Malignant spinal cord compression secondary to testicular seminoma at the time of initial presentation and at relapse while on surveillance

Abstract

We report cases of 2 pure seminoma patients who developed metastatic spinalcord compressions. One patient was diagnosed at age 33 years with stage 1seminoma and, after undergoing an orchidectomy, chose to be followed ona surveillance protocol. He was lost to follow-up and presented again 22months later with back pain, leg weakness and sensory loss when his diseaserecurred as a spinal cord compression. He was treated with urgent surgicaldecompression and subsequent standard chemotherapy. More than 2years posttreatment, he is disease-free with normal neurologic function inhis lower extremities. The second patient presented at age 44 years withback pain and rapid loss of leg strength and sensation. Investigations revealeda malignant cord compression with lymphatic and vertebral body metastases.On physical examination, the patient was found to have a 6-cm lefttesticular mass. He was treated with emergency radiotherapy to the regionof his cord compression followed by a left inguinal orchidectomy. Pathologyconfirmed a pure classic seminoma. Postoperatively, he received standardchemotherapy and eventually regained neurologic function in his legs. Althoughit is rare for malignant spinal cord compression to occur in seminoma patients—either as the initial presentation of disease or as a site of disease recurrencein stage 1 patients on surveillance—it is crucial to consider seminoma as apossible etiology in young men diagnosed with malignant spinal cord compressionbecause timely contemporary treatments for seminoma will cure mostof these patients and offer them excellent functional recovery.

Acute cord compression secondary to spinal relapse of testicular seminomas

“…All three case reports of isolated thoracic spine relapses following treatment of a primary testicular seminoma presented with acute spinal cord compression as summarised in Otable 1 14 15. There was no mention of any preceding back pain or radicular pain in all three cases, which is unusual given that only 5–10% of patients with spinal metastases present with cord compression as an initial symptom 16.…”

“…A review of the literature reveals only two other case reports of isolated thoracic spine relapse of testicular seminomas and both were treated with surgery and active surveillance alone 14 15. Adjuvant radiotherapy has been shown to be an effective means of locoregional disease control for stage 1 seminomas with a 5-year relapse-free survival rate of more than 95% 2–4.…”

Isolated Femoral Muscle and Bone Metastases Rarely Encountered in Testicular Seminoma

“…Of stage I patients, the most common sites of relapse are the para-aortic lymph nodes and lungs [4]. Isolated muscle and bone metastases are rarely observed in pure seminomas [5, 6]. Generally, they present together with multiple visceral metastases.…”

“…The number of cases diagnosed with stage I seminoma and relapsed solely with muscle and bone metastases, as in the present case, is limited in the literature [5, 6]. Only orchiectomy was applied in a case and followed up; MRI, which was performed after 22 months because of difficulty in walking, revealed spinal cord compression due to a pathologic fracture involving the 12th thoracic vertebra [5].…”

Testicular cancer in Down syndrome with spinal cord metastases

“…Vertebral metastases from testicular tumors are rare. [3] The most common sites for metastases are the lung (89%), liver (73%), brain (31%), and bone (30%). [4]…”