Clinical history: A 31-year-old man was admitted in 2/95 with an enlarging testicular mass that had been present for 1 y, and left leg pain, weakness, and numbness of 6 months' duration. For the past 2 mo he needed crutches. There was a 30-pound weight loss over the year. Abnormalities on physical examination were tenderness over the left iliac crest and an 8 cm non-tender mass in the right testis. No muscle wasting was noted, but left hip flexion and quadriceps strength were diminished. Left patellar tendon and ankle reflexes were absent, and sensation was decreased over the medial aspect of the left thigh.
Laboratory examination showed WBC 11.6 k/µl, Hct 43%, Hb 13.8 g/dl, platelets 520 k/µl. LDH was 612 units, alpha-fetoprotein 13,000 units, and ß-hCG 69 units.
Radiographic findings included multiple 0.5 to 2 cm lung nodules. CT scans of the abdomen showed a mass eroding the left side of the pelvis and involving gluteal muscles but not viscera, and a pathologic fracture of the left femoral head. Small retroperitoneal nodes were also noted. A right radical orchiectomy was performed.
Image 1 | Image 2 | Image 3 | Clinical history continued | Radiology | Image 4 | Image 5 | Image 6 | Discussion
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