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.