Shahrokh Soroush, Shahin Mohadese, Abolhasani Maryam, Arefpour Amir Mohammad
Graduate Medical Education, HCA Houston Healthcare Kingwood/University of Houston School of Medicine, Kingwood, USA.
Department of Radiation Oncology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, IRN.
Cureus. 2022 Jan 25;14(1):e21603. doi: 10.7759/cureus.21603. eCollection 2022 Jan.
Spontaneous primary tumor regression, or burned-out tumors, refers to the presence of a metastatic tumor with the histological regression of the primary lesion. The burned-out phenomenon has been reported in various malignancies, with testicular germ cell tumors (GCTs) accounting for a significant share of these cases. However, burned-out testicular tumors are a rare clinical phenomenon and are generally difficult to diagnose, as there is no evidence of primary testicular cancer. Here, we describe the case of a 42-year-old male who presented to our hospital complaining of right abdomen and groin pain for several months. On physical exam, the patient had normal genital and rectal exams. An abdominal-pelvic computed tomography (CT) scan of his abdomen and pelvis revealed a large retroperitoneal mass with radiographic characteristics of a sarcoma. Given his groin pain, the patient had a testicular ultrasound, which revealed scar tissue in the right testicle. His testicular tumor markers showed elevated β-human chorionic gonadotropin (β-hCG) and lactate dehydrogenase (LDH) but normal α-fetoprotein (AFP). He underwent right radical inguinal orchiectomy, with pathologic examination of the testicle revealing a burned-out testicular tumor. The patient was then treated with four cycles of bleomycin, etoposide, and cisplatin (BEP). His post-treatment tumor markers were normalized; however, his abdomen-pelvic CT scan showed a persistent mass. The patient underwent retroperitoneal lymph node dissection (RPLND) with the removal of 12 lymph nodes. However, pathologic evaluation of the lymph nodes revealed no evidence of neoplastic cells. The patient has remained disease-free after five years of follow-up. This report highlights the potential of burned-out testicular tumors in young and middle-aged men presenting with a retroperitoneal mass. Furthermore, it underscores the importance of obtaining testicular ultrasound in these patients to rule out regressed testicular tumors.
自发性原发性肿瘤消退，即肿瘤自行消退，是指存在转移性肿瘤而原发性病灶出现组织学消退的情况。肿瘤自行消退现象在各种恶性肿瘤中均有报道，其中睾丸生殖细胞肿瘤（GCT）在这些病例中占相当大的比例。然而，睾丸肿瘤自行消退是一种罕见的临床现象，通常难以诊断，因为没有原发性睾丸癌的证据。在此，我们描述一例42岁男性患者，他因右腹部和腹股沟疼痛数月前来我院就诊。体格检查时，患者生殖器和直肠检查正常。对其腹部和盆腔进行的腹部盆腔计算机断层扫描（CT）显示，腹膜后有一个大肿块，具有肉瘤的影像学特征。鉴于其腹股沟疼痛，患者接受了睾丸超声检查，结果显示右侧睾丸有瘢痕组织。他的睾丸肿瘤标志物显示β-人绒毛膜促性腺激素（β-hCG）和乳酸脱氢酶（LDH）升高，但甲胎蛋白（AFP）正常。他接受了右侧根治性腹股沟睾丸切除术，对睾丸进行病理检查发现是一个自行消退的睾丸肿瘤。随后，患者接受了四个周期的博来霉素、依托泊苷和顺铂（BEP）治疗。治疗后他的肿瘤标志物恢复正常；然而，他的腹部盆腔CT扫描显示肿块仍然存在。患者接受了腹膜后淋巴结清扫术（RPLND），切除了12个淋巴结。然而，对淋巴结的病理评估未发现肿瘤细胞的证据。经过五年的随访，患者一直无病生存。本报告强调了在出现腹膜后肿块的中青年男性中，睾丸肿瘤自行消退的可能性。此外，它还强调了对这些患者进行睾丸超声检查以排除消退性睾丸肿瘤的重要性。
