This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Urethra & Penis, Subject name: Surgery
A 25-year-old male presented with painless testicular swelling and with history of fever and weight loss. All the following investigations are indicated in this patient, except: 
Select and explain. 
A. USG scrotum, B. CT abdomen and pelvis, C. Chest x-ray, D. Trans-scrotal biopsy
D: Trans-scrotal biopsy
Answer: D: Trans-scrotal biopsy 
Explanation: Ans. (d) Trans-scrotal biopsyRef: Bailey and love, 26th Edition, Pages 1385-1388* Painless testicular swelling in a 25 male with history of fever and weight loss amounts to a diagnosis of malignant testicular swelling, i.e. testicular cancer.* To confirm the histopathological evidence of testicular cancer, orchidectomy in form of high inguinal orchidectomy to be done after a manuever known as Chevasu Manuever* Trans scrotal biopsy is contraindicated, as Tunica albuginea will be breached during biopsy. Since Tunica albuginea is a natural barrier to testicular cancer, following biopsy, this will be breached and extend into the scrotum.