EC Pulmonology and Respiratory Medicine

A 24 year old male presented with hemoptysis and chest pain of one month. Chest x-ray and thorax CT revealed multiple nodules in both lungs. PET/CT showed high ¹⁸FDG uptake in all pulmonary nodules and at the right anterior testis. ß-HCG was 201.744 IU while PSA and AFP levels were within physiologic limits. Bronchoscopic examination revealed normal findings. Cytologic examination of BAL was negative. BAL culture did not grow any organisms including bacteria, mycobacteria, or fungus. Scrotal ultrasonography demonstrated a small heterogenic parenchymal area with calcifications at the left testis. Left orchiectomy was performed with a preliminary diagnosis of testis carcinoma. Histopathologic examination of the resected specimen revealed regressed germ cell testis tumor.

Our case displays crucial features for the diagnostic implications in regard to clinical presentation concerning both patient symptoms and the indistinct CT and nuclear imaging patterns. CT was non-diagnostic while PET/CT showed high tracer activity in the right testis consistent with malignancy while ultrasonography disclosed a subtle and inconspicuous image for a probable malignancy in the left testis. Clinicians should be aware that advanced imaging modalities as CT and PET/CT can lead to misleading and equivocal findings while ultrasound may exhibit barely distinct but not highly accurate sensitivity in regressed germ cell testis tumors.

Keywords: Testis Carcinoma; Regressed Germ Cell Testis Tumor; Germ Cell Tumor; Diagnosis

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