Fungating extra-scrotal mass: Clinical T4 testicular cancer in a young adult

Testicular cancer primarily manifests as a painless mass, yet atypical presentations can hinder effective diagnosis and management. Here we present a 34-year-old male with a large, ulcerated, fungating extra-scrotal mass invading the inguinal canal. Laboratory showed markedly elevated alpha-fetoprotein, and imaging confirmed advanced disease with bilateral pulmonary metastases. The patient underwent radical orchiectomy with partial scrotectomy. Histopathology revealed a pure post-pubertal yolk sac tumor. Despite guideline-directed systemic chemotherapy, the course was complicated by tumor-related bleeding and venous thromboembolism, resulting in death from massive pulmonary embolism. This case highlights the aggressiveness of adult yolk sac tumors and need for early intervention.