JOURNAL OF CLINICAL AND BIOMEDICAL SCIENCES

Abstract

A 75 year male patient presented with severe low back ache and unable to walk since two months. He had swellings in both the groin region and left scrotum for the last eight months, with history of loss of weight. He had undergone right sided herniorraphy for obstructed inguinal hernia one and half years back and was treated conservatively for blunt trauma to the left scrotum six months back. On examination the patient was pale. His blood pressure was 180/100 mm of Hg. He had bilateral enlarged inguinal nodes two on the right side and three on the left, each measuring 3x2 cm, hard, non tender. Skin over the swellings was free. Right inguino scrotal scar measuring 10x 2 cm, healed by primary intention was also seen. (Fig.1) Left testis was enlarged measuring 8 x3 cm, firm, and non-tender. There was no mass in the abdomen/organomegaly/ascites. He had grade-two prostatomegaly. Spine tenderness was elicited over the lumbosacral region. Straight leg raising test was positive. A 3x2 cm cutaneous non tender swelling was noted on the right forearm. (Fig.1 inset). Examination of the other systems was unremarkable. We made a diagnosis of left testicular tumor with bilateral inguinal lymph node metastases with secondaries in the lumbar spine and lipoma over the right. All the relevant laboratory investigations were within normal limits except for lactate de-hydrogenase which was markedly elevated (2165.00u/l).