Scrotal Involvement with Testicular NonseminomatousGerm Cell Tumour

A 37-year-old male presented with a traumatic injury to the scrotal region necessitating emergency surgery. Evacuation of ahaematoma and bilateral orchidectomy were performed. A left sided nonseminomatous germ cell tumour (NSGCT), predominantlyyolk sac, was identified. Microscopic margins were positive for tumour. Initial tumour markers revealed an AFP of 22,854 ng/mL,HCG of<1 mIU/mL, and LDH of 463 IU/L. Eight weeks after surgery, AFP levels remained elevated at 11,646 ng/mL. Computedtomography (CT) scanning demonstrated left inguinal adenopathy, 1.5 cm in max dimension. On review, extensive evidence ofscrotal involvement was evident. His tumour was staged as stage IIIC, poor risk NSGCT. He was treated with 4 cycles of bleomycin,etoposide, and cisplatin over a 12-week period. His tumour markers normalised after 3 cycles. There was a marked improvementnoted clinically. Follow-up CT scans demonstrated complete resolution of his tumour. He later underwent further surgery to removea small amount of remaining spermatic cord. Histology revealed no malignant tissue. The patient suffered many complicationsincluding testosterone deficiency, osteopenia, infertility, and psychological distress.Discussion. A small proportion of testicularcancer may present in an atypical manner. The scrotum and testicle have markedly different embryonic origins and therefore adistinct anatomic separation. As a result the scrotum is not a typical site of spread of testicular cancer. Case reports have beendescribed that were managed in a similar manner with good outcomes. Therefore, even with significant scrotal involvement, iftimely and appropriate treatment is administered, complete resolution of the tumour may be achieved.