Upper Gastrointestinal Bleeding as Initial Presentation of Burned-out Testicular Tumor

Abstract

We report a case of 33-year-old man who initially presented with upper gastrointestinal bleeding caused by metastatic testicular cancer. Physical examination was significant for a palpable abdominal mass. Emergency gastroduodenoscopy yielded an ulcerated infiltrating mass in the third portion of the duodenum. Computerized tomography of the abdomen demonstrated a retroperitoneal mass. Histological examination of the retroperitoneal mass biopsy showed a nonseminamatous germ cell tumor consisting of embryonal cell carcinoma. Examination of the testes revealed a normal-sized firm left testis, and a normal right one. Ultrasonography of the testes showed multiple left testicular calcifications. The patient underwent left radical inguinal orchiectomy and histological examination of the resected testis showed spontaneous regression of testicular germ cell tumor. We suppose that the tumor was a socalled 'burned-out' testicular tumor. He was treated with four courses of chemotherapy with cisplatin, etoposide and bleomycin. At five year follow-up, the patient was doing well, with no recurrens. Keywords: Burned-out, Gastrointestinal bleeding, Metastatic testicular neoplasm, Testicular germ cell tumor ÖZET ‹lk Bulgusu Üst Gastrointestinal Sistem Kanamas› Olan Burned-out Testis TümörüBu çal›flmada, ilk flikayeti metastatik testiküler kanser nedeniyle üst gastrointestinal kanama olan 33 yafl›nda erkek hastay› sunduk. Fizik muayenede belirgin bat›nda belirgin kitle mevcuttu. Acil endoskopide duodenum 3. k›tada ülsere infiltratif kitle izlendi. Bat›n tomografisinde retroperitoneal kitle tespit edildi. Retroperitoneal biyopsinin histolojik incelemesinde embriyonel hücreli karsinomadan oluflan nonseminamatöz germ hücreli tümör saptand›. Skrotal muayenede sol testis normal boyutlarda olup sert k›vamda, sa¤ testis ise normal palpe edildi. Testis skrotal ultrasonunda sol testisde multiple kalsifikasyonlar saptand›. Hastaya sol radikal inguinal orfliektomi uyguland› ve rezeke edilen testisin histolojik incelenmesinde testiküler germ hücreli tümörün spontan regresyone oldu¤u görül-dü. Tümörün burned-out testiküler tümör oldu¤u kan›s›na var›ld›. Dört kür cisplatin, etoposide, bleomycin kemoterapisi sonras› 5 y›l-d›r kontrolde olan hastada rekurrens saptanmad›.