Testicular Germ Cell Tumor Presenting as Torsion in a Young Patient

Abstract

Testicular torsion is a relatively common urological emergency, which involves the twisting of the spermatic cord and its contents leading to ischemia to the testes, which usually presents as sudden, severe scrotal pain. In comparison, testicular neoplasms are far less commonly encountered in the emergency department as they often present as painless hard masses that grow slowly over longer periods of time. Extremely rare cases of testicular neoplasms present as sudden scrotal pain that causes a challenging task in the emergency department as physical examinations and ultrasound findings could vary and not be specific enough in confirming the diagnosis. In this case, we report a 22-year-old male who was referred from the emergency department (ED) as a case of testicular torsion from the presenting history; however, his physical examination and Doppler ultrasound findings were suspicious of testicular malignancy. The patient presented with a history of right scrotal pain for a few hours with no predisposing factors; however, examination and imaging were highly suspicious of an underlying neoplasm. The patient underwent an inguinal orchidectomy, and histology confirmed the presence of a germ cell tumor of varying components. In conclusion, a high index of suspicion for testicular torsion should always be present when a patient presents with sudden onset testicular pain; however, the differential diagnosis including testicular neoplasms should not be overlooked as it can change the management and outcome.

Keywords: acute scrotum; scrotal exploration; scrotal mass; testicular germ cell tumors; testicular torsion; urological malignancy.

Figure 1. Color Doppler ultrasound showing disrupted, heterogenous right testis in the lateral view (left) and anterior view (right)

Figure 2. CT scan of the abdomen and chest for cancer staging demonstrating bilateral pulmonary metastasis (left - red arrow) and multiple retroperitoneal lymph nodal involvement (right - encircled in yellow)

CT scan of the abdomen and chest for cancer staging demonstrating bilateral pulmonary metastasis (left - red arrow) and multiple retroperitoneal lymph nodal involvement (right - encircled in yellow)