Delayed Diagnosis of Malignant Testicular Mass

Case Overview

This case involves a forty-two-year-old male patient who presented to his primary care physician with complaints of a mass in his right testicle. The PCP sent the patient for an ultrasound that was interpreted as normal and had no signs of any acute scrotal abnormality. The patient was started on antibiotics for what was suspected to be epididymitis. The patient waited two weeks for the medication to exert its effects and, in that time, the mass doubled in size. The PCP sent the patient to a urologist who read the original radiology report, but it recently had an addendum added that stated the patient had a 1.8 x 1.6 ill-defined mass like lesion present in the right testicle. The urologist performed an additional ultrasound and ran blood work that revealed the patient had an HCG marker for testicular cancer that was at a level of 4200. The patient’s follow-up ultrasound was highly suggestive of cancer and the patient underwent an orchiectomy procedure the following day.

Questions to the Hematology expert and their responses

Should this malignancy have been ruled out during the first visit?

Yes, more testing should have been done on the initial visit with a patient that presents with a testicular mass. The normal workup of patients with suspected testicular cancer includes a complete history and physical examination. Blood should be obtained for a chemistry profile including lactate dehydrogenase (LDH), complete blood count, serum tumor markers including alpha fetoprotein (AFP), and the beta subunit of human chorionic gonadotropin (beta-hCG).

About the expert

This expert has over 30 years of experience in hematology and oncology. He earned his BA from Yeshiva University, before receiving his MD from the State University of New York Downstate Medical College and his MBA from the Edinburgh Business School in Scotland. He then went on to complete two residencies in internal medicine at the New York-Presbyterian Lower Manhattan Hospital and the Hahnemann University Medical Center, respectively, followed by a fellowship in hematology and oncology at the Long Island Jewish Hillside Hospital Medical Center. Today, this expert is double board-certified in internal medicine and medical oncology. He is an active member of the American Society of Hematology and the American Society of Clinical Oncology. He has also authored 28 peer-reviewed journal articles, 10 abstracts, and 16 reviews. This expert previously served as the director of the cancer center at Generations Manhattan, as an associate professor of clinical medicine at Cornell University, as the chief of hematology and oncology and as the associate director of the cancer center at the Lincoln Medical Center, as the co-director of medical oncology and hematology at Brookdale University Hospital, and as an associate professor of medicine and the chief of hematology and oncology at the University of Medicine and Dentistry of New Jersey. Currently, he serves as an associate attending at a hospital in New York.

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Specialties:

Hematology

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