Clinical Implications of Metachronous Testicular Tumours

Testicular tumours are the most common solid malignancy in young males. Usually being unilateral and of germ cell tumour type, bilateral testicular tumours are very rare. The postoperative follow-up with imaging studies is of high importance, in order to rule out recurrence or the development of new testicular tumours. We present the case of a 53-year-old man with a history of left radical orchiectomy and testicular prosthesis placement performed 29 years ago, for testicular teratocarcinoma stage I, who underwent an MRI for the evaluation of a symptomatic anal fistula. MRI of the fistula showed a solid mass in his right testis suggestive of seminoma. The patient had undergone a right radical orchiectomy with an anatomopathological result of seminoma pT1a. CT of the thorax, abdomen, and pelvis and preoperative serum tumour markers were normal. At the four-week postoperative follow-up, the patient reported hot flashes, and his wound showed good appearance. Exogenous testosterone was prescribed, and the patient was referred to an oncologist who decided no adjuvant treatment was necessary. At the one-year follow-up, the patient was asymptomatic. Control CT and serum tumour markers were within normal limits. Long-term follow-up is necessary in patients with a previous history of testicular tumour, using imaging studies to detect recurrence or a new testicular tumour. Testis-sparing surgery should be considered as the first option when tumours are less than 2 cm. Patients with bilateral orchiectomy should start exogenous testosterone as soon as possible.