Testicular Tumor Presenting as Scrotal Gangrene

A 38 year old man with a 14-month history of a large scrotal mass was seen in the emergency room complaining of asthenia, fever, pain, and fetid discharge through the scrotal skin. On physical examination an 11 cm tumor was revealed in the right hemiscrotum with scrotal gangrene and two ulcers in the left hemiscrotum (Figure 1). The patient had been treated for schizophrenia for 8 years and failed to search for treatment for his scrotal mass. Wide excision of the hemiscrotum including the right testicle was carried out; no other treatment except for antibiotics was carried out. Histopathological examination showed a testicular embryonal carcinoma invading scrotal skin (Figure 2). Consequently, staging was performed. Serum alpha-fetoprotein was 6408 ng/ml, and abdominal CT scan identified a 9 cm retroperitoneal mass. Chest CT scan was negative for lung metastasis (TNM stage = T4N3M0). After surgery the patient was referred to the oncology department for chemotherapy and was treated with 3 courses of chemotherapy consisting of bleomycin, etoposide, and platinum. An excellent response to chemotherapy was obtained. The regression rate of retroperitoneal lymph node metastasis was 95% on CT, and a 2.1 cm residual mass in the retroperitoneum has been followed with no evidence of biochemical recurrence after 26 months of follow-up. Due to this response, both the oncologists and the patient’s family opted for close surveillance rather than surgery. The scrotal