Synchronous bilateral testis cancer: A case report and literature review

同時性雙側睪丸癌：病例報告及文獻回顧

Ruei-Je Chang, Kai-Jie Yu, Cheng-Keng Chuang*

張睿哲, 虞凱傑, 莊正鏗*

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taiwan

林口長庚紀念醫院外科部泌尿外科系

Introduction:

    Bilateral testicular tumors are exceedingly uncommon, representing only 1% to 5% of all testicular germ-cell tumors (TGCTs). The majority of primary bilateral TGCTs occur metachronously, with synchronous tumors making up around 0.5% to 1% of total cases. Synchronous tumors typically exhibit a consistent histological pattern, primarily seminoma, while synchronous bilateral TGCTs (SBTGCTs) with discordant subtypes are exceptionally rare.

Case Presentation:

A 35-year-old man with no chronic illnesses presented to our outpatient clinic after experiencing a tight sensation and mild pain in his left testicle for several weeks. Upon physical examination, a hard nodule was palpated in the left testis, raising suspicion of a testis tumor. Further investigations were initiated, revealing laboratory findings of alpha-fetoprotein (AFP) at 6.3 ng/mL, lactate dehydrogenase (LDH) at 187.0 U/L, and beta-human chorionic gonadotropin (β-HCG) at a higher range of 3.25 mIU/mL (normal range < 2.50 mIU/mL). Although no abnormalities were noted in the right testis, bilateral testicular heterogeneity was observed on testicular ultrasound. Computed tomography (CT) confirmed the presence of partial hypodense hypoenhancing lesions in both testes, with no signs of lymphadenopathy.

Given the high suspicion of testicular cancer, bilateral orchiectomy was performed. Prior to surgery, semen analyses and sperm storage were conducted. The pathology report revealed a mixed germ cell tumor in the left testis (comprising 90% seminoma and 10% teratoma), staged as pT1NxMxS1, while the right testis exhibited seminoma, staged as pT1bNxMxS1. Post-surgery, all tumor markers normalized, and the patient underwent surveillance along with testosterone replacement therapy.

Discussion:

This case highlights the rare occurrence of synchronous bilateral testicular tumors and their uncommon discordant histopathology. A comprehensive review of similar cases in the literature was conducted, focusing on SBTGCTs with discordant subtypes. A search of past literature yielded 25 articles until March 2024 in the PubMed database, reporting a total of 54 cases. The standard treatment approach typically involves bilateral radical orchiectomy (RO), with further management tailored based on the most aggressive histological subtype.

Conclusion:

    Despite their rarity, SBTGCTs are managed using the same treatment principles as unilateral cases.