A very unusual metastatic pattern exhibited by a mixed non-seminomatous germ cell tumour: a case report and review of literature

Abstract

It is a known fact that the retroperitoneum is the commonest metastatic site for testicular germ cell tumours. Contrary to this we are hereby reporting a case of an advanced testicular non-seminomatous germ cell tumour (NSGCT) presenting with a huge anterior abdominal wall metastatic mass and no evidence of retroperitoneal lymphadenopathy. A 36 yearold gentleman who underwent bilateral orchidopexies as a child, presented with a huge anterior abdominal wall mass engulfing the external genitalia. Incisional biopsy showed a yolk sac tumour. He was treated primarily with immediate chemotherapy with a dramatically good response. This was followed by right radical orchidectomy. Unfortunately, a few months later he developed recurrences into the anterior abdominal wall as well as brain metastasis. We conclude with two main messages. Firstly, previous inguino-scrotal procedures can significantly alter the lymphatic drainage from the testicles. Secondly, primary chemotherapy before orchidectomy can have a very favourable outcome in selected patients.