A Rare Case of an Aggressive Mixed Germ Cell Tumor Following Testicular Torsion

Testicular cancer is one of the leading malignancies affecting young men, with germ cell tumors (GCTs) being the most prevalent type. These tumors are classified into two main subtypes: seminomas and non-seminomatous germ cell tumors (NSGCTs), with the latter known for their higher likelihood of metastasis. Early detection through imaging and tumor markers like alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (HCG) is crucial for favorable outcomes. We present a case of a 40-year-old male patient with a recent history of a surgically repaired right testicular torsion presenting with progressive right testicular swelling and pain. Scrotal ultrasound revealed a markedly enlarged and heterogeneous right testicle measuring 5.4 cm, with mixed echogenicity and cystic features, highly suspicious for malignancy. Tumor markers were significantly elevated, with AFP at 19,420 ng/mL and HCG at 4,749 mIU/mL, indicating a high-risk testicular tumor. The patient underwent a right radical orchiectomy, which was complicated by tumor rupture during surgery. Pathology confirmed a testicular mixed GCT composed of embryonal carcinoma, yolk sac tumor, and teratoma with vascular/lymphatic invasion. This case highlights the importance of rapid intervention in managing NSGCTs, potential role of tumors in testicular torsions, and the unusual presentation of a rapidly growing NSGCT.