Retroperitoneal seminoma with ‘burned out’ phenomenon in the testis

Perimenis, Petros; Athanasopoulos, Anastasios; Geraghty, J.M.; MacDonagh, Ru

doi:10.1111/j.1442-2042.2004.00987.x

Cited by 21 publications

(23 citation statements)

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“…Retroperitoneal seminoma without involvement of the testis is uncommon [1][2][3]. Two to five percent of the malignant germ cell tumors (GCT) are extragonadal in origin [1,4].…”

Section: Discussionmentioning

confidence: 99%

“…The burned out tumors of the testis need to be distinguished from true EGGCT because the primary removal of the testicular tumor leads to a satisfactory outcome. These malignancies are treated surgically with or without adjuvant chemotherapy or radiotherapy [1,2]. Seminomatous EGGCT have an equivalent prognosis as their primary gonadal counterpart [1,4].…”

Section: Discussionmentioning

confidence: 99%

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Burned Out Seminomatous Testicular Tumor with Retroperitoneal Lymph Node Metastasis: A Case Report

Sahoo

Mandal

Mukhopadhyay

et al. 2013

Indian J Surg Oncol

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Germ cell tumor is the most common malignancy in men aged 15-35 years. About five percent of the malignant germ cell tumors are extragonadal in origin. However metastatic deposit of seminoma in retroperitoneal lymph node without presence of any tumor in the testes is uncommon. We present a case of metastatic retroperitoneal seminoma as the initial presentation of a burned out testicular primary. The patient presented with pain in abdomen and back. Ultrasonography of the testis showed a lesion, which after high inguinal ochidectomy was reported as fibrosis only, without any tumor, i.e. burned out phenomenon. A laparotomy biopsy of the retroperitoneal lymph node mass was taken and reported as metastatic seminoma after immunohistochemistry. After 14 months of chemotherapy there is a residual lymph node of less than 3cm, serum tumor markers are normal and the patient is under observation.Keywords Seminoma . Burned out phenomenon . Testis . Extragonadal germ cell tumor Case ReportA 33 year old Indian male presented to our Institute with pain in abdomen and back intermittently, for 3 months duration. Patient is a tobacco chewer and hypothyroid under treatment. There was no significant history, physical examination was normal.Ultrasonography (USG) of abdomen revealed a heterogeneous mass in the retroperitoneum. Contrast enhanced computed tomography (CECT) of abdomen showed a rim enhancing lesion 6.1×5.0 cm at aortic bifurcation [ Fig. 1a]. Trucut biopsy was done and histopathological examination (HPE) reported as poorly differentiated carcinoma or NonHodgkin's lymphoma. Immunohistochemistry (IHC) showed CD117 positivity in the tumor cells, suggestive of seminoma. The tumor cells were negative for pancytokeratin, CD30 and CD45.To find out the primary, USG of bilateral testes was done, which showed a heterogenous lesion of 1.5×1.2 cm in the left testicle [ Fig. 1b]. Testicular tumor serum markers human chorionic gonadotropin (hCG), alphafetoprotein (AFP) and lactate dehydrogenase (LDH) were normal.Left high inguinal orchidectomy was done. On gross, a whitish scar like lesion was noted [Fig. 1c]; microscopically no tumor was found; only fibrosis was seen. Re-grossing and re-examination of the specimen was reported as same.Laparotomy and biopsy from the retroperitoneal lymph nodal mass was done. HPE showed neoplastic cells in sheets and nests with intervening thin fibrous septae and scattered lymphocytes. The cells had vesicular nuclei, prominent nucleoli and pale cytoplasm [ Fig. 1d], suggestive of (1) metastatic/ primary seminoma, (2) metastatic/primary poorly differentiated carcinoma. No definite lymph nodal architecture could be

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“…Retroperitoneal seminoma without involvement of the testis is uncommon [1][2][3]. Two to five percent of the malignant germ cell tumors (GCT) are extragonadal in origin [1,4].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Burned Out Seminomatous Testicular Tumor with Retroperitoneal Lymph Node Metastasis: A Case Report

Sahoo

Mandal

Mukhopadhyay

et al. 2013

Indian J Surg Oncol

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show abstract

“…Often it's difficult for clinicians distinguish primary germ cells tumour to metastatic lesion specially for seminoma, which tend to spread by lymphatic channel to retroperitoneal lymph nodes. Previous reports in literature described a "burned out" phenomenon of germ cells tumours, consisting in extragonadal germ cell tumour with no evidence of neoplasm at the testis level [5][6][7][8][9].…”

Section: Discussionmentioning

confidence: 99%

“…These studies showed favourable outcomes both for short and long follow-up periods with combined modality treatment approach and revealing the higher frequency of metastatic retroperitoneal tumours from primary unevolved testicular tumour [5,[18][19][20][21][22][23] (Table 1). …”

Section: Discussionmentioning

confidence: 99%

A Case Report of Retroperitoneal Seminoma and Literature Review

Chiumento¹

2013

J Nucl Med Radiat Ther

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Aims and background: Extra-gonadal germ cell tumours (EGCT) are rare tumors, which usually occur in the mediastinum or retroperitoneum; in particular, primary retroperitoneal seminomas account for approximately 2% of all seminomas. We report the case of a 34-year-old male with a locally advanced retroperitonal seminoma. Methods:The patient underwent debulking surgery followed by cisplatin-based chemotherapy and radiotherapy. Results: No evidence of recurrence was detected during a 30 months follow-up. Although retroperitoneal seminoma is rare, this entity should be considered in the differential diagnosis of a male patient presenting with a mass in the retroperitoneum. Conclusions:Our case, according to data reported in literature, confirms the curability of retroperitoneal seminoma even in presence of bulky disease, and it represents an example of revised treatment procedure due to patient's particular condition.

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“…Çeşitli immünolojik veya iskemik mekanizmalar öne sürülse de en olası mekanizmanın immünolojik olduğu düşünülmektedir. Endokrin bir takım bozuklukları olan hastalarda burnedout tümör bildiren yayınlarda endokrin bozuklukların varlığı immünolojik mekanizmalar ile ilişki tutulmuştur (43,44). Saleh ve ark.…”

Section: Tümör Regresyon Patogeneziunclassified

“Burned-Out” Germ Cell Tumors of the Testis

Özlük

2014

uob

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Testiste "burned-out" tümör kavramı, mevcut germ hücreli tümörün herhangi bir tedavi almadan, spontan total ya da parsiyel regresyonu olarak tanımlanır. Klinikte sıklıkla hastada metastatik bir odağın saptanması ile ortaya çıkar. Testiküler "burned-out" tümör nadir rastlanılan bir antite olup, bu derlemede klinik, radyolojik ve patolojik özelliklerinin vurgulanması amaçlanmıştır. Bu hastalarda en sık metastatik odak retroperitoneal lenf nodudur. Testise yapılan klinik muayenede çoğu zaman palpasyon bulgusu olmayıp, yapılan skrotal ultrasonografik incelemelerde hipoekojen odaklar veya kalsifikasyonlar saptanır. Orşiektomi materyallerinde patolojik değerlendirmede rezidü tümör ve/veya fibröz doku belirlenebilir. Sadece fibröz dokunun bulunduğu durumlarda hematoksifilik cisimcikler, mikrolitler, tubuler atrofi ve intratubuler germ hücre neoplazisi varlığı regrese bir germ hücreli tümör lehine yorumlanmalıdır. Metastaz ile kliniğe yansıyan, testisteki primer tümörün regresyonu ile karakterize "burned-out" germ hücreli tümörler nadir ama akılda tutulması gereken tümörlerdir. Retroperitoneal germ hücreli tümörler aksi ispat edilene kadar testisteki regrese odağın metastazı olarak kabul edilmelidir. Hem tanı hem de tedavi amacı taşıması nedeni ile bu hastalarda orşiektomi mutlaka yapılmalıdır. Orşiektomi materyallerinde makroskopik incelemenin çok sayıda kesit alınarak yapılması küçük odakların dahi saptanabilmesi için oldukça önemlidir. Anah tar Ke li me ler: Burned-out, testis, germ hücreli tümörBurned-out tumors of the testis are defined as spontaneous total or partial regression of a testicular germ cell tumor without any treatment. They usually present at the metastatic stage. Burned-out testicular tumors are rare entities and it was aimed to emphasize their clinical, radiological and pathological features in this review. Retroperitoneal lymph nodes are the most common metastatic sites of these tumors. Physical examination of testicles shows no palpable mass. Scrotal ultrasonography may show hypoechoic lesions and/or calcifications. Orchiectomy materials mostly display residual tumor and/or fibrous scar. Hematoxyphilic bodies, microliths, tubular atrophy and intratubular germ cell neoplasia in a testis having only a fibrous scar indicate regression of primary testicular tumor. Metastatic testicular germ cell tumors showing regression in the primary site, so-called burned-out tumors, should be kept in mind although they are rare. Retroperitoneal germ cell tumors should always be considered as burned-out testicular neoplasm until proven otherwise. Orchiectomy should be certainly performed for both diagnostic and therapeutic purposes. Macroscopic evaluation of orchiectomy materials via having many section samples is important in the detection of small foci of regressed tumors.

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Retroperitoneal seminoma with ‘burned out’ phenomenon in the testis

Cited by 21 publications

References 3 publications

Burned Out Seminomatous Testicular Tumor with Retroperitoneal Lymph Node Metastasis: A Case Report

Burned Out Seminomatous Testicular Tumor with Retroperitoneal Lymph Node Metastasis: A Case Report

A Case Report of Retroperitoneal Seminoma and Literature Review

“Burned-Out” Germ Cell Tumors of the Testis

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