A 24-year-old healthy man with a history of retractile right testicle managed with right orchidopexy at age 9 presents with a several weeks’ history of discomfort in the left testicle. He has no family history of testicular cancer. Investigations: Ultrasound reveals a left-sided, 8-mm, hypoechoic intratesticular lesion with increased Doppler flow, consistent with an intratesticular malignancy (Figure 1). Both testicles are equal in size. The left testicle contains multiple calcifications; the right testicle is without lesions.
The mass is not palpable on physical examination, and no other intrascrotal pathology is present. The patient has no gynecomastia or breast tenderness. Tests for serum tumor markers are negative. An MRI scan of the left testicle, with and without gadolinium, shows the lesion to be 7 mm in size, avidly enhancing, and most consistent with seminoma. What is the best…
