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

Year 2017, Volume: 12 Issue: 3, 53 - 57, 01.10.2017

Lütfi Canat Osman Can Hasan Anıl Atalay İlter Alkan Süleyman Sami Çakır Fatih Altunrende

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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