Tweet
Hi All,
Ever since I went in for my ultrasound I've been lingering here checking out a lot of your posts. You all have given a lot of inspiration through this nightmare I've been in so far. This has to have been the longest month I've ever had in my life.
I'm going to give a little back story of what has happened as well as some questions that I have and hoping some of you guys who've been experienced with this may be able to shed some light on. I will also follow up with my urologist with them as well.
So here's the back story of how I ended up here. My brother about two months ago went into a walk in clinic with right testicular pain that radiated all the way down through his lower back. They thought it was a hernia and sent him home. I think they told him to schedule something with his primary care physician.
Fast forward a couple of weeks after this incident. We were on a video call (we work together) and he was in excruciating pain. We all told him to go to the ER. When he landed in the ER the last thing on his mind was he had testicular cancer.
They did a CT scan and found a large mass in his abdomen and were trying to figure out what it was. They did a biopsy of the mass and concluded he had a Seminoma. Everything I've read thus far all says this is the most treatable type of cancer.
I guess if you were to have TC this would be a "good" prognosis. After speaking with my brother and what happened, I decided to go to my primary care physician. Here is where is gets weird. This year I was experiencing intermittent pains in my left testicle.
I just thought this was due to working out or something that I did. The pain wasn't much but it would be like a light throb here and there. After what happened to my brother I decided to schedule my own appointment and get checked out right. Why not.
My doctor gave my a physical and everything checked out. He ordered a bunch of blood work and everything came back normal. By the grace of God he went ahead and ordered an ultrasound for "piece of mind". Thank goodness he ordered this. A week later I had the ultrasound and saw the look on the lady's face who did it.
She looked concerned but wouldn't tell me what she saw. I know they're not allowed to tell us but I tried to pry some information but was unsuccessful. All she said it something looked swollen which could have been the cause for some pain.
Here are the results of that ultrasound.
LEFT:
The left testicle measures 4.7 cm in length, 2.4 cm AP, and 3.4 cm transverse. There are scattered microcalcifications throughout the left testicle. There are 3 solid masses in the left testicle., concerning for neoplasm. A solid mass inferiorly and laterally measures 1.2 x 0.7 x 0.7 cm. A 2nd solid mass inferiorly and laterally measures 0.8 x 0.5 x 0.8 cm. The 3rd mass in the mid left testicle medially measures 0.4 x 0.3 x 0.4 cm.
The left epididymal head measures 0.9 x 1.2 x 1.4 and is within normal limits in appearance. Vascularity is grossly normal on color doppler.
No left hydrocele or varicocele.
This is the report of the bad testicle in which was promptly sent to my urologist. My urologist get me in quickly in the beginning of April. He took a urine sample which came back ok and did an exam. The masses weren't palpable. He decided to write me an RX for Cipro to see if it was some sort of infection. Fast forward 2 weeks and I had a follow up ultrasound. The masses were still there but did not grow.
He decided to schedule a testicular exploration. He did tell me he'd most likely remove the testicle. Here is the report from the operation I had last week,
ANESTHESIA: General.
1ST Assistant:
PREOP DIAGNOSIS: Left testicular mass.
POSTOP DIAGNOSIS: Left testicular mass.
OPERATION: Left inguinal exploration and left radical orchiectomy.
SURGICAL INDICATIONS: Patient is a 33-year old health male whose brother was recently diagnosed with metastatic testicular cancer. He was experiencing some pain in the left testicle., which he felt could be psychological, but he went to his family practice doctor to get it checked out and was found to have a small mass in the inferior poll of the left scrotum and had a testicular ultrasound performed which revealed 3 hypoechoic lesions within the left testicle, suspicious for neoplasm. On physical exam, we cannot discern discrete nodule in the testicle, so we gave him 2 weeks of antibiotics, repeated the ultrasound, and again these 3 lesions within the testicle were unchanged in size or appearance from the previous ultrasound and after discussion of the options with him, he has opted for left radical orchiectomy. Risks, benefits, and alternative of therapies were reviewed with the patient. Consent obtained. Tumor markers normal.
OPERATIVE REPORT: The patient was brought to the operating room, put to sleep by Anesthesia. He was positioned supine on the operating room table, and the pelvis was shaved, prepped and draped in usual sterile fashion. External ring was palpated through the scrotum and a transverse incision was marked with a sterile marking pen just above the level of the external ring. With the patient asleep, we made a transverse incision just above the inguinal ring roughly 1.5 inches in length with a #15 scalpel blade. The subcuticular layers were divided with the Bovie. There was a small vessel within the subcutaneous tissue layer, which was divided with a 3-1 Vicryl, and then the external oblique aponeurosis and fascia was exposed and the external ring was easily indentified. Weitlaner retractor was placed to expose the external ring, and then we freed up the spermatic cord laterally and medially, and we lifted the spermatic cord up through the incision and placed a tourniquet for hemostasis and to control and hematogenous seeding. We then freed up the lateral medial cremasteric attachments to the cord, and we were able to deliver the testicle easily up through the incision. The testicle appear hypoplastic and soft and in the lower pole of the testicle was a firm nodule corresponding to the largest lesion seen on the ultrasound. For that reason, we opted to proceed with orchiectomy. We divided the gubernacular attachments to the testicle with a Bovie, made a careful check for hemostasis and then we lifted up on the spermatic cord and dissected it back to the external ring, taking down any cremasteric attachments. We place a right angle clamp to the external ring and we lifted up on the external oblique aponeurosis and made a small incision along the line of the fibers with a 15 blade and took care not to injure the nerve. We then exposed the cord, but not below the external oblique and then we divided the fatty later away from the cord which left just the spermatic cord contents itself. We doubly ligated this with Kelly clams and then we doubly ligated the fat alongside the cord and then we triply ligated the spermatic cord with 2-0 chromic ties and 1-0 chromic ligature. We then transected the cord on a sterile field to make sure there was no hematogenous seeding in the incision, and we sent the specimen for pathology inspection. We then took off each of hte Kelly clamps, made a careful visual inspection of the cord, saw no evidence of any bleeding. So, we turned the stump of the cord back underneath the external oblique and then we reapproximated external oblique with interrupted sutures of 3-0 Vicryl. We then made a careful check for hemostasis, saw no evidence of any active bleeding, so the Scarpa fascia was reapproximated with interrupted 3-0 chromic sutures and the skin was reapproximated with a 4-0 Vicryl subcuticular closure and we did place a 0.25% Marcaine in a subcuticular layer for local anasthetic, a total of 5mL was used. Sponge and needle counts were correct X2. Pathology is pending on specimens.
Sorry if this is too much. I just copied all of my results in here.
Here is my pathology report:
Specimen:
A. LEFT - TESTICLE AND SPERMATIC CORD
Gross Description:
Received in formalin labeled "left testis and spermatic cord" is a testis and spermatic cord. The testis measures 5.5 x 4.0 x 2.0 cm and the spermatic cord measures 10 cm in length x 1.2 cm in diameter. The specimen had a weight of 70 grams. The outer margins are inked with black ink. The spermatic cord margin is inked with blue ink. The spermatic cord and the next section are obtained. On sectioning along the length of the spermatic cord no lesions are noted. Multiple representative sections are submitted as follows: 1) spermatic cord margin and neck section; 2) mid-spermatic cordl 3) distal spermatic cord;4-8) representative sections of testis; 9.10) representative sections of fibroadipose tissue adjacent to the testis.
FINAL DIAGNOSIS
Left testis, left orchiectomy:
- Seminoma.
Specimen laterality: Left.
Tumor focality: Multifocal.
Tumor size: 0.6 cm.
Macroscopic extent of tumor: confined to testis.
Histological type: Seminoma, classic type and intratubular germ no neoplasia - seminomatous.
Spermatic cord mardin: Uninvolved by tumor.
Microscopic tumor extension: Not identified.
Primary tumor (pT) : pT1.
Regional lymph nodes (pN) : pNX.
Distant metastasis (pM) : Not applicable.
Ever since I went in for my ultrasound I've been lingering here checking out a lot of your posts. You all have given a lot of inspiration through this nightmare I've been in so far. This has to have been the longest month I've ever had in my life.
I'm going to give a little back story of what has happened as well as some questions that I have and hoping some of you guys who've been experienced with this may be able to shed some light on. I will also follow up with my urologist with them as well.
So here's the back story of how I ended up here. My brother about two months ago went into a walk in clinic with right testicular pain that radiated all the way down through his lower back. They thought it was a hernia and sent him home. I think they told him to schedule something with his primary care physician.
Fast forward a couple of weeks after this incident. We were on a video call (we work together) and he was in excruciating pain. We all told him to go to the ER. When he landed in the ER the last thing on his mind was he had testicular cancer.
They did a CT scan and found a large mass in his abdomen and were trying to figure out what it was. They did a biopsy of the mass and concluded he had a Seminoma. Everything I've read thus far all says this is the most treatable type of cancer.
I guess if you were to have TC this would be a "good" prognosis. After speaking with my brother and what happened, I decided to go to my primary care physician. Here is where is gets weird. This year I was experiencing intermittent pains in my left testicle.
I just thought this was due to working out or something that I did. The pain wasn't much but it would be like a light throb here and there. After what happened to my brother I decided to schedule my own appointment and get checked out right. Why not.
My doctor gave my a physical and everything checked out. He ordered a bunch of blood work and everything came back normal. By the grace of God he went ahead and ordered an ultrasound for "piece of mind". Thank goodness he ordered this. A week later I had the ultrasound and saw the look on the lady's face who did it.
She looked concerned but wouldn't tell me what she saw. I know they're not allowed to tell us but I tried to pry some information but was unsuccessful. All she said it something looked swollen which could have been the cause for some pain.
Here are the results of that ultrasound.
LEFT:
The left testicle measures 4.7 cm in length, 2.4 cm AP, and 3.4 cm transverse. There are scattered microcalcifications throughout the left testicle. There are 3 solid masses in the left testicle., concerning for neoplasm. A solid mass inferiorly and laterally measures 1.2 x 0.7 x 0.7 cm. A 2nd solid mass inferiorly and laterally measures 0.8 x 0.5 x 0.8 cm. The 3rd mass in the mid left testicle medially measures 0.4 x 0.3 x 0.4 cm.
The left epididymal head measures 0.9 x 1.2 x 1.4 and is within normal limits in appearance. Vascularity is grossly normal on color doppler.
No left hydrocele or varicocele.
This is the report of the bad testicle in which was promptly sent to my urologist. My urologist get me in quickly in the beginning of April. He took a urine sample which came back ok and did an exam. The masses weren't palpable. He decided to write me an RX for Cipro to see if it was some sort of infection. Fast forward 2 weeks and I had a follow up ultrasound. The masses were still there but did not grow.
He decided to schedule a testicular exploration. He did tell me he'd most likely remove the testicle. Here is the report from the operation I had last week,
ANESTHESIA: General.
1ST Assistant:
PREOP DIAGNOSIS: Left testicular mass.
POSTOP DIAGNOSIS: Left testicular mass.
OPERATION: Left inguinal exploration and left radical orchiectomy.
SURGICAL INDICATIONS: Patient is a 33-year old health male whose brother was recently diagnosed with metastatic testicular cancer. He was experiencing some pain in the left testicle., which he felt could be psychological, but he went to his family practice doctor to get it checked out and was found to have a small mass in the inferior poll of the left scrotum and had a testicular ultrasound performed which revealed 3 hypoechoic lesions within the left testicle, suspicious for neoplasm. On physical exam, we cannot discern discrete nodule in the testicle, so we gave him 2 weeks of antibiotics, repeated the ultrasound, and again these 3 lesions within the testicle were unchanged in size or appearance from the previous ultrasound and after discussion of the options with him, he has opted for left radical orchiectomy. Risks, benefits, and alternative of therapies were reviewed with the patient. Consent obtained. Tumor markers normal.
OPERATIVE REPORT: The patient was brought to the operating room, put to sleep by Anesthesia. He was positioned supine on the operating room table, and the pelvis was shaved, prepped and draped in usual sterile fashion. External ring was palpated through the scrotum and a transverse incision was marked with a sterile marking pen just above the level of the external ring. With the patient asleep, we made a transverse incision just above the inguinal ring roughly 1.5 inches in length with a #15 scalpel blade. The subcuticular layers were divided with the Bovie. There was a small vessel within the subcutaneous tissue layer, which was divided with a 3-1 Vicryl, and then the external oblique aponeurosis and fascia was exposed and the external ring was easily indentified. Weitlaner retractor was placed to expose the external ring, and then we freed up the spermatic cord laterally and medially, and we lifted the spermatic cord up through the incision and placed a tourniquet for hemostasis and to control and hematogenous seeding. We then freed up the lateral medial cremasteric attachments to the cord, and we were able to deliver the testicle easily up through the incision. The testicle appear hypoplastic and soft and in the lower pole of the testicle was a firm nodule corresponding to the largest lesion seen on the ultrasound. For that reason, we opted to proceed with orchiectomy. We divided the gubernacular attachments to the testicle with a Bovie, made a careful check for hemostasis and then we lifted up on the spermatic cord and dissected it back to the external ring, taking down any cremasteric attachments. We place a right angle clamp to the external ring and we lifted up on the external oblique aponeurosis and made a small incision along the line of the fibers with a 15 blade and took care not to injure the nerve. We then exposed the cord, but not below the external oblique and then we divided the fatty later away from the cord which left just the spermatic cord contents itself. We doubly ligated this with Kelly clams and then we doubly ligated the fat alongside the cord and then we triply ligated the spermatic cord with 2-0 chromic ties and 1-0 chromic ligature. We then transected the cord on a sterile field to make sure there was no hematogenous seeding in the incision, and we sent the specimen for pathology inspection. We then took off each of hte Kelly clamps, made a careful visual inspection of the cord, saw no evidence of any bleeding. So, we turned the stump of the cord back underneath the external oblique and then we reapproximated external oblique with interrupted sutures of 3-0 Vicryl. We then made a careful check for hemostasis, saw no evidence of any active bleeding, so the Scarpa fascia was reapproximated with interrupted 3-0 chromic sutures and the skin was reapproximated with a 4-0 Vicryl subcuticular closure and we did place a 0.25% Marcaine in a subcuticular layer for local anasthetic, a total of 5mL was used. Sponge and needle counts were correct X2. Pathology is pending on specimens.
Sorry if this is too much. I just copied all of my results in here.
Here is my pathology report:
Specimen:
A. LEFT - TESTICLE AND SPERMATIC CORD
Gross Description:
Received in formalin labeled "left testis and spermatic cord" is a testis and spermatic cord. The testis measures 5.5 x 4.0 x 2.0 cm and the spermatic cord measures 10 cm in length x 1.2 cm in diameter. The specimen had a weight of 70 grams. The outer margins are inked with black ink. The spermatic cord margin is inked with blue ink. The spermatic cord and the next section are obtained. On sectioning along the length of the spermatic cord no lesions are noted. Multiple representative sections are submitted as follows: 1) spermatic cord margin and neck section; 2) mid-spermatic cordl 3) distal spermatic cord;4-8) representative sections of testis; 9.10) representative sections of fibroadipose tissue adjacent to the testis.
FINAL DIAGNOSIS
Left testis, left orchiectomy:
- Seminoma.
Specimen laterality: Left.
Tumor focality: Multifocal.
Tumor size: 0.6 cm.
Macroscopic extent of tumor: confined to testis.
Histological type: Seminoma, classic type and intratubular germ no neoplasia - seminomatous.
Spermatic cord mardin: Uninvolved by tumor.
Microscopic tumor extension: Not identified.
Primary tumor (pT) : pT1.
Regional lymph nodes (pN) : pNX.
Distant metastasis (pM) : Not applicable.
Comment