Nonseminomatous mixed germ cell tumor of the testis: Case report

Abstract

Testicular germ cell tumors (GCTs) are the most common solid malignancies in young males, with nonseminomatous germ cell tumors (NSGCTs) representing a significant subset characterized by aggressive behavior and elevated tumor markers. This case report highlights the diagnostic and therapeutic challenges in a young male with a history of surgically corrected testicular ectopy, presenting with progressive testicular enlargement and pain, ultimately diagnosed as a mixed NSGCT. A 25-year-old male presented with a 1-month history of right testicular enlargement and pain. Physical examination revealed a tender, enlarged right testicle. Laboratory investigations showed elevated tumor markers, including Alpha-fetoprotein (AFP: 1,200 ng/mL) and Beta-human chorionic gonadotropin (BHCG: 450 IU/L). Magnetic Resonance Imaging (MRI) of the scrotum was performed, including T2-weighted axial and coronal sequences, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCE-MRI) with gadolinium. Radical inguinal orchiectomy was performed, and the resected specimen was subjected to histopathological examination. MRI revealed a large, heterogeneously hyperintense mass (50 × 50 × 45 mm) replacing the right testicular parenchyma, with irregular margins, hemorrhagic streaks, and low apparent diffusion coefficient (ADC) values (0.6 × 10⁻⁶ mm²/s). Dynamic postcontrast imaging demonstrated weak and progressive enhancement, consistent with NSGCT. Radical orchiectomy confirmed a grossly enlarged testicle with necrotic and hemorrhagic regions. Histopathology confirmed a mixed NSGCT, comprising embryonal carcinoma and yolk sac tumor components. Postoperative recovery was uneventful, and the patient was referred for further oncological management. This case underscores the importance of a multimodal diagnostic approach, integrating clinical evaluation, tumor markers, advanced imaging, and histopathology, in the management of testicular malignancies. Elevated AFP and BHCG levels were pivotal in raising suspicion for NSGCT, while MRI provided detailed characterization of the tumor’s size, internal architecture, and enhancement patterns, guiding surgical intervention. The histopathological findings confirmed the aggressive nature of the tumor, necessitating a multidisciplinary approach for further management. Early diagnosis and prompt intervention are critical for improving outcomes in patients with NSGCTs, particularly those with mixed histological components. This case highlights the pivotal role of MRI in diagnosing and staging testicular malignancies, complemented by tumor markers and histopathology. The integration of these modalities ensures accurate diagnosis and guides appropriate surgical and oncological management. Future studies should focus on refining imaging techniques and biomarkers to enhance diagnostic precision and personalize treatment strategies for testicular GCTs.