Case history
Case history
A 35-year-old man presents with nonspecific testicular discomfort and the feeling of a mass in the testis. On exam, a 2 cm by 1 cm smooth, painless mass is palpated in the right testis. The mass does not transilluminate with light. There is no lymphadenopathy.
Other presentations
Symptom onset is usually more than 2 weeks. Up to 20% of men present with painful swelling of sudden onset (due to associated hemorrhage or infection). In rare cases, changes in testicular volume and/or consistency may be early indicators of malignancy. Patients with seminoma tend to have a longer history of testicular abnormality than those with nonseminomas. While most men are diagnosed with localized disease, 18% have regional spread and 12% have distant metastases at time of diagnosis.[8] Metastatic disease can manifest as a neck mass from a pathologic supraclavicular lymph node, respiratory symptoms due to pulmonary metastases, or flank and lumbar back pain due to massive retroperitoneal disease.[1] Other presenting symptoms of metastatic disease are bone pain, nervous system abnormalities due to mechanical nerve root involvement, lower extremity swelling, and symptoms and/or signs of hyperthyroidism.[9] Gynecomastia can be the presenting sign of testicular cancer in 5% of cases.[10]
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