Giant testicular tumor-the usefulness of upfront chemotherapy: A case report

We experienced the case of a giant testicular tumor which was successfully treated with upfront chemotherapy and consolidation surgery. A 37-year-old man was admitted to our hospital with the complaint of left testicular indolent swelling of about 4 months' duration. A massive tumorous lesion continuing from the genital region to the left inguinal region was observed. The tumor was accompanied with elevated levels of serum LDH, AFP and HCG, left inguinal lymph node enlargement, mediastinal lymph node enlargement, and multiple lung nodules. Tumor biopsy revealed embryonal carcinoma, and the clinical diagnosis was non-seminomatous testicular germ cell tumor, T4N3MlaSx, stage H, Because immediate orchidectomy was considered to be inappropriate due to remarkable local progression, we decided to treat the patient with upfront chemotherapy. After 4 courses of BEP therapy while controlling local infection with antibiotics, tumor markers markedly decreased, the primary tumor, bilateral inguinal lymph node and lung metastases shrunk markedly, and the mediastinal lymph node metastases disappeared. We performed left orchiectomy and bilateral superficial/deep inguinal lymph node dissection with a defect reconstruction using a rectus abdominis flap. In addition, thoracoscopic partial resection of the right lower lobe of the lung was performed for the residual lesion of the lung. No viable cancer cells were identified by pathological evaluation of all resected tissues, and no recurrence has been observed during the two years since the diagnosis.