Testicular cancer: Embryonal cell carcinoma

Case contribution: Dr Radhiana Hassan


  • A 20 years old man
  • No known medical illness
  • Presented with right scrotal swelling for one month
  • No fever, non-tender
  • No constitutional symptoms
  • AFP=94.6 IU/mL (normal <7.4)
Ultrasound scrotum

Ultrasound findings:

  • There is a largeĀ  testicular mass measuring about 7.0 x 5.0 cm
  • It shows heterogeneous hypoechogenicity with no obvious cystic component or calcification within it
  • On Doppler, there is increased colour flow in the periphery of mass
  • The scrotal wall is thickened and heterogenous.
  • The left testisĀ  is pushed superoposteriorly in the left scrotum. It is normal in size measuring 3.1 x 1.2 cm. It shows homogenous echogenicity with no focal mass lesion within.

Diagnosis: Testicular cancer (HPE: embryonal cell carcinoma)


  • Testicular cancers are the most common neoplasm in men between the ages of 20 and 34 years.
  • Risk factors: cryptochidism, family history, radiation, previous contralateral testicular tumour, microlithiasis, hypospadia, infection, infertility and Klinefelter syndrome
  • More than 90% are primary tumours and about 90% are testicular germ cell tumour
  • Secondary tumour include secondary testicular lymphoma (most common testicular malignancy in older men), testicular leukaemia and metastasis to testis
  • Testicular embryonal cell carcinoma is a type of non-seminomatous germ cell tumour with peak incidence at around 25-30 years of age.

Progress of patient:

  • Orchidectomy done
  • Planned for chemotherapy after operation
  • Patient request postponed chemotherapy to finish his study
  • 4 months later, repeat CT scan show metastasis to lung, liver and aortocaval nodes
CT scan thorax in axial plane, lung window shows multiple lung nodules (red arrows)
CT abdomen in axial planes, soft tissue window post contrast show liver metastasis (yellow arrow), right hydronephrosis (blue arrow) and an enlarged aortocaval node (white arrow)
Author: radhianahassan