A 34-year-old man presented with a painless swelling in his right testicle that had grown over the past 5 months. On examination, there was a large, firm mass in the right side of the scrotum, and the right testicle could not be felt separately from the mass. The left testicle was normal. Based on the physical findings, the doctor's provisional diagnosis was a tumor of the right testicle.

1. A CASE OF TESTICULAR MALIGNANCY
By
DR. SWAPAN DAS
PGT, Unit- VI, GS.

2. HISTORY
My patients Mr. Rakhal Garai 34 years old Hindu male, resident of
Onda, Bankura, auto driver by occupation, belongs to lower middle
socioeconomical class, presented with-
chief complaints of painless swelling of right side of scrotum for last
5 months.

3. History of Present illness:
Mr. Rakhal Garai was apparently well 5 month ago, when he notice
painless swelling in right side of scrotum which is gradually
increasing in size for initial 4 months, but for the last one month there
is rapid increase in size. He also feels heaviness of scrotum for last
1 month. The swelling has been painless through out its course.
There is no history of alternation in size of the scrotum with change of
posture or during routine activities.

4. There is no history of trauma to scrotum. History of high risk
sexual behaviour is absent. There is no history of any other
swelling in groins, neck region or in abdomen
He has no history of, fever, vomiting, constipation, low back pain,
cough, haemoptysis, jaundice. No history of recent weight loss.

5. History of Past illness :
He had no history of undescended testis. No operative procedure
was done in past. He is normotensive, non-diabetics, had no history
of tuberculosis.
Personal History:
Mr. Rakhal Garai is married for last 9 years and has three children.
He is chronic smoker and smoked 5-7 cigarettes per day for last 3
years (0.9 pack year). He also drink alcohol occasionally for last one
year. He has no history of any other addiction.
Bowel and bladder habits of the patient is regular, sleep and appetite
is normal.

6. Family History :
His both parents are alive and healthy. he has 2 young brothers and one sister,
all leads healthy life. No history of similar illness in the family.
Treatment History:
He does not take any medication for any disease regularly.
History of Allergy:
The patient has no history of allergy to any known drugs and foods or
substances.

7. PHYSICAL EXAMINATION
General Survey:
• The patient is alert, conscious, co-operative and oriented to time,
place and person.
• Performance status: ECOG-1.
• Decubitus of choice
• Average build with poor nutritional status and BMI is 17 kg/m2.
• Mild pallor present, icterus, cyanosis, clubbing and oedema absent.
• Pulse rate 94 bpm, regular rhythm, normal volume.
• Neck vein not engorged, neck gland not palpable.
• Blood Pressure 116/76 mm of Hg, Resp. Rate 18/min.
• Temp – Not raised.

8. LOCAL EXAMINATION
Examination of Scrotum:
On inspection right side of the scrotum is enlarge in size with
single globular approximately (7×4) cm2 swelling. The swelling
extended from base of the scrotum to root of the scrotum with
loss of overlying skin rugosity. Left side of the scrotum is normal in
size and shape with skin rugosity preserved.
No dilated veins are present. There is no ulcer, sinus or scar
mark. Cough impulse is absent. Penis is normal in appearance
with slightly deviated to left side.

9. On palpation there is (7.5×4×2.5) cm3 globular mass with firm
consistency, well define margin, smooth surface in the right side of
the scrotum. Temperature of the overlying skin is not raised.
Getting above the swelling is possible. Right sided testis is not
palpable separately. The swelling is nontender and there is loss of
testicular sensation. Fluctuation and translucency of the swelling is
absent. Right sided spermatic cord is normal.
Left sided testis and spermatic cord is normal. Scrotal skin is
pinchable from the underlying structure.

10. SYSTEMIC EXAMINATION:
Examination of Abdomen:
Abdomen is scaphoid in shape with centrally located, inverted
umbilicus. There is no, dilated veins, scar mark, ulcer or visible
swelling. All quadrants of the abdomen move with respiration.
On palpation abdomen is soft, non tender with no organomegaly.
Supraclavicular and inguinal lymph node is not palpable.
Examination of back appears normal and no abnormality found in
digital per rectal examination.

11. Central Nervous system-
Higher functions are normal. No focal neurological deficit at
present.
Cardiovascular System-
Pulse rate 94 bpm, regular rhythm, normal volume.
Blood Pressure -116/76 mm of Hg.
S1 and S2 audible, murmur absent.
Respiratory System-
Respiratory Rate 18/min.
Bronchial and vesicular breath sound audible. Wheeze and
rhonchi absent.

12. SUMMARY
My patients Mr. Rakhal Garai 34 years old male from Onda,
Bankura, auto driver by occupation belongs to lower middle
socioeconomical class, presented with chief complain of swelling
of right side of scrotum for last 5 months.
He was apparently well 5 month ago, when he notice painless
swelling in right side of scrotum which is gradually increasing in
size for initial 4 months but size increase rapidly for last one
month. He also feels heaviness of scrotum for last 1 month. He
has no history of trauma to scrotum. Both testis are present in
scrotum since birth.

13. The patient is alert, conscious, co-operative and oriented to time, place
and person with Performance status in ECOG scale is 1.
On inspection right side of the scrotum is enlarge in size with loss of
skin rugosity. On palpation there is (7.5×4×2.5) cm3 globular mass
with firm consistency, well define margin, smooth surface in the right
side of the scrotum. Getting above the swelling is possible. Right sided
testis is not palpable separately. The swelling is euthermic, nontender
and there is loss of testicular sensation.
Other systemic examination does not revels any major abnormality.
.

14. PROVISIONAL DIAGNOSIS
This is a case of 34 years old gentleman with right sided testicular
tumour.