Seminoma\Secondary Surgery

Male, 27 years old Discharge Summary Department: Urology (as per original record) Admission date: May 16, 12:21 Discharge date: May 20, 08:49 Outpatient diagnosis: Testicular tumor Admission diagnosis: Testicular tumor Discharge diagnosis: Testicular tumor Admission status Chief complaint: Right scrotal mass discovered 2 months ago History of present illness: The patient discovered a right scrotal mass himself 2 months earlier. There was no fever, low back pain, urinary frequency, urgency, dysuria, or difficulty urinating. On March 28, ultrasound showed an enlarged right testis with heterogeneous echotexture and several hypoechoic and mixed-echo nodules, the largest measuring approximately 3.8 × 2.5 cm with detectable blood flow signals. The left side was unremarkable. On March 28, beta-human chorionic gonadotropin was 16.75 mIU/ml. Further MRI on March 28 revealed a right testicular mass, suspicious for malignancy. The patient was admitted to our department for further diagnosis and treatment under the diagnosis of “testicular tumor.” Key laboratory results On May 16, D-dimer 0.86 mg/L ↑, fibrin(ogen) degradation products 5.60 μg/ml ↑; direct bilirubin 10.2 μmol/L ↑, total bilirubin 37.3 μmol/L ↑, sodium 136.90 mmol/L ↓, lactate dehydrogenase 254 U/L ↑, urea 3.00 mmol/L ↓, uric acid 474.00 μmol/L ↑, fasting blood glucose 3.82 mmol/L ↓; myoglobin 14.80 ng/ml ↓. Special examinations and important consultations On May 16, chest CT plain scan: no obvious abnormalities. On May 16, electrocardiogram: normal. Treatment course On May 18, the patient underwent unilateral orchiectomy. Intraoperatively, a 7 cm × 6 cm × 5 cm solid mass was found in the right testis and was completely excised. The procedure went smoothly, and the patient returned to the ward in stable condition. Vital signs were stable, and he was advised to follow up after discharge. Complications: None Status at discharge The patient was in fair spirits with no subjective discomfort. Vital signs were stable, heart and lungs were normal. The abdomen was soft, with no tenderness or rebound tenderness. Liver and spleen were not palpable below the costal margin. No abdominal masses were felt. Shifting dullness was negative. Bowel sounds were normal. The wound showed no exudation and was well approximated. Post-discharge medications and advice 1. Return to the wound care clinic for suture removal according to the scheduled appointment. 2. Light physical activity only for 3 months after discharge. Avoid fatigue. No special dietary restrictions. Focus on easily digestible, high-nutrition foods, with adequate fruits, vegetables, and high-fiber items to maintain smooth bowel movements. If constipation occurs, mild laxatives may be used. 3. Schedule outpatient follow-up on Monday afternoon in advance. 4. Maintain good nutrition and rest, drink plenty of water, consume high-fiber foods, keep bowels regular, and engage in appropriate physical exercise. Avoid nephrotoxic medications. 5. Seek prompt medical attention if fever, abdominal pain, or other discomfort develops. Follow-up plan: As above Treatment outcome: Cured

MRI Report Department: Urology Outpatient Clinic Clinical diagnosis: Scrotal enlargement; right testicular hydrocele Requesting physician’s instructions: Consultation Examination site and name: Scrotal and testicular MRI plain scan + contrast-enhanced Examination method: Abdominal coil; supine position; plain scan: T2WI (TSE/FSE + fat suppression), T1WI (VIBE/QUICK four-phase), DWI; contrast-enhanced: T1WI (VIBE/QUICK + fat suppression). Contrast agent: gadopentetate dimeglumine. Radiological findings: The right testis is enlarged, containing a mass measuring up to 47 × 54 mm in cross-section. The lesion shows slightly low signal on T1WI and predominantly high signal on T2WI with mixed signals, internal septations, restricted diffusion, and marked enhancement on contrast imaging. The left testis is normal in size, shape, and signal intensity, with no abnormal enhancement. Radiological diagnosis: Right testicular mass, suspicious for malignancy. Clinical correlation recommended. Examination time: March 23, 17:43:29 Report written: March 23, 20:38:40 Report verified: March 24, 09:25:52

Pathology Report Received date: May 19 Referring hospital: This hospital Gross findings: Right testis: 9 × 7 × 6 cm, spermatic cord: 8 × 2 × 1 cm. Cut surface entirely tumoral, gray-white and soft, with focal gray-brown areas. A-E: tumor blocks, F: spermatic cord margin, G: rete testis. Pathological diagnosis: “Right testis” mixed germ cell tumor, predominantly seminoma, with components of embryonal carcinoma and teratoma (9 × 7 × 6 cm), with necrosis, invasion of the tunica albuginea, involvement of the epididymis, and intravascular tumor thrombi. Intratubular germ cell neoplasia is also present. Spermatic cord margin negative. Report date: May 28

Immunohistochemistry Report Pathology number: 22-09 Received date: May 21, 11:07 Referring hospital: This hospital Specimen: Right testis Immunohistochemical diagnosis: “Right testis” mixed germ cell tumor, predominantly seminoma, with components of embryonal carcinoma and teratoma. C sections: Tumor cells HCG(−), AFP(−), CK(−), OCT3/4(+), PLAP(+) A sections: Tumor cells OCT3/4(−), Ki67(70%), AFP(+), PLAP(−), CK(+), LCA(−), CD30(+), P53(−). Report date: May 28

Discharge Summary Admission date: June 23, 09:26 Discharge date: June 29, 09:05 Outpatient diagnosis: Testicular tumor Admission diagnosis: Status post right orchiectomy Discharge diagnosis: Status post right orchiectomy Admission status Two months earlier, the patient discovered a right scrotal mass himself. There was no fever, low back pain, urinary frequency, urgency, dysuria, or difficulty urinating. On March 12, ultrasound showed an enlarged right testis with heterogeneous echotexture containing several hypoechoic and mixed-echo nodules, the largest approximately 3.8 × 2.5 cm with blood flow signals. The left side was unremarkable. Beta-human chorionic gonadotropin on March 12 was 16.75 mIU/ml. MRI on March 23 showed a right testicular mass, suspicious for malignancy. On May 18, unilateral orchiectomy was performed at our hospital. Intraoperatively, a 7 cm × 6 cm × 5 cm solid mass was found in the right testis and completely removed. Postoperative pathology: “Right testis” mixed germ cell tumor, predominantly seminoma, with components of embryonal carcinoma and teratoma (9 × 7 × 6 cm), with necrosis, invasion of the tunica albuginea, involvement of the epididymis, and intravascular tumor thrombi. Intratubular germ cell neoplasia present. Spermatic cord margin negative. Tumor cells: HCG(−), AFP(−), CK(−), OCT3/4(+), PLAP(+); A sections: OCT3/4(−), Ki67(70%), AFP(+), PLAP(−), CK(+), LCA(−), CD30(+), P53(−). On May 16, PET-CT at our hospital: 1. Right testicular mass with increased FDG uptake, highly suspicious for malignancy—pathological confirmation recommended. Multiple small lymph nodes in bilateral inguinal regions, bilateral iliac vessels, and para-aortic areas without significant FDG uptake—close follow-up advised. 2. Increased FDG uptake around the right pharyngeal recess, likely inflammatory. 3. Focal increased FDG uptake in the right shoulder and back skin, likely inflammatory. Key laboratory results On June 23, complete blood count: white blood cell count 6.66 × 10⁹/L, neutrophils 67.8%, lymphocytes 25.2%, etc. (all values preserved exactly as documented); D-dimer 0.09 mg/L, etc.; BNP 16.0 pg/mL; blood type A, Rh(D) positive; troponin I 0.00 ng/ml, etc.; urine analysis normal; renal and liver function panels with specific values including uric acid 453.00 μmol/L ↑, etc. On June 26, C-reactive protein 30.26 mg/L ↑, white blood cell count 11.35 × 10⁹/L ↑, neutrophils 87.0% ↑, etc.; total bilirubin 37.7 μmol/L ↑, etc. On June 27, syphilis confirmatory test negative. Special examinations and important consultations On June 23, electrocardiogram: normal. On June 23, chest CT plain scan: no obvious abnormalities. Treatment course After admission, relevant examinations were completed. After ruling out contraindications, on June 25 the patient underwent Da Vinci robotic retroperitoneal lymph node dissection with laparoscopic robotic assistance under general anesthesia. Intraoperatively, no obvious enlarged retroperitoneal lymph nodes were found. The procedure went smoothly, and the patient returned to the ward. Postoperative supportive treatment with fluids was given. The patient reported no specific discomfort. Vital signs were stable and general condition satisfactory, so he was discharged. Complications: None at present Status at discharge The patient was alert and comfortable with no specific complaints. Vital signs stable, heart and lungs normal. Abdomen soft, no tenderness or rebound tenderness. Liver and spleen not palpable. No abdominal masses. Shifting dullness negative. Bowel sounds normal. Post-discharge medications and advice 1. Suture removal at the wound care clinic one week after surgery. Light physical activity only for 3 months. Avoid fatigue. Easily digestible, high-nutrition diet with fruits, vegetables, and fiber. Use mild laxatives if needed for constipation. 2. Expert outpatient follow-up in 1 month (Wednesday afternoons or Thursday mornings). 3. Maintain nutrition and rest, drink plenty of water, consume high-fiber foods, keep bowels regular, and exercise appropriately. Avoid nephrotoxic drugs. 4. Seek prompt care for fever, abdominal pain, or other symptoms. Follow-up plan: As above Treatment outcome: Cured