Ultrasound on second, remaining testicle

[GD1345]

This past week I asked for an ultrasound on my left testicle after feeling slight soreness in my waistline area. The result showed the following results:
"There is a subtle 5 x 4 mm hypoechoic to isoechoic rounded lesion in the superior left
testicle, which is concerning for a neoplasm. There are a few dystrophic calcifications seen within the left testicle peripherally. No hydrocele. There is a small left-sided
varicocele."

This is all after I have had right orchiectomy and RPLND surgery in the past two months. I was hoping to be moving into surveillance, but am returning to worry about a recurrence of my TC. The right testicle was determined, by pathology, to be 100% pure embryonal carcinoma.

Any idea what. is meant by "hypoechoic to isoechoic"? How serious are dystrophic calcifications and varicocele? Looking for support of anyone else who has been through the removal process once already and possibly looking for a second removal.

[Harxxony]

Hello, I'm sorry for your situation. Hypoechoic and isoechoic are (ultra)sound terms, hypoechoic means that sound has different echo on this part of the testicle in a way that this part returns less echo/sound than other parts of the testicle, or more sound waves go through; area is less dense than normal tissue. Isoechoic means that this part of testicle has same echo or same density. So basically this area is not very different in the matter of density than normal tissue, but it is there. There are no information about vascularity in this area and that is good sign, but maybe the area is to small to notice it. Calficications and varicocele are not serious. As this ultrasound doesn't give good picture what is going on, I think that you are candidate for another ultrasound in next few weeks.

[Davepet]

GD1345, just to clarify, if the hypoechoic results turn out to be TC, this is a new primary cancer, not a recurrence of your earlier TC. Not that makes your life any easier going forward. It might be possible for them to do a frozen section prior to finishing the I/O to make sure it needs to come out, but seems it's rare to wake up with that testicle, I'm afraid. Life with no testicles is not as odd as you'd think, if that is what needs to happen. Please keep us posted as you learn more we can help you with information.

[Ryan Bi]

I think just in two months a new cancer growing up, that would quite unusual.i am very sure they checked your remainings two months ago. How is your bloodwork?

If it is new one. You caught it very early.

Hoping good news.

Amy, Ran’s mom

[Davepet]

While it is, indeed ,rare, we have had a few guys who had 2x on their first Dx, so, it has to be considered as a possibility. With those U/S results, it seems likely at this point to be TC. Might be good to check with a frozen section, but it seems like that rarely results in saving a testicle, Just my observation.

[Mike]

I would certainly ask my doctor, assuming that my markers are normal if a repeat ultrasound within the next 6 weeks would be a reasonable approach since the lesion is so small.

As far as dystrophic calcifications, I suppose I would want more details from the radiologist. As far as I know true dystrophic calcified nodules in the testicle are rare and i would want to know if they would be related to a burned-out neoplasm.

Mike

[GD1345]

Thanks all for the responses. I had my appointment on Wednesday of this week. The lesion has remained unchanged since January. Dr. Cary and Dr. Einhorn agree to wait on an additional round of tests (ultrasound, chest x-ray, ct scan-abdomen, blood work) in May. Dr. Einhorn had a chest x-ray done at this visit, which showed no signs of cancer at this time.

It sounds like in May, if nothing changes, then I am likely going to have a partial orchiectomy and then possibly follow-up radiation treatment to make sure there is not any cancer remaining.

@Mike: I did not know it was possible to have a "burned-out neoplasm." Is that like a cancer tumor, or cell, that doesn't do anything?

[Mike]

Thanks all for the responses. I had my appointment on Wednesday of this week. The lesion has remained unchanged since January. Dr. Cary and Dr. Einhorn agree to wait on an additional round of tests (ultrasound, chest x-ray, ct scan-abdomen, blood work) in May. Dr. Einhorn had a chest x-ray done at this visit, which showed no signs of cancer at this time.

It sounds like in May, if nothing changes, then I am likely going to have a partial orchiectomy and then possibly follow-up radiation treatment to make sure there is not any cancer remaining.

@Mike: I did not know it was possible to have a "burned-out neoplasm." Is that like a cancer tumor, or cell, that doesn't do anything?

That sounds like a good plan and you are in great hands with Clint and Larry as they are awesome. Let us know how May goes.

Yeah, tumors can "burnout" basically it is thought that they can cut off their own blood supply and die but cells can escape and make masses in the abdomen with no real signs in the testicle hard to determine if the mass is really a primary in the abdomen (which happens too) or if it spread from the testicle.

Mike

[GD1345]

Interesting. I will make sure to keep everyone posted here.

In good news, the chest x-ray done last Wednesday came back with no signs of cancer.

[GD1345]

I had my check-in yesterday with Dr. Einhorn as well as surveillance scans. CT scan and Chest X-ray appeared normal. Bloodwork for tumor markers are normal. Ultrasound on left testicle remains almost unchanged with a sight increase of maybe 1mm, according to Dr. Einhorn. I meet with Dr. Cary virtually on Friday for a check-in and will hear his feedback.

As of now, a partial orchiectomy with follow-up radiation could be a plan. Or, if it remains mostly unchanged, then the lesion could be a scar and benign. In that case, then surveillance would just be necessary. I will listen to Dr. Cary and go by what he thinks is best.

[Mike]

Sounds like a great plan and I hope you find comfort with Dr. Einhorn and Dr. Cary. They are both amazing in my book.

Mike

[GD1345]

I met with Dr. Cary today. He provided me with options and advice. I decided to go with an outpatient surgery that will basically investigate whether or not the small lesion is cancerous. If it turns out to be cancerous, then he will remove the whole testicle. My testosterone levels are already pretty low and I will eventually need replacement therapy either way. If the small lesion turns out to be benign, then he will just close me back up and that's it.

[Davepet]

Sounds like a decent plan. It's almost easier if there is good evidence of TC, the plan going forward is much more straightforward....

[Mike]

I agree, that it sounds like a good plan. If there is cancer in there, trying to salvage the testicle, with already low testosterone, and probably needing to irradiate the testicle as well, probably doesn't serve much in my thoughts.

Mike

[GD1345]

So, I am awaiting a scheduling of surgery with Dr. Cary. But, since this surgery is not time-sensitive (due to my recent normal surveillance scans), I am wondering if I should pursue an alternative urologist since he is not counted as “In-Network� per my health insurance plan. This is difficult, though, because Dr. Cary knows the context of my cancer past and also it is unclear what exactly the outcome of this potential surgery will do. Since he was going to investigate and determine with a pathologist whether the small lesion was cancerous, how can I even ask other urologists if they can do this same operation? I don't know if there is a code for this?

I am asking for any advice about this. I am INCREDIBLY grateful for the life-saving care received at IU-Health by Dr. Cary and Dr. Einhorn. I highly recommend them for anyone facing life-saving care. At the same time, both of them are considered Out-of-Network on my health insurance benefits. And, if I can afford to avoid another Out-of-Network surgery, then it would be financially helpful.

Should I go forward and figure out the health care bills later? Or should I try to find another urologist and, if so, how do I even begin explaining my seemingly complicated story?