BILATERAL TESTICULAR CANCER: A RARE CASE REPORT

Putu Kurnia Darma Pratama1, Ricky Agave Ompusunggu2, Lukman Hakim1

1Department of Urology, Faculty of Medicine Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia
2Department of Urology, Abdoel Wahab Sjahranie Hospital, Samarinda, Indonesia

BACKGROUND
Bilateral testicular cancer is a rare incident, affecting 0,5 to 5% of all testicular tumor
cases. Proper diagnostic workup and decision-making to manage this case is crucial
since it may affect the patient’s condition physically and psychologically. We reported a
case of bilateral testicular cancer.

CASE PRESENTATION
A 46-year-old man complained mass
on his right abdomen since 8 months
before and a testicular mass for 6
month, both without pain. He
experienced right-undescended
testicle and infertility within 10 years
of marriage. There was an increase in
LDH (737 U/L), while the BHCG
serum examination (9.78 MIU/ml)
and AFP (1.64 ng/mL) were at
normal range. Contrast-enhanced
Abdominal-pelvic CT scan showed
two encapsulated with round shape
intraabdominal solid masses sized
15.5 cm x 11.9 cm (70 HU) and 13.4
cm x 10.5 cm. Solid-mass was found
Figure 1. Abdominal CT Scan
on his left testicle (59 HU), sized 11.4
cm x 7.7 cm (Figure 1). We excised
the right intrabdominal solid mass
and continued with left-inguinal
orchiectomy (Figure 2).
Histopathological analysis showed
seminoma in both tumors,
infiltrating to bilateral spermatic
cord. The patient is currently on
chemotherapy using BEP regiments
to target the residual tumor in the
abdomen.
Figure 2. Intraabdominal mass (left) dan left testicular mass (right)

CONCLUSION
Bilateral testicular cancer is a rare entity. Diagnostic method and therapy in this case is not
different from unilateral testicular cancer case. From two types of bilateral testicular cancer, both
synchronous and metachronous have their own prognosis and influenced by many factors.

REFERENCES
Adham, W. K. et al. (2005) ‘Bilateral testicular tumors: Seminoma and mixed germ cell tumor’, Radiographics, 25(3), pp. 835–839.doi: 10.1148/rg.253045188.
Boujelbene, Noureddine et al. (2011) ‘Pure seminoma: A review and update’, Radiation Oncology. BioMed Central Ltd, 6(1), p. 90. doi: 10.1186/1748-717X-6-90.
Campobasso, D., Ferretti, S. and Frattini, A. (2017) ‘Synchronous bilateral testis cancer: Clinical and oncological management’, Wspolczesna Onkologia, 21(1), pp. 70–76. doi:
10.5114/wo.2017.66660.
1. Campobasso,
Das, S. (2017) ‘Synchronous D., Ferretti, S. andCancers:
and Metachronous Frattini, A. (2017)
An Update’, ‘Synchronous
Ann Clin bilateral
Case Rep, 2, p. 1388. testis
Available cancer: Clinical and oncological management’, Wspolczesna
at: http://www.anncaserep.com/full-text/accr-v2-id1388.php.
Onkologia,
Laguna, M. P. et al. 21(1), pp.guidelines
(2020) ‘EAU 70–76. on doi: 10.5114/wo.2017.66660.
testicular cancer: 2020 update’, European Urology.doi: 10.1016/j.eururo.2011.05.038.
Leão,
2. Das,R., Ahmad,
S. A.(2017)
E. and Hamilton, R. J. (2019) ‘Testicular
‘Synchronous and Cancer Biomarkers: A Role
Metachronous for Precision
Cancers: AnMedicine in Testicular
Update’, AnnCancer’,
Clin Clinical Genitourinary
Case Rep, Cancer.
2, p. Elsevier Inc., 17(1),
1388. pp. e176–e183.
Available at:
doi: 10.1016/j.clgc.2018.10.007.
http://www.anncaserep.com/full-text/accr-v2-id1388.php.
Oldenburg, J. et al. (2013) ‘Testicular seminoma and non-seminoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up’, Annals of Oncology. Elsevier Masson SAS,
3. Laguna,pp.
24(SUPPL.6), M. P. et al. (2020)
vi125–vi132. ‘EAU guidelines on testicular cancer: 2020 update’, European Urology. doi: 10.1016/j.eururo.2011.05.038.
doi: 10.1093/annonc/mdt304.
Ondrus,
4. Sarici, D., Hornak, M. and O.
H., Telli, Mat’oska,
and J.Eroǧlu,
(2001) ‘Bilateral testicular germ-cell
M. (2013) ‘Bilateraltumors - A single centre
testicular germ long-term experience’,
cell tumor’, TurkInternational
UrolojiUrology and Nephrology,
Dergisi, 39(4), pp. 33(3),249–252.
pp. 521–524.doi:
doi:
10.1023/A:1019594602015.
10.5152/tud.2013.062.
Sarici, H., Telli, O. and Eroǧlu, M. (2013) ‘Bilateral testiküler germ hücreli tümörler’, Turk Uroloji Dergisi, 39(4), pp. 249–252. doi: 10.5152/tud.2013.062.
5. Zequi, A.S.and
Stephenson, D.Gilligan,
C. etT.al. (2012)
(2016) ‘Bilateral
‘Neoplasms testicular
of the Testis’, germ cell
in Campbell-Walsh tumours:
Urology, EleventhAEdition.
systematic
11th edn. review’,
Philadelphia:BJU International,
Elsevier, 110(8), pp. 1102–1109. doi:
Inc., pp. 784–814.
Zequi, S. D. C. et al. (2012) ‘Bilateral testicular germ cell tumours: A systematic review’, BJU International, 110(8),pp. 1102–1109. doi: 10.1111/j.1464-410X.2012.11056.x.
10.1111/j.1464-410X.2012.11056.x.

Contact Information: kurniadarmapratama@gmail.com