The management of extratesticular seminoma without gonadal involvement

Diagnosis, treatment and follow-up of 8 patients from 1955 to 1975 with extratesticular seminoma are presented. In 5 patients, the neoplasm developed in the mediastinum and in 3 in the retroperitoneum. All the patients were treated by radiation therapy after resection or biopsy. In the entire group, no tumor was diagnosed in the testes. Two patients expired with disease, one after 2 months due to pneumonia, and the other 5 years after diagnosis (10 months after treatment) due to cerebral metastases. Two patients died 12 and 16 years after diagnosis and treatment. At death, they were free of seminoma and the cause of death was a second malignancy. Four patients are alive and healthy, free of disease, 5, 10, 13, and 17 years after diagnosis and treatment. In essence, of the 8 patients, only one actually died of disease, and he was not adequately treated. We feel that this is an entity with an excellent prognosis if adequately and appropriately treated with radiation. We recommend not to perform an orchiectomy when the testes are clinically normal, and to follow the patient closely after treatment.