A giant testicular tumor requiring skin valvuloplasty

Giant testicular tumors, typically defined as those with volumes exceeding ten times the normal testicular volume, are extremely rare in developed countries. However, a relatively high number of such cases have been reported in Japan. Social stigma and lack of awareness often contribute to delayed medical consultation, resulting in advanced disease requiring complex surgical interventions. Despite its aggressive presentation, testicular cancer is curable when diagnosed early, highlighting the importance of public education and awareness. A 45-year-old man presented with hemorrhagic shock due to bleeding from massively enlarged left scrotum. He first noticed painless scrotal swelling 3 years earlier, which rapidly progressed over the previous 6 months. Imaging revealed a 34-cm heterogeneous testicular mass with bilateral inguinal lymphadenopathy. Tumor marker levels were significantly elevated (alpha-fetoprotein: 689 ng/mL, lactate dehydrogenase: 6,566 IU/L). Emergency radical orchiectomy and bilateral inguinal lymph node dissection were performed. Due to extensive skin necrosis, vacuum-assisted closure therapy was initiated, followed by delayed skin valvuloplasty. Histopathological analysis confirmed nonseminomatous germ cell tumor (Stage IIIA), and adjuvant vincristine, ifosfamide, and cisplatin chemotherapy was administered. The patient remains recurrence-free 2 years postoperatively. Although rare, giant testicular tumors require prompt diagnosis and multidisciplinary management. Early detection is essential for preventing life-threatening complications and enabling curative treatment. Public awareness of testicular self-examination and high curability of testicular cancer can significantly reduce delays in seeking medical attention.