Monday, May 15, 2017

Backing Up to Testicular Cancer Surgery

April 2016

Okay, so I'm taking a leap backward before we go forward once again. Stay with me.
My eyes started buggaring up at the beginning of that month. Remember those new glasses I mentioned? Yeah...
I headed to Roanoke, VA, for a work-related event, and convinced my husband to meet me in Ashville, NC, the following week, so we could hang out and get a mini vacation with just the two of us. Since I'd had my event, Darling Daughter (who was ten at the time) stayed with family in TN.

In other words, my husband and I were free to claim some private time.

We check into the b&b we're staying at, and he tells me about a lump he's found on his man bits. This thing isn't small. We're talking 3cm (that's just over an inch).

He tells me he plans to see a doctor about it, but he also says the dreaded C word. For a week, we try not to think about it as we spend some time.

The next week, he called for an appointment, and the week after that, they were removing the mass and everything around it in a procedure called an orchiectomy. This all happened SO fast! Appointment with doc on Tues, ultrasound Wed, surgery Fri. 

This was the pathology report we got (and we didn't understand a lick of it):

—Mixed germ cell tumor (seminoma 75%, mature teratoma 10%, immature teratoma 5%, embryonal carcinoma 5%, yolk sac tumor 5%, 5.1cm.
—Epididymis, spermatic cord, tunica vaginalis, and surgical margin, negative for tumor.
—No definitive lymphovascular invasion seen.
—Intratubular germ cell neoplasia (ITGCN).

Gross examination:
"Left testical and spermatic cord," in formalin, consist of 92 gram purple multinodular testicle and attached spermatic cord. The testicle measures 7 x 4 x 4.3 cm and the cord measures 11 x 2 cm. The entire testis is occupied by a bilobed mass two-thirds of which is soft reddish-brown and the other third is firmer and yellowish-white, overall measuring 5.1 x 3.3 cm. No involvement of the tunica vaginalis. The epididymis is uninvolved.

Microscopic examination:
(16 H & E, including deeper levels)
The spermatic cord is negative for tumor, including the proximal surgical margin. The testicular mass is a mixed germ cell tumor comprised of the articles listed above. The seminoma cells are large, round, with either clear or pink cytoplasm, and with macronucleoli within vesicular nuclei. There are some thin fabrous septa and there are lymphocytes percolating throughout. Occassional syncytiotropholbasts are present in the seminoma. The mature teratoma shows hyaline cartilage, respiratory-type glands, focal retinal pigment, and focal squamous cysts. The immature teratoma component is represented by primative neuroepithelial structures, including rosettes and tubules. The embryonal carcinoma component has a papillary architecture and large, highly pleomorphic basophilic cells. The yolk sac tumor component shows a myxoid, microcystic, and focal glandular pattern. Some seminoma cells are occasionally seen within vascular spaces, however, possibly representing scalpel contaminant, as no definitive attachment to vessel wall is seen; therefore, no definitive lymphovascular invasion is seen. The epididymis and tunica vaginalis are negative for tumor. The seminiferous tubules often show lack of maturation and large atypical cells with clear cytoplasm.

He was in a lot of pain for a number of weeks. This surgery is no joke. They remove everything. It's very invasive.

Now, I have more knowledge of what that report means, but in the interest of keeping you where we were at the time, I won't go into it. This is also a record of learning and how knowledge was gained. I don't wanna jump ahead.

We were told by the urilogical surgeon that after this surgery, there was a very good chance that would be it (true).

My husband had just turned 44, and we'd just celebrated our second wedding anniversary.

The oncologist we were referred to did tests every other month after this and told us more may be needed but they wanted to watch the AFP numbers rather than leap into chemo. We agreed with that 100%. What happened next will come later when the timeline dictates.

For tomorrow, we need to go back to the beginning of June because my fun was just getting started.

I'm going to interject here: CHECK YOUR MAN BERRIES!! PLEASE PLEASE! Mamas, teaching your sons to do this is just as important as teaching your daughters how to do self-exams on their breasts.

Until then!

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