A 40-year-old man presents with a painless, firm, non-translucent right testicular mass. AFP is 450 ng/mL, beta-hCG is 1200 mIU/mL, and LDH is 350 U/L. CT staging shows retroperitoneal lymph nodes up to 2.5 cm; no visceral metastases. What is the appropriate initial surgical management?

• A Transscrotal biopsy of the testicular mass to confirm histology before further management
• B CT-guided biopsy of retroperitoneal nodes to stage the disease
• C Immediate BEP chemotherapy without surgery as serum markers confirm germ cell tumour
• D Radical (inguinal) orchidectomy as the first diagnostic and therapeutic step ✓

Explanation

Radical inguinal orchidectomy (not transscrotal) is the mandatory first step in suspected testicular germ cell tumour — it provides histological diagnosis and is therapeutic (primary tumour removal). Transscrotal approach is absolutely contraindicated as it disrupts lymphatic drainage and risks inguinal and pelvic nodal spread, altering staging and treatment. Elevated AFP (non-seminoma marker — seminomas do not produce AFP), beta-hCG, and LDH support germ cell tumour diagnosis. BEP chemotherapy follows staging and histological confirmation.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.