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I started having pain in my right testicle randomly in aproximately May 2023. It was always just brief pains 1-2 minutes and then would fade away. They weren't frequent in nature, just once a week, every other week. I shrugged it off, until July 3rd it started and was pretty constant through the day, at this point I noticed that it was also oddly shaped. I called a urologist office Tuesday, and they said they couldnt schedule due to lack of referral. Wednesday Morning I made an online appointment with a hospital affiliated urgent care, and they called me as I was walking out the door to head to their office, and told me to go to the ER as they couldn't perform the testing at the Urgent Care. I went to the ER reluctantly, I mean pain in the testicles, is it really an "emergency?" I felt silly going to the ER for that. They were packed, but got me into the back pretty quick, did an ultrasound, and put me back in a room. The doctor came in and said that I did have a mass, and the hypervascularity appears consistent with cancer, but he couldnt diagnose it as such. He had spoken to the urologist on call, and that he wanted me to be at his office the next day, they were working me in. "If I were you, I would make this appointment at all costs, they are a very busy practice and they tend to book weeks out" was the doctors advice. I went to the urologist, he concurred with the ER doctor and said that he suspects the same thing, that 95% of masses are cancer, and until something proves otherwise they were going to proceed as if it is cancer. Surgery scheduled the following Wednesday (1 week from ER visit) CT scan done the day before surgery. Wednesday I had a Radical Right Orchiectomy, and the pathology results came back consistent with Stage 1 Pure Seminoma.
That brings us to current situation.
I have been scheduled with a consultation to talk to a doctor about Chemo, and another doctor about radiation. To get information to weigh pros and cons of each. Basically the urologist is putting it in my hands to decide between Observation, Chemo, or Radiation. Observation would be CT scans once every 4 months for a year, then every 6 months until the 4 year mark, then every year for the rest of my life. I will copy and paste Labs, CT, and Pathology reports below. From what I can gather and the urologists opinion we caught it fairly early. At the same time, I dont want to have to worry about it coming back later down the road, somewhere else and having to deal with something that could be harder to treat. I am a 37 year old male with a 4yr old daughter. I kind of want to be around to see her graduate high school and get married.
Labs, CT, and Pathology Below
CT Scan
Kidneys: No ureteral calculi or hydronephrosis is seen. Within the lateral cortex of the lower pole of the left kidney, note is made of a 15 mm ovoid relatively hypoenhancing area. On the previous examination, this structure appear more cystic in nature. However on today's study this structure demonstrates significantly higher density with areas of possible internal septation, possible internal solid components, or possible internal enhancement seen. Given this apparent interval change, further characterization of this lesion with a dedicated renal mass protocol CT or MRI is recommended. This structure has not enlarged significantly in the interval, however.
IMPRESSION: 1. No acute appearing abnormality is identified within the abdomen or pelvis.
2. No abdominal/pelvic adenopathy or other findings of overt metastatic malignancy are appreciated.
3. 15 mm ovoid lesion is present within the lateral cortex of the lower pole the left kidney. On today's study, this structure appears somewhat complex in nature with possible internal septation, possible solid components and/or possible internal enhancement. Previously, this structure appeared cystic in nature. Given this apparent interval change, further characterization of this lesion with a dedicated renal mass protocol CT or MRI is recommended.
Pathology
Final Pathologic Diagnosis
RIGHT TESTICLE, ORCHIECTOMY: - TUMOR TYPE: PURE SEMINOMA.
-TUMOR SIZE (CM): 2.6 CM.
- TUMOR FOCALITY: UNIFOCAL
- MICROSCOPIC TUMOR EXTENSION: CONFINED TO TESTIS
- VASCULAR INVASION ABSENT.
- MARGINS: NEGATIVE
- AJCC PATHOLOGIC STAGE: pT1a pN NOT ASSIGNED (NONE SUBMITTED OR IDENTIFIED)
Diagnosis Comment The sections of the tumor show nests of loosely cohesive epithelial cells with intervening fibrous stroma containing abundant lymphocytes. The tumor has a uniform morphology and is morphologically consistent with a pure seminoma. Large areas of tumor necrosis are present. The tumor appears confined to the testis and does not show extension through the tunica. Immunoperoxidase stains of the tumor show positive staining for PLAP and C-kit with positive staining of background lymphocytes for CD45 (LCA). A few scattered AE1/AE3 keratin positive cells are seen but overall the tumor does not show extensive keratin positivity. CD30 is negative. Focal areas of intratubular germ cell neoplasia are seen adjacent to the tumor.
Gross Description
Received in formalin labeled with the patient's name and "right testicle" is a 59.4 g, 6.5 x 4.5 x 3.1 cm radical orchiectomy specimen with a 9.5 x 1.8 x 1.7 cm spermatic cord resection margin. The purple-red, edematous tunica vaginalis is intact. The specimen is inked black and sectioned to reveal a 2.6 x 1.9 x 1.6 cm white-pink to red-yellow, heterogenous mass with poorly defined, irregular borders within the tan-orange testicular parenchyma. The mass appears confined to the tunica albuginea and is 9.7 cm from the spermatic cord resection margin. A 3.1 x 1.5 x 1.5 cm unremarkable epididymis is present noted. No additional masses or lesions are appreciated. Representative sections are submitted as follows: A1-spermatic cord resection margin, en face; A2-mid cross-section of spermatic cord; A3-distal cross-section of spermatic cord; A4-mass in relation to epididymal tissue; A5-A6-mass in relation to tunica albuginea; A7-A8-mass in relation to surrounding testicular parenchyma. (TNB)
Labs
AFP: < 2.7 ng/mL
HCG: 1 mlntlUnit/mL
FSH: 8.3 mlntlUnit/mL
LDH: 275 EnzU/L (high)
LH: 8.2 mlntlUnit/mL
_______________________________
Advice, Suggestions, Thoughts to lend to helping me decide which path to take, would be greatly appreciated.
They are waiting at the moment for me to decide which path on when to do a renal CT for that mass. The urologist believes it is an over read by the radiologist, but wants to have it done just to be on the safe side. He said if we do the observation path, he will schedule it in 4 months with my first set of CTs, if I choose a different path he would get it scheduled before the other treatment starts.
That brings us to current situation.
I have been scheduled with a consultation to talk to a doctor about Chemo, and another doctor about radiation. To get information to weigh pros and cons of each. Basically the urologist is putting it in my hands to decide between Observation, Chemo, or Radiation. Observation would be CT scans once every 4 months for a year, then every 6 months until the 4 year mark, then every year for the rest of my life. I will copy and paste Labs, CT, and Pathology reports below. From what I can gather and the urologists opinion we caught it fairly early. At the same time, I dont want to have to worry about it coming back later down the road, somewhere else and having to deal with something that could be harder to treat. I am a 37 year old male with a 4yr old daughter. I kind of want to be around to see her graduate high school and get married.
Labs, CT, and Pathology Below
CT Scan
Kidneys: No ureteral calculi or hydronephrosis is seen. Within the lateral cortex of the lower pole of the left kidney, note is made of a 15 mm ovoid relatively hypoenhancing area. On the previous examination, this structure appear more cystic in nature. However on today's study this structure demonstrates significantly higher density with areas of possible internal septation, possible internal solid components, or possible internal enhancement seen. Given this apparent interval change, further characterization of this lesion with a dedicated renal mass protocol CT or MRI is recommended. This structure has not enlarged significantly in the interval, however.
IMPRESSION: 1. No acute appearing abnormality is identified within the abdomen or pelvis.
2. No abdominal/pelvic adenopathy or other findings of overt metastatic malignancy are appreciated.
3. 15 mm ovoid lesion is present within the lateral cortex of the lower pole the left kidney. On today's study, this structure appears somewhat complex in nature with possible internal septation, possible solid components and/or possible internal enhancement. Previously, this structure appeared cystic in nature. Given this apparent interval change, further characterization of this lesion with a dedicated renal mass protocol CT or MRI is recommended.
Pathology
Final Pathologic Diagnosis
RIGHT TESTICLE, ORCHIECTOMY: - TUMOR TYPE: PURE SEMINOMA.
-TUMOR SIZE (CM): 2.6 CM.
- TUMOR FOCALITY: UNIFOCAL
- MICROSCOPIC TUMOR EXTENSION: CONFINED TO TESTIS
- VASCULAR INVASION ABSENT.
- MARGINS: NEGATIVE
- AJCC PATHOLOGIC STAGE: pT1a pN NOT ASSIGNED (NONE SUBMITTED OR IDENTIFIED)
Diagnosis Comment The sections of the tumor show nests of loosely cohesive epithelial cells with intervening fibrous stroma containing abundant lymphocytes. The tumor has a uniform morphology and is morphologically consistent with a pure seminoma. Large areas of tumor necrosis are present. The tumor appears confined to the testis and does not show extension through the tunica. Immunoperoxidase stains of the tumor show positive staining for PLAP and C-kit with positive staining of background lymphocytes for CD45 (LCA). A few scattered AE1/AE3 keratin positive cells are seen but overall the tumor does not show extensive keratin positivity. CD30 is negative. Focal areas of intratubular germ cell neoplasia are seen adjacent to the tumor.
Gross Description
Received in formalin labeled with the patient's name and "right testicle" is a 59.4 g, 6.5 x 4.5 x 3.1 cm radical orchiectomy specimen with a 9.5 x 1.8 x 1.7 cm spermatic cord resection margin. The purple-red, edematous tunica vaginalis is intact. The specimen is inked black and sectioned to reveal a 2.6 x 1.9 x 1.6 cm white-pink to red-yellow, heterogenous mass with poorly defined, irregular borders within the tan-orange testicular parenchyma. The mass appears confined to the tunica albuginea and is 9.7 cm from the spermatic cord resection margin. A 3.1 x 1.5 x 1.5 cm unremarkable epididymis is present noted. No additional masses or lesions are appreciated. Representative sections are submitted as follows: A1-spermatic cord resection margin, en face; A2-mid cross-section of spermatic cord; A3-distal cross-section of spermatic cord; A4-mass in relation to epididymal tissue; A5-A6-mass in relation to tunica albuginea; A7-A8-mass in relation to surrounding testicular parenchyma. (TNB)
Labs
AFP: < 2.7 ng/mL
HCG: 1 mlntlUnit/mL
FSH: 8.3 mlntlUnit/mL
LDH: 275 EnzU/L (high)
LH: 8.2 mlntlUnit/mL
_______________________________
Advice, Suggestions, Thoughts to lend to helping me decide which path to take, would be greatly appreciated.
They are waiting at the moment for me to decide which path on when to do a renal CT for that mass. The urologist believes it is an over read by the radiologist, but wants to have it done just to be on the safe side. He said if we do the observation path, he will schedule it in 4 months with my first set of CTs, if I choose a different path he would get it scheduled before the other treatment starts.
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