Case report and review: Simultaneously detected bilateral testicular cancer of different histopathological origina challenging situation for the urologist

Background: A 36-year-old male with a history of cryptorchidism of the right side, treated with orchidopexy at the age of 4, presented with bilateral testicular swelling. Investigations: Investigations included laboratory workup, ultrasound of both testes, as well as CT-scan of the chest, abdomen, and pelvis. Initial treatment was bilateral orchiectomy. Results: Scrotal examination revealed a mass on the left side and a small right testis with a hard mass at the lower pole. One markedly enlarged right inguinal lymph node was palpable. LDH, βHCG, and AFP were significantly elevated. Scrotal ultrasound revealed a homogeneous hypoechoic right testis without a mass and a heterogeneous mass containing multiple inhomogeneous cystic areas on the left side. A hypoechoic mass was visualized in the right groin. CT evaluation revealed an enlarged retroperitoneal lymph node on the left side. Diagnosis: Histopathological evaluation revealed seminoma of the right testis, nonseminomatous germ cell tumor of the left testis, and metastatic seminoma in the right groin postoperatively. Conclusions: Due to improved diagnostic tools as well as the establishment of various adjuvant treatment options, the mortality of testicular cancer generally decreased in the last decades. However, metastatic bilateral testicular cancer of different histology is a challenging situation for the urologist, which warrants further discussion. Adjuvant treatment as well as postoperative follow-up should be chosen carefully.