In Reply We appreciate the interest in our Clinical Challenge1 and thoughtful insights provided by O’Neil and Maughan. As they correctly point out, testicular cancer is an important diagnosis to consider in patients, especially young men, presenting with a retroperitoneal mass. Testicular cancer was indeed considered in the differential diagnosis for the patient. The patient received a careful testicular examination during his surgical clinical visit with no abnormalities noted. Had any abnormalities been identified, scrotal ultrasonography and germ-cell tumor markers certainly would have been obtained. A normal testicular examination does not entirely rule out the possibility that a retroperitoneal mass could still be a germ-cell tumor. However, the entity described as a primary extragonadal retroperitoneal germ-cell tumor is thought to be extremely rare and is almost always rather a metastasis from either a viable or burned-out testicular cancer.2
Van Arendonk KJ, He J. A More Common Massive Retroperitoneal Mass—Reply. JAMA Surg. 2017;152(8):803. doi:10.1001/jamasurg.2017.0547
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