# Atypical Cutaneous Presentation and Diagnostic Challenges in Advanced Metastatic Testicular Cancer

## TL;DR

A 29-year-old man with advanced testicular cancer showed unusual skin and neurological symptoms, highlighting the challenges in diagnosing and treating metastatic cases.

## Contribution

This case report highlights the atypical cutaneous and neurological presentation of metastatic testicular cancer.

## Key findings

- The patient exhibited neurological deficits and subcutaneous nodules, atypical for testicular cancer.
- Imaging revealed brain lesions and metastases, with elevated tumor markers confirming non-seminomatous germ cell tumor.
- Multidisciplinary treatment led to significant neurological improvement and stabilization.

## Abstract

A 29-year-old male presented with acute left-sided weakness in both the upper extremity (UE) and lower extremity (LE), an atypical symptom for testicular cancer but not uncommon for brain metastasis. Testicular cancer usually manifests as a testicular mass or discomfort. His medical history included a previously resected testicular mass, with pathology results unknown due to the patient being lost to follow-up. Upon examination, he exhibited significant neurological deficits and multiple subcutaneous nodules. Imaging revealed multiple enhancing brain lesions and widespread metastases to the lungs and other regions. Laboratory tests showed elevated alpha-fetoprotein and lactate dehydrogenase levels, supporting a diagnosis of advanced non-seminomatous germ cell tumor. He received multidisciplinary treatment, including dexamethasone, levetiracetam, and chemotherapy. The patient responded well to the treatment, showing significant improvement in neurological function and stabilization of his condition. This case underscores the diagnostic and therapeutic challenges of metastatic testicular cancer, particularly with rare presentations such as cutaneous involvement, and highlights the importance of comprehensive diagnostic evaluations and multidisciplinary care.