Rare case, needs help!

[Jens]

Hi guys.

A TC buddy needs our help. A while ago I posted about his situation, with no result. Now there has been a further development.
I’ll try and make it short, but you know how it is....

UL scan showed masses in both testicles – more predominantly in the left.
Surgical setup for bilateral(!) orchiectomy.

Left inguinal incision, retraction, freeze sectioning showed cancer, testicle removed.
Right inguinal incision, retraction, freeze sectioning showed NO cancer, testicle put back in.

As it turned out, put back in, in a way that later had to be corrected (not sure about the details, but there was a lot of pain!)

It’s standard procedure in Danmark to take a biopsy of the contralateral testicle, trough a scrotal incision. I had it done... (hurts more than the orchiectomy, btw).


1. question: Has anyone ever heard of something like this????


Pathology said seminoma.

CT scan showed a 3,2 cm tumor near the left kidney and he had 15 RT sessions with 25 GY in all, followed by 5 boost-RTs of 10 GY in all, directly on the tumor.
Tumor was (is) seminoma. It's now shrunk to 1 cm.

A new tumor has recently been discovered and removed from the empty right scrotal compartment! It grew from 0,5 to 3,5 cm in 2-3 weeks. (I don’t know why it took so long to get it out, but let me assure you that this is not the worst experience this poor guy has had with the hospital that’s ”treating” him)
Pathology – after second opinion – seminoma.

2. question: Has anyone ever heard of something like this????

He really needs our help guys!

Best wishes
Jens

[Scott]

That's a new one for me. Might be worth asking about on TC-NET, too.

[Rune]

I've posted on TC-NET in hope of answers.

As far as the frozen section on the testicle is concerned, they did the same thing in my case. The section showed cancer so they removed the testicle.. if it hadn't they would have put it back as well.

[huckchef]

i had a small 1/2cm tumor removed from my left testical and it was put back in. i knew this going in to the first surgery that i may have some or none when i wake up. it was on the top corner and easy to remove but was later removed because of no production. my right was 96% tumor and removed the first time. looking back on it all now...i would have had them both removed at once. no partial removal. but it was worth a shot a guess!!!

[Jens]

Thanks so far guys.

I'd like to repeat the 2. question:

Have any of you heard of a second tumor in the scrotum?

It's my understanding that inguinal orchiectomy is used because the spreading pattern of TC is so consistent and not compromised by inguinal access, whereas a scrotal incision might cause an unforeseeable spreading. This is why this case is so tricky. There was no scrotal incision.

Thanks.

Jens

[Rune]

I, for one, have never heard about it.

I posted on TC-NET yesterday but haven't received any replies yet. Apparently Doug Bank, the president of TCRC, is on vacation at the time.. hopefully he'll answer once he gets back.

[Scott]

Doug replied this evening: "Sounds weird and probably due to some mistakes. I think scrotal germ cell tumors like this are due to strange treatment or anatomy. Unfortunately, I think he should probably have chemo unless they can really keep the radiation away from his belly. Frankly, I think he should have had chemo for the previous tumor... Oh well."

[Jens]

Thanks Guys.

Will convey the messaage.

Best wishes
Jens

[Rune]

If I'm reading this abstract correctly, apparently about 2% of stage I patients on surveillance develop a tumor in the scrotal/inguinal region.

[Jens]

Hi Rune.

Up to date really dosen't cover it....
Well done. Lars will be thrilled to read this.

Jens