Referral Note

• The history of recent onset gynecomastia with elevated estradiol and beta HCG raises the suspicion of a germ cell tumor-seminoma, embryonal carcinoma, or choriocarcinoma. Although no discrete testicular masses were identified, the findings on scrotal USG are of concern. I think the findings on MRI are likely to represent incidental microadenomas. However, if you feel the testes are not the source of the elevated HCG, further evaluation of the pituitary will be undertaken.