Synchronous Bilateral Testicular Tumors with Different Histology: Case Report and Review of Literature

Abstract

Abstract Introduction/Objective Germ cell tumor (GCT) is the most common cancer among males in the 20–39 year-old age range, representing 21% of invasive cancer diagnoses. Majority of bilateral testicular tumors are metachronous. The synchronous tumors comprise approximately 0.5%-1% of all cases. Most of the synchronous tumors share the same histologic pattern, predominantly seminoma. The synchronous bilateral testicular GCTs (SBTGCTs) with discordant subtypes are extremely rare. Methods/Case Report A 26-year-old male presented with left testicular pain, the ultrasound revealed bilateral testicular masses with calcifications and microlithiasis in the right side. His serum markers showed elevated alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG). Lactate dehydrogenase (LDH) was normal. He underwent bilateral orchiectomy. The pathology report showed a non-seminomatous mixed germ cell tumor, 2.0 cm in greatest dimension, predominantly embryonal carcinoma (90%), with a minor yolk sac tumor component (10%), lymphovascular invasion, Germ-cell neoplasia in situ (GCNIS) and calcifications in the left testicle, and a seminoma, 0.3 cm in greatest dimension with GCNIS and calcifications in the right testicle. The pathologic staging was pT2pNX for the left testicle and pT1pNX for the right testicle. Computed tomography (CT) revealed two mildly enlarged left sided para-aortic retroperitoneal lymph nodes. Radical pelvic lymph node dissection was performed. The pathology report showed four para-aortic lymph nodes positive for metastatic carcinoma. Tumor was positive for CD30 in the embryonal component, positive for Glypican-3 in the yolk sac tumor component, and seminoma was positive for PLAP. The final staging was IIB for the left testicle and IA for the right testicle. He underwent 4 cycles of Etoposide and Cisplatin chemotherapy (EP). He is in complete remission after 10 months of his diagnosis. Results (if a Case Study enter NA) NA. Conclusion The SBTGCTs with discordant subtypes represent a rare entity with no standard therapy. Our patient was treated with 4 cycles of chemotherapy and achieved complete remission.