Gastrointestinal tract metastasis in patients with germ-cell tumor of the testis

Abstract

A study of the incidence and clinical course of testicular germ-cell tumor metastatic to the gastrointestinal tract is presented. Gastrointestinal tract metastasis occurred in 25 cases, 5% of all patients evaluated with germ-cell tumor of the testis. Although embryonal carcinoma was the dominant component in all cases, element of choriocarcinoma were found in 20 cases and HCG was positive in 22 cases. Metastasis occurred most commonly by direct invasion from adjacent tumor. The most frequent site of gastrointestinal involvment was the proximal small intestine. Ivolvement of the duodenum was noted in seven cases. The most common gastrointestinal tract manifestations were intestinal obstruction and gastrointestinal bleeding. Although a variety of therapeutic modalities were tried, the average length of survival from the time of diagnosis of gastrointestinal metastasis to death was six months.

Duodenal involvement by seminomatous tumors

“…In relation to the affinity for GI tract among different histological types of GCT, it is well-known that seminoma, the one diagnosed in our patient, has a lower GI metastasis rate than non-seminomatous tumors (1)(2)(3)5). Because of that, there are actually few cases in literature reporting involvement of duodenum due to metastatic seminoma (7,8).…”

“…Its usual symptoms are bowel obstruction and digestive bleeding (2,3). However, GI infiltration from GCT is uncommon, ranging from 3.6% (1) to 5.1% (3). The article by Fu (4), published in 2012, identified only 15 cases.…”

“…Involvement of gastrointestinal (GI) tract in patients presenting such malignancies is due to three patterns: Infiltration from affected retroperitoneal lymph nodes or, less frequently, by peritoneal seeding and direct hematogenous metastatic spread (2,3). Its usual symptoms are bowel obstruction and digestive bleeding (2,3).…”

Seminoma presented with acute abdomen due to ileum perforation

“…Johnson et al, [22] reported GI metastasis in only two of 21 metastatic germ cell tumors in autopsy studies. Another autopsy study, by Chait et al [23], did not demonstrate GI events of germ cell tumors. The bowel involvement of germ cell tumors can occur by direct invasion from an adjacent tumor, intraperitoneal seeding or hematogenous spread [23].…”

“…Another autopsy study, by Chait et al [23], did not demonstrate GI events of germ cell tumors. The bowel involvement of germ cell tumors can occur by direct invasion from an adjacent tumor, intraperitoneal seeding or hematogenous spread [23]. One study reported that metastatic tumors of the small intestine usually present with either obstruction or bleeding [24].…”