Spontaneous Regression As A 'burned-out' Non-seminomatous Testicular Germ Cell Tumor: A Case Report And Literature Review
Dorantes-Heredia, R., Motola-Kuba, D., Murphy-Sanchez, C., Izquierdo-Tolosa, C. D., & Ruiz-Morales, J. M. (2019). Spontaneous regression as a 'burned-out' non-seminomatous testicular germ cell tumor: a case report and literature review. Journal of surgical case reports, 2019(1), rjy358. https://doi.org/10.1093/jscr/rjy358
View Original Source →Abstract
Testicular germ cell tumors (TGCTs) are the most frequent type of cancer in young adults. An exceptional event is the spontaneous regression (SR) of the primary tumor. Herein, we describe a burned-out non-seminomatous TGCT case and relevant literature review. A 34-year-old male presenting with low back pain was found to have a retroperitoneal mass upon urotomography. During workup, a heterogeneous testicular mass was evident, and its biopsy showed findings that support the diagnosis of spontaneous tumoral regression. The patient underwent unilateral orchiectomy and a chemotherapy protocol was later initiated, with 85% regression of the retroperitoneal metastatic mass. No progression of the primary tumor has been found. The etiology of SR across different cancer types appears to be associated with the host's immune response and an angiogenic disturbance of the tumor microenvironment. The burned-out phenomenon is a rare event that needs further research into its molecular sequencing.
Case Details
Disease Location
Testicles
Personal Characteristics
34-year-old male. History of chemonucleolysis of l5–s1 due to a discopathy, and radicular compression of the nerve and left renal enlargement
Clinical Characteristics
Presented to the emergency room with moderate to severe low back pain that limited ambulation, and was partially controlled with the administration of non-steroidal anti-inflammatory drugs. During the workup, an urotomography scan was performed, which confirmed multiple retroperitoneal masses in the left paraaortic region measuring 10 × 8 × 6 cm. There were satellite lymph nodes around the retroperitoneal mass and the left psoas, causing lateral displacement of the left kidney, compressing the pyelocaliceal system, conditioning hydronephrosis. Testicular sonogram showed the left testicular heterogeneous parenchyma, with high vascularity and irregular borders, with a size of 28 × 23 × 14mm3 and a volume of 4.9cm3. These findings were suggestive of a primary testicular germ cell tumors (tgct). Laboratory studies revealed an elevated serum alpha fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase. The patient underwent left radical orchiectomy. Pathology results showed subtotal atrophy of the testis with extensive fibrosis, multifocal calcifications, focal hemorrhage and leydig’s cell hyperplasia.
Remission Characteristics
There was no evidence of germ cell tumor