Bilateral metachronous testicular seminoma.

BACKGROUND: A 33-year-old male presented to hospital with a painless right testicular mass measuring 2 x 3 cm and no systemic symptoms. The patient had no relevant medical history. CT and blood tests did not reveal metastasis and the patient was treated with a right inguinal orchiectomy and radiotherapy. After 4 years a routine follow-up examination revealed a 1 cm palpable mass in the left testis. INVESTIGATIONS: CT, tumor marker assessment, scrotal ultrasonography, Doppler ultrasound examination, and biopsy. DIAGNOSIS: Bilateral metachronous testicular seminoma, stage pT1N0M0S0. MANAGEMENT: Radiotherapy, radical orchiectomy, bilateral placement of testicular prostheses, androgen substitution therapy, regular follow-up assessment.