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Mixed germ cell tumor complicating an intra-abdominal cryptorchidism
images and diagnosis Mixed germ cell tumor complicating an intra-abdominal cryptorchidism Ahmed Abu-Zaid
a,*
, Ayman Azzam
b,c
, Tarek Amin
c
a College of Medicine, Alfaisal University, Riyadh, Saudi Arabia, b Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt, c Department of Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
* Corresponding author. Address: College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia. Tel.: +966 566305700; fax: +966 11 215 7777 Æ [email protected] Æ Accepted for publication 30 September 2013 Hematol Oncol Stem Cell Ther 2013; 6(3–4): 122–123 ª 2013 King Faisal Specialist Centre & Research Hospital Published by Elsevier Ltd. All rights reserved. DOI: http://dx.doi.org/10.1016/j.hemonc.2013.09.003
A
25-year-old man with a known case of uncorrected left cryptorchidism, presented with a six-month history of a rapidly growing mass in the left groin. Physical examination revealed a huge, palpable, tender mass involving the left groin. A genitourinary examination revealed an absent left testicle. Laboratory investigations showed elevated serum levels of alpha fetoprotein (AFP; 120,000 ng/mL) and lactate dehydrogenase (LDH; 445 IU/L). Coronal (Figure A) and axial (Figure B) contrast-enhanced computed tomography (CT) scans showed a 17 · 19 · 35 cm retroperitoneal mass demonstrating heterogeneous enhancement with multiple large necrotic areas. No distant metastasis was identified. Histopathological examination of a CT-guided needle-
Figure A. Coronal contrast-enhanced computed tomography (CT) scan showing a retroperitoneal mass demonstrating heterogeneous enhancement with multiple large necrotic areas.
122
core biopsy revealed a mixed germ cell tumor (mostly yolk sac tumor: 90–95%, other germ cell types: 5– 10%) complicating an intra-abdominal cryptorchidism (Figure C). The tumor was predominately composed of diffuse infiltrates of atypical cells with clear cytoplasm and signet ring features––distinctive for testicular components of yolk sac tumor. Patient underwent orchiectomy. Postoperatively, the patient received four cycles of bleomycin, etoposide and cisplatin (BEP) regimen. A one-year follow-up failed to show recurrence and serum tumor markers normalized. Testicular tumor affects 1% of the male scrotal testis population, and cryptorchidism increases the risk 3.7–7.5-fold, accounting for 10% of all testicular germ cell tumors.
Figure B. Axial contrast-enhanced computed tomography (CT) scan showing a retroperitoneal mass demonstrating heterogeneous enhancement with multiple large necrotic areas.
Hematol Oncol Stem Cell Ther 6(3–4)
Fourth Quarter 2013
hemoncstem.edmgr.com
GERM CELL TUMOR COMPLICATING CRYPTORCHIDISM
images and diagnosis CONFLICTS OF INTERESTS Authors report no conflicts of interests regarding the publication of this manuscript.
Figure C. Hematoxylin and Eosin (H&E) stain showing tumor cells predominately composed of infiltrates of atypical cells with clear cytoplasm and signet ring features –– distinctive for testicular components of yolk sac tumor.
Hematol Oncol Stem Cell Ther 6(3–4)
Fourth Quarter 2013
hemoncstem.edmgr.com
123
a,*
, Ayman Azzam
b,c
, Tarek Amin
c
a College of Medicine, Alfaisal University, Riyadh, Saudi Arabia, b Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt, c Department of Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
* Corresponding author. Address: College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia. Tel.: +966 566305700; fax: +966 11 215 7777 Æ [email protected] Æ Accepted for publication 30 September 2013 Hematol Oncol Stem Cell Ther 2013; 6(3–4): 122–123 ª 2013 King Faisal Specialist Centre & Research Hospital Published by Elsevier Ltd. All rights reserved. DOI: http://dx.doi.org/10.1016/j.hemonc.2013.09.003
A
25-year-old man with a known case of uncorrected left cryptorchidism, presented with a six-month history of a rapidly growing mass in the left groin. Physical examination revealed a huge, palpable, tender mass involving the left groin. A genitourinary examination revealed an absent left testicle. Laboratory investigations showed elevated serum levels of alpha fetoprotein (AFP; 120,000 ng/mL) and lactate dehydrogenase (LDH; 445 IU/L). Coronal (Figure A) and axial (Figure B) contrast-enhanced computed tomography (CT) scans showed a 17 · 19 · 35 cm retroperitoneal mass demonstrating heterogeneous enhancement with multiple large necrotic areas. No distant metastasis was identified. Histopathological examination of a CT-guided needle-
Figure A. Coronal contrast-enhanced computed tomography (CT) scan showing a retroperitoneal mass demonstrating heterogeneous enhancement with multiple large necrotic areas.
122
core biopsy revealed a mixed germ cell tumor (mostly yolk sac tumor: 90–95%, other germ cell types: 5– 10%) complicating an intra-abdominal cryptorchidism (Figure C). The tumor was predominately composed of diffuse infiltrates of atypical cells with clear cytoplasm and signet ring features––distinctive for testicular components of yolk sac tumor. Patient underwent orchiectomy. Postoperatively, the patient received four cycles of bleomycin, etoposide and cisplatin (BEP) regimen. A one-year follow-up failed to show recurrence and serum tumor markers normalized. Testicular tumor affects 1% of the male scrotal testis population, and cryptorchidism increases the risk 3.7–7.5-fold, accounting for 10% of all testicular germ cell tumors.
Figure B. Axial contrast-enhanced computed tomography (CT) scan showing a retroperitoneal mass demonstrating heterogeneous enhancement with multiple large necrotic areas.
Hematol Oncol Stem Cell Ther 6(3–4)
Fourth Quarter 2013
hemoncstem.edmgr.com
GERM CELL TUMOR COMPLICATING CRYPTORCHIDISM
images and diagnosis CONFLICTS OF INTERESTS Authors report no conflicts of interests regarding the publication of this manuscript.
Figure C. Hematoxylin and Eosin (H&E) stain showing tumor cells predominately composed of infiltrates of atypical cells with clear cytoplasm and signet ring features –– distinctive for testicular components of yolk sac tumor.
Hematol Oncol Stem Cell Ther 6(3–4)
Fourth Quarter 2013
hemoncstem.edmgr.com
123