor risk tumor (due to AFP >10,000) and completed BEP chemotherapy for 4 cycles. He underwent repeat CT scans post treatment in February 2022 showing complete resolution of the pulmonary nodules with evidence of chronic pulmonary embolus as well as dramatically favorable treatment response with the left retroperitoneal mass now measuring 4 cm in the greatest dimension. His AFP post treatment had also trended down to 72 ng/mL. After interdisciplinary discussion, the decision was made to proceed ahead with radical orchiectomy in April 2022 given his AFP had risen to 109 ng/mL on surveillance follow up. He is still being actively followed by oncology and urology.