Metachronous testicular embryonal carcinoma after the treatment of seminoma. A report of two similar cases

Abstract

Introduction: Patients diagnosed with testicular germ cell tumors have higher risk of developing metachronous testicular tumors. Seminoma is the most prevalent type of bilateral testicular germ cell disease. We report the cases of two patients with metachronous testicular embryonal carcinoma after the treatment of seminoma. Case 1: A 30-year-old patient underwent left orchiectomy for a testicular classical  seminoma stage pT1 at the age of 25 years on January 2011. A postoperative computed tomography (CT) scan of the chest and abdomen were normal. He underwent prophylactic radiotherapy to para-aortic field. He remained well until December 2015 when an ultrasound scan of the right testis showed an 12 x 9 x 11 mm heterogeneous hypoechogenic areas. A CT scan of the chest and abdomen and the blood serum tumor markers were normal. After the sperm cryopreservation, the patient underwent right testicular exploration of the palpable lesion and excisional biopsy. Analysis of frozen biopsy sections revealed an embryonal carcinoma and radical orchiectomy was performed. Following consultation at an oncology clinic, the patient consented to treatment with a single dose of carboplatin. The patient is free from recurrence 11 months after the treatment. Case 2: A 31-year-old patient with a history of left testicular seminoma stage pT1 and right atrophic testis (8 cc), underwent left orchiectomy after the sperm cryopreservation on January 2011. A postoperative CT scan of abdomen revealed that the presence of left paraaortic and renal hilar lymph nodes. The patient underwent radiotherapy to paraaortic field and left renal hilum. The patient remained well until October 2015 when an ultrasound scan of the right atrophic testis showed an 6 x 5.5 x 5 mm heterogeneous solid lesion. A CT scan of the chest and abdomen and the blood serum tumor markers were normal. The patient underwent radical right orchiectomy. The pathological diagnosis was embryonal carcinoma combined with teratoma and ITGCN. The patient remained under surveillance and he is free from recurrence 12 months after the right orchiectomy. Conclusion: A closely follow-up protocol included physical examination and scrotal ultrasound evaluation of the contralateral testis made possible early diagnosis of the second tumor.

Keywords

• Metachronous testicular tumor,embryonal carcinoma,seminoma,radiotherapy

Seminom tedavisi sonrası metakron testiküler embryonal karsinom gelişimi. Benzer iki vakanın sunumu

Abstract

Giriş: Testiküler germ hücreli tümör öyküsü olan hastalar metakron testiküler tümör gelişimi için yüksek risklidir. Seminom, bilateral testiküler germ hücreli hastalığın en yaygın tipidir. Burada, seminom tedavisi sonrası nadir görülen metakron embryonal karsinom gelişen iki vaka sunulmuştur. Vaka 1: Ocak 2011’de 25 yaşında, sol testiküler kitle nedeniyle orşiektomi yapılan hastanın patoloji sonucu klasik seminom, evre pT1’dir. Operasyon sonrası batın ve toraks bilgisayarlı tomografi (BT) incelemesinde patoloji saptanmamıştır. Profilaktik amaçlı para-aortik alana radyoterapi uygulanmıştır. Aralık 2015’de yapılan sağ testiküler ultrasonda12 x 9 x 11 mm heterojen, hipoekoik alan saptanmıştır. BT ve serum tümör belirteçlerinde patoloji izlenmemiştir. Sperm dondurma sonrası sağ testiküler eksplorasyon yapılmış, frozen biyopsi patolojisi embryonal karsinom rapor edilmesi üzerine de sağ radikal orşiektomi yapılmıştır. Onkoloji kliniği ile konsülte edilen hastaya tek doz karboplatin verilmiştir. Operasyon sonrası 11. ayda hastada tümörsüz olarak takip edilmektedir. Vaka 2: Ocak 2011’de 26 yaşında, sağ atrofik testis ve sol testiküler kitle nedeniyle sperm dondurma sonrası sol orşiektomi yapılan hastanın patolojisi klasik seminom, evre pT1’dir. Operasyon sonrası kontrol BT’de sol para-aortik ve sol renal hiler lenf nodlarına radyoterapi uygulanmıştır. Ekim 2015’e kadar nükssüz takip edilen hastada, bu tarihte yapılan kontrol sağ testiküler ultrasonda 6 x 5.5 x 5 mm heterojen, solid lezyon saptanmıştır. BT ve serum tümör belirteçlerinde patoloji olmayan hastaya sağ radikal orşiektomi yapılmıştır. Patolojisi teratom ve ITGCN ile birlikte embryonal hücreli karsinom olarak rapor edilen hasta, tedavi sonrası 12. ayda nükssüz olarak takip edilmektedir. Yorum: Testiküler germ hücreli tümör tedavisi sonrası metakron testis tümörü gelişim riski nedeniyle karşı taraf testise fizik muayene ile birlikte testiküler ultrason yapılması, ikincil tümörlerin erken tanısına katkı sağlamaktadır.

Keywords

• Metakron testis tümörü,embryonal karsinom,seminom,radyoterapi

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