Muhanna Adel, Nimri Faisal, Almomani Zaid A, Al Momani Laith, Likhitsup Alisa, Hamid Fadi
Internal Medicine, University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, USA.
Internal Medicine, Henry Ford Health System, Detroit, USA.
Cureus. 2021 Sep 14;13(9):e17962. doi: 10.7759/cureus.17962. eCollection 2021 Sep.
Testicular germ cell tumors account for 95% of testicular cancers in men with approximately 71,000 patients being diagnosed with testicular cancer every year. The overall survival of testicular germ cell tumors is approximately 95%. However, the prognosis becomes less favorable when distant metastasis is present. Gastrointestinal (GI) tract metastasis occurs in less than 5% of patients with non-seminomatous tumors, and in less than 1% in patients with pure seminomas. GI metastasis usually involves the colon, esophagus, and stomach with the most common symptoms of GI metastasis being diarrhea, nausea, vomiting, and obstruction. We discuss the case of a 42-year-old male patient with GI manifestations as the first presentation of testicular seminoma with metastasis to the small bowel. Computed tomography of the abdomen and pelvis revealed a small bowel mass, and the diagnosis was confirmed with histopathologic examination of endoscopic biopsy samples. The patient subsequently underwent chemotherapy treatment with close surveillance. Clinicians should maintain a high index of suspicion in the differential diagnosis of abdominal pain in young male patients, especially when associated with symptoms like unexplained weight loss, constitutional symptoms, and testicular pain or swelling. Metastasis to the GI tract from the testis should be promptly diagnosed and managed, as the overall survival rates can significantly decrease with the delay of diagnosis.
睾丸生殖细胞肿瘤占男性睾丸癌的95%，每年约有71000例患者被诊断为睾丸癌。睾丸生殖细胞肿瘤的总体生存率约为95%。然而，当出现远处转移时，预后就不那么乐观了。胃肠道转移在非精原细胞瘤患者中发生率不到5%，在纯精原细胞瘤患者中不到1%。胃肠道转移通常累及结肠、食管和胃，胃肠道转移最常见的症状是腹泻、恶心、呕吐和梗阻。我们讨论了一例42岁男性患者，以胃肠道表现为睾丸精原细胞瘤伴小肠转移的首发症状。腹部和盆腔计算机断层扫描显示小肠肿块，经内镜活检样本的组织病理学检查确诊。患者随后接受化疗并密切监测。临床医生在对年轻男性患者腹痛进行鉴别诊断时应保持高度怀疑，尤其是当伴有不明原因体重减轻、全身症状以及睾丸疼痛或肿胀等症状时。睾丸转移至胃肠道应及时诊断和处理，因为诊断延迟会使总体生存率显著降低。
