Burned-Out Testicular Cancer: Really a Different History

Abstract

Two or more histological types characterize more than 60% of testicular germ cell tumors (GCTs). Burned-out testicular tumor refers to partial or complete histological regression of the primary testicular lesions. The most frequent GCT type involved in this kind of histological regression is choriocarcinoma, followed by embryonal carcinoma. To our knowledge, there are no cases of the burned-out phenomenon in teratoma. We report a case of a 19-year-old man presenting to our institute with a right testicular lesion, evidence of mediastinal and abdominal lymph node metastasis, and high levels of GCT serum biomarkers. After orchiectomy, the histopathological examination showed a mixed GCT: mature teratoma, immature teratoma, and histological features of testicular cancer regression (burned-out phenomenon). The patient underwent first-line chemotherapy (BEP regimen) which resulted in a complete instrumental and biochemical response after 4 cycles. Teratoma is considered a less aggressive type of GCT. In this particular case, metastatic disease seems to result from non-germ cell components which underwent early spontaneous regression.

‘Burned‑out’ syndrome of testicular teratoma: A case report

“…The teratomas [which are non-seminomatous neoplasms, included in the group of germline tumors derived from GCNIS according to WHO 2016 classification ( 11 )] remain as the histological group with the lowest likelihood of regression ( 16-20 ). Previous studies, as claimed also by Mosillo et al ( 21 ) in their case report, have shown that lymph-node diffuse metastases in testicular mature teratoma tend to be caused by aggressive germ cell components that have undergone early regression. That is what we consider best explains what occurred in the present case, although this is purely conjectural as it cannot be manifestly supported by histological evaluation of orchiectomy.…”

Spontaneous testicular tumor regression: case report and historical review

“…Examination of the scrotal sacs through palpation is insufficient to exclude testicular tumours. The findings depend on the size of the tumour, its relation to the size of the testicle, the placement, consistency and/or associated pathologies, such as hydrocele, cysts or others [7, 26, 28, 56, 58]. In our casuistry, the physical exam found no testicular tumours, supplemented with ultrasound.…”

“…Over time, the ‘phenomenon’ of tumour regression has been described in different pathologies such as melanoma, breast cancer, lymphoma, renal carcinoma, among others [1, 2]. It is currently known that the process that keeps tumours alive does not only depend on their ability to multiply and block apoptosis, but there is also a close relationship with the immune environment in which the tumour develops, the so-called tumour microenvironment [4, 26–28].…”

“…In the collection of histological data, it was found that the ultrasound findings most frequently related to regression were hypo- and hyperechogenic lesions and microlithiasis. Another useful imaging test for metastatic lesion detection that is also essentially in the control and follow-up after chemotherapy is positron emission tomography, along with multislice tomography (PET/CT) through radiopharmaceutical administration of F18-FDG [24, 28, 37, 62].…”

Rare Presentation of Burned-Out Testicular Seminoma

“…A burned-out testicular tumor describes the finding of a regressed primary testicular lesion with a metastatic focus of disease. This is thought to be due to the primary tumor outgrowing its blood supply resulting in its regression [7 , 8] .…”