CUTANEOUS RELAPSE OF TESTICULAR EMBRYONIC CARCINOMA

Abstract

Cutaneous metastases from testicular cancer are rare and only a few cases have been reported in the literature. Of 6 cases reported to date 5 had advanced disease with metastases to lung, liver or brain at the time of diagnosis of cutaneous metastases. CASE REPORT A 30-year-old man with a testicular tumor containing components of embryonic carcinoma and seminoma had metastases to the lung and mediastinum at the time of diagnosis. He was initially treated with 4 cycles of chemotherapy, consisting of bleomycin, etoposide and cisplatin, with complete response. At 6-month followup computerized tomography (CT) revealed progression of a mediastinal lymph node. The patient underwent thoracotomy with resection of lymph nodes, which were histologically classified as embryonic carcinoma, and received 3 cycles of cisplatin, etoposide and ifosfamide. CT of the thorax, abdomen and pelvis were negative. Five months later the patient noticed a firm, elevated subcutaneous tumor below the left scapula proximal to the thoracotomy scar. Ultrasonography and CT showed a 17 3 30 mm. tumor (fig. 1). The mass was removed surgically and histological examination revealed embryonic carcinoma elements identical to the primary testicular tumor (fig. 2). No other manifestation was detected. The patient received local radiation therapy. At completion of the radiotherapy another subcutaneous tumor was detected cranially to the previously detected tumor and outside the previous surgical and irradiated site. Histological examination confirmed embryonic carcinoma components. At the time of detection and removal of the second subcutaneous metastasis CT of the thorax showed multiple lung metastases with 4 lesions in the right lung and 1 in the left lung. The patient had normal serum levels of a-fetoprotein, human chorionic gonadotropin and lactate dehydrogenase. He was treated with paclitaxel, bleomycin, etoposide and cisplatin. Brain metastases were diagnosed and treated with palliative radiotherapy. The patient died 15 months after the initial diagnosis of a metastatic skin lesion. DISCUSSION