Quick Case: Malignant Germ Cell Tumor Presents as Discharging Scrotal Mass

A 69-year-old male presented with urinary obstruction for 6 months and bilateral testicular pain for 9 months. Gradually the severity increased so that he needed permanent supra-pubic catheterization, due to severe urethral stricture, and the whole scrotal sac swelled up with multiple sinus formation and foul-smelling discharge. General health was more or less preserved, and no significant lymphadenopathy was detected. Mantoux was non-reactive. A chest X-ray revealed changes of pneumonitis but no nodular opacity. Urinary bladder and kidneys were normal. A clinical possibility of pyogenic bacterial abscess was considered, and the discharge was sent for microbiological and cytological tests. Culture was negative and the cytology confirmed the possibility of a germ cell tumor (seminomatous) that was eventually confirmed by histopathological studies. Radiation was effective in reducing the mass, but after radical surgery due to post-operative infections, the patient died after 6 months following the diagnosis.

Learning Points/Take Home Messages

Germ cell tumor of the testicles may mimic scrotal abscess without any lymphadenopathy!