Fungating testicular germ cell tumours: Case report and narrative review of clinical presentation and management strategies

Fungating testicular germ cell tumours represent a rare and extreme manifestation of neglected testicular cancer. These cases typically arise after significant delays in presentation, reflecting advanced local disease and, in many instances, concurrent metastatic spread. We present the case of a 41 year-old man with a year-long history of a progressively enlarging, ulcerated scrotal mass. Biopsy confirmed seminoma without evidence of metastasis. Given the extent of local disease, the patient received neoadjuvant etoposide-cisplatin chemotherapy, resulting in dramatic tumour regression. This facilitated a radical orchidectomy and wide local excision with primary closure and clear margins. He remains disease-free 12 months post-treatment. To better understand the management and outcomes of this rare presentation, a narrative review was performed, indentifying 19 comparable cases of fungating GCTs over the past 28 years. The median age at presentation was 36, with a median diagnostic delay of 6 months. Non-seminomatous subtypes, particularly embryonal carcinoma, predominated and carried a higher risk of metastasis. While upfront surgery was attempted in ten cases, it frequently required extensive resections and yielded positive margins. In contrast, six patients received neoadjuvant chemotherapy, leading to marked tumour regression in five, improved surgical outcomes, and no reported positive margins. These findings highlight the potential advantages of neoadjuvant chemotherapy in managing extensive, locally advanced GCTs, even in Stage I disease. While concerns exist regarding infection risk in the setting of fungating tumours, these were not borne out in the reviewed cases. Multidisciplinary input is invaluable in optimising sequencing of therapy in such complex presentations.