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Burned out seminomatous testicular tumor with retroperitoneal lymph node metastasis: a case report
Pradyumna Kumar Sahoo1, Palash Kumar Mandal2, Supti Mukhopadhyay2
1Department of Surgical Oncology, Cancer Centre Welfare Home and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, 700063 West Bengal India ; Department of Surgical Oncology, Cancer Centre Welfare Home and Research Institute, Mahatma Gandhi Road, Thakurpukur, Kolkata, 700063 West Bengal India.
Abstract:
Germ cell tumor is the most common malignancy in men aged 15-35 years. About five percent of the malignant germ cell tumors are extragonadal in origin. However metastatic deposit of seminoma in retroperitoneal lymph node without presence of any tumor in the testes is uncommon. We present a case of metastatic retroperitoneal seminoma as the initial presentation of a burned out testicular primary. The patient presented with pain in abdomen and back. Ultrasonography of the testis showed a lesion, which after high inguinal ochidectomy was reported as fibrosis only, without any tumor, i.e. burned out phenomenon. A laparotomy biopsy of the retroperitoneal lymph node mass was taken and reported as metastatic seminoma after immunohistochemistry. After 14 months of chemotherapy there is a residual lymph node of less than 3cm, serum tumor markers are normal and the patient is under observation.
Insights
Metastatic retroperitoneal seminoma, a rare cancer presentation in young men, can occur even when testicular tumors are absent. This case highlights a "burned out" primary testicular tumor presenting initially as retroperitoneal lymph node metastasis.
Area of Science:
- Oncology
- Urology
- Pathology
Background:
- Germ cell tumors are the most common malignancy in men aged 15-35.
- Extragonadal germ cell tumors account for approximately 5% of malignant germ cell tumors.
- Metastatic seminoma in retroperitoneal lymph nodes without detectable primary testicular tumor is rare.
Observation:
- A patient presented with abdominal and back pain.
- Testicular ultrasonography revealed a lesion, but high inguinal orchidectomy showed only fibrosis, indicating a
- burned out
- primary testicular tumor.
- Retroperitoneal lymph node biopsy confirmed metastatic seminoma via immunohistochemistry.
Findings:
- The patient's initial presentation was metastatic retroperitoneal seminoma.
- The primary testicular tumor was occult, a phenomenon known as
- burned out
- seminoma.
- Following chemotherapy, residual retroperitoneal lymph nodes were less than 3cm, with normalized serum tumor markers.
Implications:
- This case underscores the importance of considering metastatic disease even with absent or occult primary testicular tumors.
- Immunohistochemistry is crucial for diagnosing metastatic seminoma in retroperitoneal lymph nodes.
- Effective management strategies, including chemotherapy, can lead to favorable outcomes in such rare presentations.
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