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Early Random Find

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  • Early Random Find

    Hello Everyone,

    I will share and update my story in this topic. I hope this information will help as yours have helped me.

    Birth: 1991 (26 at time of writing)
    Country: Brazil
    Race: Caucasian
    Background: Not a drinker, smoker, never used any long-term medicine or anabol, overall a healthy person with a lot of work related stress.

    One month ago I went to a urologist because I wanted to use finasteride and wanted to get my testoterone measured before the treatment began.
    Urologist found a little varicocele on my left testis, requested a US since I was already there.

    My testis was not abnormal, not much smaller or bigger, maybe a little soft and atrophied. But overall normal and sperm count/testosterone normal.

    US Results (13-july-2017) (images attached):
    Left testis with hypoechoic nodular images (3) with peripheral and central vascularization measuring 11x7mm, 4x3mm, 12x11mm.
    Testis size: 31x11x25
    Epydidimus: preserved
    Left Varicocele
    After I got the results appointment with Urologist 03-august-2017. He looks at my results a little suprised, he sends me to get my BHCG, AFP and PRE-OP measured and refers me rushing to a friend urologist for possible I/O.
    2 days later I am on my new Urologist, He wanted to wait for the markers, he thinks it is possible to be only cists.

    Blood Work (08-August-2017):
    Hemogram: All Normal.
    AFP: 1,2 ng/mL (< 9)
    BHCG: 4,69 mUI/mL (< 0,1)
    Ok, Now we are sure and I am expecting non-seminoma.

    Full Abdominal C Tomography (09-August-2017)
    Used Iodinated Contrast
    After 3 days the results came all clear.
    Left Radical Inguinal Orchiectomy (10-August-2017)
    Surgery went pretty well, Urologists says that the testis looked healthy, with no apparent tumor signals on it or in the spermatic cord.
    Pathology Report (24-August-2017):
    Translating the best I can.

    Macroscopic:

    Product of IO weighting 34g, measuring 6X3X1cm, the epydidimus 5X0,6cm and the spermatic cord 4cm.
    The piece is externally surrounded by tunica vaginalis.
    From the slides, we can note tumour measuring 1,5x0,8cm, of whiteish color, fibroelastic consistency inside the testis.
    No infiltration beyond tunica albuginea.
    Espermatic cord margins are examined and tomour is sent to histological exam.

    Microscopy:

    Solid mass of large cells, poliedric, well delimited citoplasmatic membranes, with clear citoplasmm,
    vesicular nucleus with irregular chromatin, some with nucleolus.
    Extremely rare mitosis images, absence of necrosis and in the stroma presence of lymphocytes focus.
    The neoplasm do not infiltrate the testis tunics, vessels and nerves.
    Presence of focus infiltration of rete testis

    Epydidimus free of neoplasm. Spermatic cords and margin free of neoplasm.

    Diagnosis:

    Product of left I/O with Classical Seminoma of the testis, single focus, restricted to the testis, measuring 1,5cm in its larger axis
    with focus of rete testis invasion, focus of intratubular neoplasm of germ cells around the neoplasm and absence of invasion in testis tunics, vessel and nerves.
    So I guess I got the second best good news!

    Tomorrow I have the oncologist appointment, where I expect to hear surveillance or 1 or 2x Carboplatin, and I believe he will push to surveillance.
    I am not anxious about exams and outcomes, but I am a very worried person regarding chances and incorrect diagnosis, I do not like to feel that I could have done something more. So here are the current issues on my mind:

    - There is a post on this forum about center of expertise that got me a bit worried about misdiagnosis and low cure rate by non experienced doctors.

    - I asked my urologist about the other 2 nodules, I was worried because of the BHG that they were non-seminoma missed by the pathologyst. He sent me a message saying that it was 2 cysts, still I am not satisfied.

    - I have a persistent cough which makes me want to get a chest X-ray, since everyone here was asked to, and I would like to get my markers again, this time with LDH.

    - Regarding relapse rates I would be more confortable doing adjuvant 1x carboplatin (I still have to check the downside of this), since seminoma is slow and may relapse after 5 years when the surveillance protocol has weaken.

    If you have any tips, I will be glad to hear!


    All that said, thanks for reading and every post on this forum, it has been of great help navigating this new ocean of infomation. I really consider my early diagnosis an act of God and hope we all can get better.
    I will keep this topic updated.
    God bless you all.
    Attached Files
    Last edited by adrbr; 08-30-17, 10:04 PM.

  • #2
    Besides your intial tumor marker blood work, have they drawn it again? Hoping the Oncolgoist knows to treat TC. Hopefully somone with Seminoma can respond. Keep us updated.
    17 year old son Grant dx 12/21/16
    pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
    pre/o CT Scan 12/22/16 normal
    r/o 12/22/16
    Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
    PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

    -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
    2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
    BEP x 3 1/27/17
    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: 3.5cm Periaortic Teratoma, 2.5cm & 3.5cm Intraaorticaval Teratoma, and a 2.8cm Paracaval Teratoma.

    Comment


    • #3
      Originally posted by Trekga View Post
      Besides your intial tumor marker blood work, have they drawn it again? Hoping the Oncolgoist knows to treat TC. Hopefully somone with Seminoma can respond. Keep us updated.

      Hello, No they have not. I am going to ask tomorrow at my appointment. I understand that with seminoma markers aren't that important and LDH isn't always accurate, but bloodwork is so simple that I see no reason not to do it.

      Comment


      • #4
        Originally posted by adrbr View Post


        Hello, No they have not. I am going to ask tomorrow at my appointment. I understand that with seminoma markers aren't that important and LDH isn't always accurate, but bloodwork is so simple that I see no reason not to do it.

        The beta-hCG at 4.69 is not that elevated but you should have the markers checked post-operatively to make sure that they are returning to normal. Adding an LDH makes sense too. If you have a clear abdomen from the CT scan then it would be highly unusual, especially with seminoma, for it to be in your lungs but again asking for a chest X-ray seem reasonable as well.

        I would not personally be that overly concerned with a misdiagnosis as far as pathology. Perhaps if my tumor markers were elevated and pointing to something else going on but in general I would not be that overly concerned. However, I am not sure where you are being treated and the experience of the pathologist. I assume that you could always ask for a second opinion on the pathology as well.

        Let us know how your appointment goes.

        Mike
        Oct. 2005 felt lump but waited over 7 months.
        06.15.06 "You have Cancer"
        06.26.06 Left I/O
        06.29.06 Personal Cancer Diagnosis Date: Got my own pathology report from medical records.
        06.30.06 It's Official - Stage I Seminoma
        Surveillance...
        Founded the Testicular Cancer Society
        6.29.13 Summited Mt. Kilimanjaro for 7th Cancerversary

        Comment


        • #5

          Updated the pathology report.

          Comment


          • #6
            Hello Everyone,
            The oncologist seemed very knowledgeable, he treated other TC patients before and even though I was pressuring towards adjuvant chemo he put me in active surveillance.
            I will do a chest and abdomen ct plus bloodwork in november now, he estimates 15% relapse rate because of rete testis.

            Comment


            • #7
              Keep us updated
              17 year old son Grant dx 12/21/16
              pre/o markers 12/21/16- HCG:1065.15,AFP:298.8,LDH:1119
              pre/o CT Scan 12/22/16 normal
              r/o 12/22/16
              Post r/o Elevated Markers with INCREASE 4 weeks post r/o;
              PATHLOGY: mixed maligent germ cell 8.6 x 6.2 x 5.9 cm

              -80% Embryonal, 10% Yolk Sac, 5% Teratoma, 5% Choriocarcinoma w/LVI within Spermatic Cord and invasion into Rete Testis
              2nd CT scan on 1/24/17 3 nodes 2 over 2.5, one over 3.5
              BEP x 3 1/27/17
              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: 3.5cm Periaortic Teratoma, 2.5cm & 3.5cm Intraaorticaval Teratoma, and a 2.8cm Paracaval Teratoma.

              Comment

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