Synchronous bilateral testicular cancer with discordant histopathology occurring in a 20-year-old patient: A case report and review of the literature

Abstract

Introduction: Bilateral testicular tumors are very rare, accounting for 1%–5% of all testicular germ-cell tumors (TGCTs). The vast majority of primary bilateral TGCTs are metachronous, with synchronous tumors comprising approximately 0.5%–1% of all cases. Those occurring synchronously share mostly the same histological pattern, predominantly seminoma, with synchronous bilateral TGCTs (SBTGCTs) with discordant subtypes being extremely rare. Case presentation: We present the case of a 20-year-old male complaining of a palpable painless right testicular mass incidentally noticed during sexual intercourse. Ultrasonography (US) and magnetic resonance imaging (MRI) of the scrotum demonstrated bilateral testicular lesions, while staging with contrast-enhanced computed tomography (CT) exhibited normal findings. Right radical orchiectomy and left testis-sparing surgery (TSS) with concomitant onco-testicular sperm extraction (onco-TESE) were initially performed. Histology of the right testis revealed a mixed germ-cell tumor, consisting of seminoma and embryonal carcinoma, while that from the left testis disclosed embryonal carcinoma and intratubular germ-cell neoplasia unclassified (IGCNU) infiltrating the surgical margins. Hence, left orchiectomy was subsequently scheduled with histology unveiling IGCNU in the greatest part of the remaining testicular parenchyma. Following adjuvant chemotherapy, with bleomycin, etoposide, and cisplatin (BEP), the patient received testosterone replacement therapy and remained free of recurrence at an 18-month follow-up. Conclusion: This case highlights both the rarity of a bilateral testicular tumor’s synchronous appearance and its extremely infrequent discordant histopathology. A comprehensive review of the major series of SBTGCTs with discordant histology cited in the literature is additionally presented.

Benign cystic Teratoma and Gonadoblastoma developed in bilateral abdominal undescended testis

“…But incompatible subtypes are extremely rare. 3 In this case there were two different types of tumors in two testes. One of the most common abnormalities in male newborns is absence of testis in its normal position.…”

Testis sparing surgery for Leydig cell tumor, surgical approach, and clinical outcome: A case report and review of literature

“… 7 TSS also exhibits several other advantages, including improving the quality of life without affect oncological outcome, preserving fertility, and reducing the need for androgenic medications. 8 …”

“…The patient should be info with additional information about postoperative follow-up, the risk of recurrence, and the potential need for adjuvant therapy, which could impact fertility and androgen production. 8 …”

Synchronous Testicular Cancer in Monozygotic Twins

“…Fertility preservation is of utmost importance in all patients with TC and especially those who suffer from bilateral testicular malignancies [ 16 - 17 ]. Despite that, it is estimated to be provided in only 50% of all patients being treated for TC, with sperm cryopreservation appearing to be most cost-efficient [ 16 ].…”