[In two patients with economic and social issues stage I giant seminoma]

The first case was in a 39-year-old man who complained of painless, left hemiscrotal swelling. The patient's serum β human chorionic gonadotropin (β-hCG) was elevated. A chest X-ray and computerized tomography (CT) did not reveal any abnormal findings. The patient underwent left high orchiectomy. The tumor weighed 440 g, and was pathologically diagnosed as a seminoma. The patient chose surveillance as the management strategy. Five months after the operation, the patient stopped attending his periodic checkups. After 21 months, the patient complained of abdominal distention. A CT showed a para-aortic lymph node mass. The patient achieved a complete response following chemotherapy with etoposide and cisplatin for 4 cycles. Three months after the adjuvant chemotherapy, hospital visits stopped again due to financial difficulties. The second case was in a 36-year-old man who complained of painless, right hemiscrotal swelling and difficulty in walking. Clinical examination revealed an adult-head-sized testicular tumor with elevation of serum lactic dehydrogenase (LDH) and β-hCG. A chest X-ray and abdominal CT did not reveal any abnormal findings. Despite a recommendation that the patient undergo immediate orchiectomy, the patient did not undergo surgery due to his unstable lifestyle. After 1 month, the patient presented with more difficulty in walking. The patient underwent right high orchiectomy. The tumor weighed 1,926 g, and was pathologically diagnosed as a seminoma. The patient chose surveillance. There has been no recurrence for 19 months postoperatively.