Burned-out Testicular Tumor Presenting as Cervical and Retroperitoneal Lymphadenopathy

Abstract

A burned-out tumor of the testis is a rare clinical entity. It usually regresses spontaneously without any treatment and presents as metastasis to the retroperitoneum, mediastinum, cervical region, lungs, and liver. Clinical examination and ultrasound of the testis are pivotal to raising suspicion for the diagnosis of the burned-out tumor. Here, we report a case of a 23-year-old male who presented to us with a complaint of swelling on the left side of the neck. Biopsy from the neck mass suggested metastatic malignant mixed germ cell tumor, consistent with yolk sac tumor and embryonal carcinoma. The whole-body fluorodeoxyglucose-positron emission tomography-computed tomography suggested conglomerated left neck mass and retroperitoneal lymph node enlargement. Ultrasound of the scrotum suggested heterogeneously hypoechoic echotexture with few foci of microcalcification in the right testes. He underwent a right high inguinal orchidectomy, which showed no evidence of the tumor. The patient received four cycles of chemotherapy with bleomycin, etoposide, and a cisplatin-based combination regimen with a favorable response to the therapy. In view of residual viable disease and raised tumor markers, the patient received second-line chemotherapy with paclitaxel, ifosfamide, and carboplatin.