Seminoma Presenting Research Articles

Upper gastrointestinal bleed as the initial presentation of seminoma involving the duodenum in an elderly patient with 9year follow up: A case report and literature review.

Germ cell tumors are the most common malignancies in males between 20 and 40 years. However, primary extragonadal germ cell tumors are rare and account for 2%-5% of all germ cell neoplasms in adults. Extragonadal germ cell tumors are characterized by their midline locations including pineal and suprasellar regions, mediastinum, retroperitoneum and sacrococcyx. These tumors have also been reported in rare locations such as prostate, bladder, vagina, liver and scalp. Extragonadal germ cell tumors can be primary but may also represent metastases from primary gonadal germ cell tumors. In this report we describe a case of a duodenal seminoma in a 66-year-old male with no history of testicular tumors, who presented with upper gastrointestinal bleed as the initial manifestation. He was effectively treated with chemotherapy and continues to progress well clinically, with no episodes of recurrence.

Thoracic spinal cord compression & aortic thrombosis; an unusual presentation of seminoma

Thoracic spinal cord compression & aortic thrombosis; an unusual presentation of seminoma

S2896 A Rare Case of Necrotic Testicular Seminoma Presenting as a Large Retroperitoneal Mass Diagnosed With EUS and Laparotomy

Introduction: Retroperitoneal seminomas are a rare form of cancer that accounts for approximately 2% of all seminomas. Seminomas commonly present with fever, weight loss, abdominal or back pain, and a painless testicular nodule. The differential diagnosis for a retroperitoneal mass is broad, including abscess, lymphoma, sarcoma, metastatic lymph nodes, and extragonadal tumors. The pathogenesis of germ cell tumors is unclear, but the failure of primordial germ cell migration during embryonal development has been suggested. We report an atypical case of a large necrotic retroperitoneal mass diagnosed as a primary retroperitoneal seminoma after EUS and laparotomy. Case Description/Methods: A 33-year-old male with no medical history presented to the ED for new-onset flank pain and night sweats. On admission, the patient was febrile and tachycardic. The testicular exam and US of the testes were normal. CT abdomen and pelvis revealed a well-circumscribed, round mass posterior to the pancreatic head. EUS with FNA was performed, noting a round heterogenous 7.1cm x 6.2cm mass with well-defined borders and a necrotic center located posterior to the pancreatic head. An intact interface was seen between the mass and the duodenum, IVC, pancreas, and right kidney, suggesting a lack of invasion. The FNA yielded 0.5ml of blood-tinged, thick, and purulent fluid with cytology significant for malignant tumors with extensive necrosis. An exploratory laparotomy with excisional biopsy established the diagnosis of extragonadal germ cell tumor with extensive necrosis, consistent with seminoma. The patient completed four cycles of Etoposide followed by a right-sided orchiectomy for residual lesions found on the right testicle. A post-surgical PET scan did not demonstrate recurrence. Discussion: Primary retroperitoneal seminoma is a rare entity that must be considered when evaluating a retroperitoneal mass. GCTs are the most common neoplasm arising from the testes, with < 2% originating in other locations, termed primary extragonadal GCTs. Studies suggest the remission rate with chemotherapy and resection of residual masses was 92%, and the five-year overall survival rate was 88% for primary retroperitoneal tumors. Early identification of primary retroperitoneal seminomas may expand therapeutic possibilities and help improve outcomes for patients with a favorable prognosis. EUS-FNA was attempted in this case to obtain the diagnosis; however, an excisional biopsy was required to confirm the diagnosis.

CHARACTERISTIC CHEMOTHERAPY RESPONSE OF TESTICULAR CANCER PATIENTS IN TERTIARY HOSPITAL

Objective: The purpose of this study was to determine the correlation of testicular tumor markers on the success of chemotherapy in my institution. Material &amp; Methods: This research is a retrospective study single center using the medical record database at the span of the research period. The patient with testicular carcinoma who underwent complete chemotherapy between 2017 until 2022 was included. The data collected and analyzed by descriptive data and analytical correlation using SPSS Ver. 25. The comparation test using T-test and Anova. Results: A total of 31 testicular cancer patients were enrolled in the study. Fifteen patients were seminoma and 16 patients were non-seminoma. The mean age of patient at presentation of seminoma and non seminoma were 38.3 ± 17.03 and 30.74 ± 13.01. Most patients presented a karnofsky score about 79 ± 15. There was a negative correlation (r=-0.492) with a significant correlation between the types of testicular carcinoma cases and the response to chemotherapy (p=0.027). There was a significant difference in cases of seminoma and non-seminoma to the success of the chemotherapy response (p=0.024). There was a positive correlation between serum β-HCG, AFP, LDH with serial chemotherapy result with a no significant correlation (p=0.879; p=0.242; and p=0.277). Conclusion: Most types of the testicular carcinoma responses to chemotherapy. Patients with seminoma pathology have better response to chemotherapy compared to non-seminoma.

Anaplastic testicular seminoma presenting as a hydrocele, in a 36-year-old patient with a family history of anaplastic seminoma.

Testicular cancer is the solid tumor with the greatest incidence in men between 15 and 44 years old. Its main histological type is germ cell tumor, that is divided into seminomatous and non-seminomatous tumors. Seminoma, consisting 55% of testicular cancer, manifests in the fourth decade of men's life and a rare type of it is the anaplastic seminoma (5% to 15% of testicular seminoma). Diagnosis is based on clinical examination, testicular ultrasound, magnetic resonance imaging, tumor markers measurement and pathological examination, while treatment of choice is radical orchiectomy, with or without retroperitoneal lymphadenectomy, potentially followed by radiotherapy or chemotherapy. We present the case of a 36-year-old male patient, whose father suffered from anaplastic seminoma and visited the hospital due to a painless hydrocele. The testicle was swollen and hard on palpation, while cytological examination of the drained fluid detected neoplasm, potentially seminoma. Tumor markers measurement, as well as abdominal and pelvic computerized tomography scans, were evaluated and the patient was staged as IIA, according to the American Joint Commission on Cancer. Radical orchiectomy with high ligation of the seminal vesicle was performed and the pathological examination showed anaplastic testicular seminoma. Postoperatively, four cycles of chemotherapy with bleomycin, etoposide and platinum (BEP) were performed and no signs of recurrence were present after 1 year. In conclusion, anaplastic seminoma has a good prognosis and is suggested to be treated with radical orchiectomy, with or without retroperitoneal lymphadenectomy, potentially followed by radiotherapy or chemotherapy.

Contemporary Trends in Presentation and Management of Spermatocytic Seminoma

To characterize the presentation and management of spermatocytic seminoma (SS) compared to classic seminoma in adults utilizing a large cancer registry. Patients >18 years of age in the National Cancer Database from 2006 to 2016 who underwent orchiectomy for testicular tumors were identified. Demographics, oncologic characteristics, and treatment patterns were compared between patients with SS and classic seminoma. Of 53,481 adults receiving orchiectomy, 29,208 were diagnosed with classic seminoma and 299 (1%) with SS. Compared to patients with classic seminoma, SS patients were older (57 vs 39 years) and more likely to be African-American (odds ratio (OR) 1.8) and insured by Medicare (OR 2.0; all P <.05). SS patients had larger tumors on presentation (3-6 cm: OR 1.8; >6 cm: OR 1.8), but were less likely to have ≥pT2 stage (OR 0.5), regional nodal involvement (Clinical Stage II: OR 0.3), or distant metastatic disease (Clinical Stage III: OR 0.1; all P <.01). For postorchiectomy management, 73.6% of SS patients underwent surveillance while 24.5% had active treatment (retroperitoneal lymph node dissection, chemotherapy, radiation, or a combination). When stratified by year, there was an increasing trend toward surveillance compared to active treatment. SS is a rare germ cell tumor that typically presents as a larger tumor in older patients. Although these tumors are less likely to be characterized by advanced disease compared to classic seminoma, many patients have undergone aggressive postorchiectomy treatment in the past. Importantly, treatment trends have shifted toward surveillance in recent years with adjuvant therapy limited primarily to higher stage tumors.

Acute Presentation of Metastatic Testicular Seminoma as Chronic Subdural Hematoma with Extra-axial Brain Lesion with Severe Mass Effect: A Case Report and Brief Review of Literature

We present an unusual case of a 33-year-old male, who has been diagnosed with seminoma testes with retroperitoneal lymph nodes involvement 1 year back, the patient had undergone four cycles of the chemotherapy and had undergone left orchidectomy for the same. Past 1 year was uneventful and the patient was living a normal healthy life, with no evidence of any diseases and no symptoms. For the last 1 month, the patient complained of headache with no other symptoms, and on 1 day, the patient had sudden loss of consciousness. Noncontrast computed tomography (CT) head was done, which revealed a large chronic subdural collection with an extra-axial mass attached with the dura on the right parasagittal region. The patient at the time of presentation had a Glasgow Coma Scale of 5/15 with irregular respiration, and the right pupil was fixed nonreacting to the light. Urgent surgery was done, and the patient recovered fully with no deficit and was discharged. The patient will be considered for chemotherapy.

Atypical Presentation of Seminoma in the Prostate – Case Report

Atypical Presentation of Seminoma in the Prostate – Case Report

Ambiguous presentation of an intra-abdominal testicular seminoma in a 40-year-old man: a case report

BackgroundCryptorchidism is the most common congenital malformation of the male genitourinary tract. The cryptorchid testis is most often located in the inguinal canal; however, intra-abdominal locations are not rare. The risk of malignancy in an undescended testis is 10% with the highest risk in an intra-abdominal testis.Case presentationHere we describe a case of a 40-year-old fertile man of Fulbe origin who presented with a non-tender lower abdominal mass of 2 months’ duration. A scrotal examination revealed just one testis in the right scrotum, with the contralateral scrotum and inguinal canal being empty. An exploratory laparotomy followed by tumor excision and histopathology revealed a testicular seminoma.ConclusionThis case report highlights the need for routine scrotal examination in all men presenting with an abdominal mass so as to rule out the possibility of an intra-abdominal seminoma.

Bilateral Torsion of Intra-abdominal Seminoma Presenting with Acute Abdomen and Intra-peritoneal Bleeding: A Case Report

Bilateral Torsion of Intra-abdominal Seminoma Presenting with Acute Abdomen and Intra-peritoneal Bleeding: A Case Report

Synchronous Hodgkin's lymphoma and seminoma: a rare coexistence and an important lesson

Key Clinical MessageSynchronous presentation of seminoma and lymphoma is rare but has important ramifications for the treatment of both malignancies. Without clinical vigilance, this situation may be easily missed, leading to inappropriate management. We describe a patient with synchronous seminoma and Hodgkin's lymphoma and discuss the implication on his treatment.

Mediastinal seminoma presenting with superior vena cava syndrome

We present a rare cause of superior vena cava syndrome (SVC) in a previously healthy male aged 31 years. Malignancy was suspected due to unintentional weight loss and childhood exposure...

Abstract #742: Testicular Seminoma Presenting as Acute Unilateral Gynecomastia

Abstract #742: Testicular Seminoma Presenting as Acute Unilateral Gynecomastia

Synchronous Hodgkin's Lymphoma and Seminoma, a Rare Co-Existence and an Important Lesson

Introduction:Second malignancies, including lymphoma, occur at a higher incidence in men previously treated for germ cell tumors than in the general population (1). Synchronous presentation of seminoma and lymphoma is rare but has important ramifications for the treatment of both malignancies. Without clinical vigilance this situation may be easily missed, leading to inappropriate management of each cancer. We describe a patient found to have synchronous seminoma and Hodgkin Lymphoma and discuss the effects of the dual diagnoses on his evaluation and care.Case presentation:A 59 year old male with no significant medical history presented with progressive swelling and erythema of the right testis. Testicular cancer was suspected and he underwent a radical right inguinal orchiectomy. Pathology revealed a 5.7cm seminoma of the testis with lymphovascular invasion and without spermatic cord involvement (pT2) (Fig. 1). His tumor markers including AFP, LDH, and Beta-HCG were normal (S0). A CT scan of the chest, abdomen and pelvis followed by a PET/CT revealed enlarged, hypermetabolic mediastinal, hilar and periportal lymphadenopathy interpreted by the radiologist as concerning for metastatic disease. Given the atypical distribution for lymphadenopathy from testicular seminoma, an excisional biopsy of a left hilar node was performed and revealed Classical Hodgkin Lymphoma with IHC positive for CD15, CD30 and PAX-5 (Fig 2). He denied any B-symptoms and his bone marrow was uninvolved by lymphoma (stage IIIA). Adjuvant therapy for his germ cell tumor, otherwise an important consideration, was deferred and he began chemotherapy with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) for 6 cycles. Interim PET/CT after 2 cycles of ABVD showed a complete response. He has completed 6 cycles of ABVD and chose observation as opposed to single dose of adjuvant carboplatin for his seminoma and is currently under surveillance for both malignancies.Discussion:The unusual coexistence of Hodgkin Lymphoma and seminoma has rarely been documented in medical literature, with three other cases previously reported (2, 3). In each case a biopsy of lymphadenopathy, primarily outside the retroperitoneum, yielded a diagnosis of lymphoma. Both Hodgkin Lymphoma and germ cell tumors commonly involve lymph nodes and present in young men. Lymphadenopathy may understandably be assumed to represent metastatic disease in a young man with known testicular cancer. Clinical vigilance is necessary to question the nature of atypical sites of lymphadenopathy in such a patient, and to pursue the possibility of an alternate diagnosis with a lymph node biopsy. A missed diagnosis of lymphoma in such a patient would also mean harmful over-staging of the germ cell tumor. While these two cancers represent two of the most curable malignancies, their treatment is different and would be grossly wrong if each cancer is not correctly diagnosed and staged.Conclusion:Our report highlights the importance of clinical suspicion of a lymphoma in patients with another cancer and lymphadenopathy not typical of metastatic disease for that tumor type. In such situations a lymph node biopsy is crucial in order to proceed with the correct therapy of each malignancy. While the simultaneous presentation of Hodgkin Lymphoma and seminoma is rare, cases like ours highlight the importance of questioning metastatic disease when lymphoma seems to be a possibility.

V11-08 LAPAROSCOPIC ADRENAL METASTATECTOMY IN TESTICULAR SEMINOMA: FIRST CASE IN AMERICA

You have accessJournal of UrologyAdrenal/Single Port Surgery/LESS/NOTES1 Apr 2016V11-08 LAPAROSCOPIC ADRENAL METASTATECTOMY IN TESTICULAR SEMINOMA: FIRST CASE IN AMERICA Marino Cabrera Fierro, Claudia Lucia Ochoa, Rodolfo Varela, Jorge Alfredo Forero, German Fabian Godoy, and Maria Cristina Maldonado Marino Cabrera FierroMarino Cabrera Fierro More articles by this author , Claudia Lucia OchoaClaudia Lucia Ochoa More articles by this author , Rodolfo VarelaRodolfo Varela More articles by this author , Jorge Alfredo ForeroJorge Alfredo Forero More articles by this author , German Fabian GodoyGerman Fabian Godoy More articles by this author , and Maria Cristina MaldonadoMaria Cristina Maldonado More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1825AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testicular germ cell tumours are the most common neoplasias presenting in young men; most of which are seminomas. The most common sites of metastasis in seminoma are the retroperitoneum, lung, liver, bones, bowel and central nervous system. Furthermore, there are unusual sites of metastases reported in the literature such as prostate, skin and adrenal gland. We describe the first case report of a metastatic adrenal seminoma treated with salvage laparoscopic adrenal metastatectomy METHODS To our knowledge there are no case reports in America of Adrenal metastasis in testicular seminoma. We performed a systematic search in PubMed and a critical analysis of the literature RESULTS 26 year-old man with a pT1N0M0S0 right testicular seminoma. He underwent right radical orchidectomy and adjuvant external para-aortic radiation therapy. Three years later he presents mediastinal metastasis treated with PEB (bleomycin, etoposide and CDDP). Relapses with mediastinal, tracheal and lung metastasis; initiating treatment with TIP (paclitaxel, ifosfamide and CDDP), but could only receive 3 cycles due to febrile neutropenia. Salvage mediastinal radiotherapy was done. He persist with lung lessions and a new onset right adrenal mass was found; he received one cycle of gemcitabine and paclitaxel with partial response to treatment. A PET/CT scan was performed in where the adrenal size increase, hence we offered salvage surgical therapy with a laparoscopic adrenal metastatectomy using a transperitoneal approach. There were no intraoperative or postoperative complications. The pathology report confirmed the presence of metastatic seminoma with negative margins. After 12 months of followup no recurrence has been found. CONCLUSIONS Adrenal metastasis are an atypical presentation of seminoma. PET/CT scan focuses therapy in patients presenting with residual masses to assess their viability. The laparoscopic approach for metastatic adrenal lesions is a feasible and safe procedure; Offering an optimal oncologic results and an adequate vascular control and resection margins. This procedure Should be done by experienced surgeons. ? © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1005 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marino Cabrera Fierro More articles by this author Claudia Lucia Ochoa More articles by this author Rodolfo Varela More articles by this author Jorge Alfredo Forero More articles by this author German Fabian Godoy More articles by this author Maria Cristina Maldonado More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impalpable Testicular Seminoma Identified on Sonoelastography

The role of sonoelastography in diagnosing cancerous masses has increased since the advent of elastography as an ultrasound modality. Its ability to display differences in the mechanical properties of cancerous masses compared to normal surrounding tissue has shown benefit in increasing the accuracy of diagnosing malignant breast and thyroid masses and has shown early potential in accomplishing better targeted prostate biopsies. To date, the literature is limited in the number of studies describing the use of sonoelastography for testicular masses. We describe a 34-year-old man who presented with an incidental finding of an impalpable hypoechoic testicular mass on grayscale ultrasound during an infertility work-up. Sonoelastography was performed displaying intermediate testicular elastic properties. Upon frozen section of the mass during surgical exploration, classic testicular seminoma was diagnosed and subsequent radical orchiectomy was performed. We would like to use this atypical presentation of testicular seminoma to review the potential role of elastography for diagnosing testicular cancer.

Intestinal metastases as an unusual presentation of a burned-out testicular seminoma: PET/CT imaging

Intestinal metastases as an unusual presentation of a burned-out testicular seminoma: PET/CT imaging

Seminoma presenting as renal mass, inferior vena caval thrombus, and regressed testicular mass.

Testicular cancer is the most common malignancy of men aged 15–40. Metastatic spread classically begins with involvement of the retroperitoneal lymph nodes, with metastases to the liver, lung, bone, and brain representing advancing disease. Treatment is based on pathologic analysis of the excised testicle and presence of elevated tumor markers. We report a case of a 34-year-old male presenting with back pain who was found to have a right renal mass with tumor extension into the inferior vena cava. Subsequent biopsy was consistent with seminoma. We review this rare case and discuss the literature regarding its diagnosis and management.

Torsion of a Giant Intra-abdominal Testicular Seminoma Presenting as Acute Abdomen.

Intra-abdominal neoplastic testicular torsion is a very rare clinical condition, which is normally not considered during differential diagnosis of acute abdomen. In any male patient with acute abdominal symptoms and absence of scrotal testis, a high index of suspicion for intra-abdominal testicular torsion should be maintained. An increased diagnostic yield is dependent on an expedient and comprehensive preoperative evaluation. An illustrated case report is presented.

Clinically apparent and occult metastasized seminoma: almost indistinguishable on the transcriptional level.

PurposeThe aim of the present study was to examine the biological differences between seminomas with occult and clinically apparent metastases at the time of diagnosis of the primary tumor to gain insight into the biology of these tumors and facilitate the identification of novel predictors of seminoma metastasis.Materials and MethodsTotal RNA including small RNAs was isolated from testicular tumors of patients with pure seminoma presenting with lymphogenic metastasis (n = 5, clinical stage IIb/c) and occult metastasis (n = 5, clinical stage I). The regulation of biological processes was examined (1) throughout the mRNA transcriptome (whole genome microarrays, 8×60 K Array, Agilent with 4 samples/group) and (2) the miRNA transcriptome employing small RNA next generation sequencing (SOLID, Life Technologies with 5 samples/group). Protein coding genes (mRNAs) and small RNAs showing a significant (≥2-fold) difference between the groups were identified. Finally (3), we examined 95 candidate miRNAs in 36 apparent metastasized and another 5 occult metastasized seminoma using logistic regression analysis.ResultsAmong 19,596 genes, on average 12,894 mRNAs appeared expressed (65.8%, SD+/−2.4; range, 62.0–69.3%) and 16.99×106/13.94×106 small RNA reads were identified for apparent/occult metastasized seminoma. These reads on average convert into 9,901/9,675 small RNAs including 422/404 mature microRNAs. None of these mRNAs/small RNAs met our selection criteria for candidate genes. From 95 candidate miRNAs 44 appeared expressed, with 3 of them showing weak but significant (p = 0.05) differences among both groups.ConclusionsOccult and apparent metastasized seminomas are biologically almost indistinguishable and probably represent no separate tumor entities. These findings may simplify future research on seminoma metastasis.