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24 y/o palpable mass MRI+US inconclusive possible teratoma?

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  • 24 y/o palpable mass MRI+US inconclusive possible teratoma?

    Im a 24 year old male bodybuilder/athlete, who is in great health and always has great blood work, BP etc, never sick, so otherwise a very healthy young man with no health problems.
    I presented the fact that I had a small palpable mass, with some "pain" (which is more discomfort and a dull ache) in the area of the testicle that somewhat radiates up into the groin/abdomen area to my GP. I had her preemptively take TC blood markers, which all came back negative (this was 3 weeks ago), and referred me to a Urologist as expected.
    Since then, Ive had both a US and a MRI w/ and w/o contrast. US was largely inconclusive, stating that it appeared to be cystic in nature and avascular, so my urologist ordered an MRI. The MRI results came back yesterday, along with a voicemail from my Urologist stating that he was a bit concerned (and I could hear the concern in his voice) with the results, although vague in details and did not mention anything definitive or conclusive from the MRI report itself. In as many words he basically said that very close surveillance could be an option involving weekly or every other week US', but that he definitely sounded as if he was leaning more towards surgery than leaving it there, which raised my suspicions even further. Im unsure whether the MRI was just not entirely conclusive (both w/ and w/o contrast and the color enhanced US, itd be hard to believe he didnt have a likely conclusion yet), or if he simply didnt want to cause too much concern over the phone since I have an appt with him tomorrow either because he isnt 100% certain it is malignant or he is and doesnt feel comfortable portraying that over the phone in a message. I find it a bit suspicious that he would sound that concerned and leaning towards surgery rather than surveillance if he did in fact have GOOD news.

    I have an appointment with him Wednesday for a follow up, so Ill have more answers then but, im a pragmatic future RN who comes from a family of medicine so ive been trying to wrap my head around possible outcomes, as well as having a father who passed away from cancer, ive been reading a lot both for my own education and advocating for my own health. At the moment, if malignant im leaning towards it being a teratoma that is mixed germ cell based off radiology, my given symptoms, and studies ive researched.

    Any experience with similar symptoms/radiology results would be appreciated.

  • #2
    It is virtually impossible to predict a path report with the info you currently have. It just can't be done.

    The U/S is usually the gold standard for diagnosing the likelihood of a TC tumor. I do not think I would consider surgery without a firm positive, unless you are dealing with a TC specialist who has the experience to second guess the scan. Most docs see only a few cases of TC in their entire career.

    I know that not knowing is difficult, but at this point, all you can do is wait for more info & hopefully get the big picture.

    Please let us know as you find out more.

    Dave
    Jan, 1975: Right I/O, followed by RPLND
    Dec, 2009: Left I/O, followed by 3xBEP

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    • #3
      I concur with Dave, you need to consult with another Urologist unless the current one is a TC specialist. Most Urologists see very few cases. Please get another opinion, or at least consult with another Urologist, wondering why they went with MRI vs CT Scan at this stage in diagnosing your pain/mass?
      Son Grant
      dx 12/21/16 at age 17

      BEP x3
      Post Chemo CT Scan on 3/28/17 still showed a few nodes over 2 cm
      2nd Post Chemo CT Scan on 4/27/17 showed all nodes still over 2cm
      Post Chemo RPLND 5/8/17: Periaortic Teratoma, Intraaorticaval Teratoma, and Paracaval Teratoma found.
      Grant is enjoying his senior year in High School Cancer Free!

      Comment


      • #4
        Originally posted by Trekga View Post
        I concur with Dave, you need to consult with another Urologist unless the current one is a TC specialist. Most Urologists see very few cases. Please get another opinion, or at least consult with another Urologist, wondering why they went with MRI vs CT Scan at this stage in diagnosing your pain/mass?
        Honestly im not sure, I figured the US would pretty much tell the full story, and that the MRI w/ and w/o contrast was just to help confirm anything on the US.
        But I saw my Urologist AFTER getting the US, in which he wasnt over concerned about it, then ordered the MRI. Then after the MRI is when he changed his tone and was a lot more concerned which is why im a bit confused and anxious to read the report tomorrow. He also was already recommending surgery in his voicemail so he clearly doesnt believe its completely nothing. Hes a good doctor but, unsure if hes specifically a TC specialist, most likely either way after tomorrow ill be getting a second opinion.

        Comment


        • #5
          I've heard of MRI being used when the U/S showed "something" but wasn't conclusive, I assume in those cases it just adds more info. I'm guessing this was a pelvic MRI & not a complete abdominal?

          Dave
          Jan, 1975: Right I/O, followed by RPLND
          Dec, 2009: Left I/O, followed by 3xBEP

          Comment


          • #6
            Originally posted by Davepet View Post
            I've heard of MRI being used when the U/S showed "something" but wasn't conclusive, I assume in those cases it just adds more info. I'm guessing this was a pelvic MRI & not a complete abdominal?

            Dave
            Yes, primary pelvic, secondary abdomen.

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            • #7
              I saw my Uro today, and received a copy of the MRI report and went over it with him. The report is a bit atypical, and not something USUALLY seen, which is why he went ahead and shared it with a few colleagues as well to see what their opinion/input/experience was. The MRI revealed a septated cystic lesion measuring 1.7cm in largest dimension, CONTAINING a 0.6cm hypervascular mural nodule that demonstrates intense homogeneous arterial-phase enhancement. Right testicle+epididymis are otherwise fine, left one, fine and there is no hydrocele, hernia or discernible lymphadenopathy.

              I found it interesting that the U/S doppler showed it to be avascular and the MRI was the only one to pick up on the hypervascularity inside the cyst.
              Ordering a round of antibiotics in hopes it is infection related (although I dont really show any symptoms of infection), which there is no harm in doing. Due to it being essentially a solid mass inside the testicle and the finding of vascularity, I think we both agree its MORE likely at this point to be a tumor. Will go for a 2nd opinion for good measure at likely either MSK or NYU. Scheduled a surgery date in case we have to use it, but the good news is that given the size and the MRI report, he seems confident that it may be a possibility to wedge it and not take out the entire testicle, but of course if the pathology comes back bad, the whole thing would come out.

              Comment


              • #8
                They sometimes do a "frozen section" where they cut a sample & send it to the lab while you are still out. Then depending on the path report, they either proceed with I/O or close you up. This is normally only done if the guy has only one testicle.

                Dave
                Jan, 1975: Right I/O, followed by RPLND
                Dec, 2009: Left I/O, followed by 3xBEP

                Comment


                • #9
                  Originally posted by Davepet View Post
                  They sometimes do a "frozen section" where they cut a sample & send it to the lab while you are still out. Then depending on the path report, they either proceed with I/O or close you up. This is normally only done if the guy has only one testicle.

                  Dave
                  Yeah Im familiar with it, I asked him about a frozen biopsy and he said that since it was so small that it would probably be an option to resection it without removing the whole testicle, IF it was benign (hopefully, but not sure how realistic that is now), but if malignant then the whole testicle would be taken out. Since its so small and im a young very healthy strong guy, hed like to try and save it if possible.

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