Delayed Diagnosis of Malignant Testicular Mass

Michael Talve, CEO

Written by
— Updated on September 28, 2017

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.

Question(s) For Expert Witness

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

Expert Witness Response E-000029

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).

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