Vasiliadis Konstantinos, Simou Chrysanthi, Tzotzou Anastasios, Kalinderis Nikolaos, Valoukas Dimitrios, Pazarli Elsa, Drakontaidis Paulos, Papavasiliou Christos
Surgical Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, Greece.
2Nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Surg Case Rep. 2023 Feb 6;9(1):18. doi: 10.1186/s40792-023-01593-z.
Spontaneous rapture of a germ cell tumor (GCT) metastases causing massive hemoretroperitoneum in a patient without choriocarcinoma component who has not received previous systemic chemotherapy is an exceedingly rare event. In such a devastating case scenario, a high index of clinical suspicion for early diagnosis and appropriate management is crucial.
We report on a 25-year-old male patient with a 4-month history of orchiectomy for testicular GCT (tGCT), who presented in the emergency department with acute abdomen and hemodynamic instability. Urgent computed tomography scan depicted a retroperitoneal mass measuring approximately 13 × 11.4 × 15 cm and massive intraperitoneal hemorrhage. Hemoperitoneum caused by spontaneous rapture of the metastatic retroperitoneal mass was suspected. COVID-19 pandemic-related deviation from the oncologic surveillance standards combined with COVID-19-related patient's emotional distress and self-neglect had led to loss of opportunity for appropriate adjuvant chemotherapy, obviously leading to the development of this devastating complication. An emergency, surgical exploration was decided. The bleeding mass was adequately exposed following a Cattell-Braasch maneuver and active bleeding was controlled by a challenging resection of approximately 80% of the lymph node mass volume. Pathological evaluation of the specimen revealed teratoma with low volume of yolk sac tumor component and extensive necrosis, findings compatible with the patient's history. Postoperative recovery was uneventful, followed by early start of adjuvant chemotherapy. Two years after the operation the patient is doing well with no evidence of recurrent disease.
Massive hemoperitoneum is a devastating event that exceedingly rarely can complicate the clinical course of patients with advanced tGCT. Emergency surgical intervention is usually necessary however, sound judgement and careful surgical techniques are required for a positive and uneventful outcome. During COVID-19 pandemic, first-line medical personnel push their limits further not only to ensure health care services standards but also, to manage unpredictable, life-threatening cancer-related complications, associated with COVID-19-related deviation from appropriate oncologic surveillance and care.
在未接受过全身化疗且无绒毛膜癌成分的患者中，生殖细胞肿瘤（GCT）转移灶自发破裂导致大量腹腔积血是极为罕见的事件。在这种严重的病例中，高度的临床怀疑对于早期诊断和恰当处理至关重要。
我们报告一名25岁男性患者，因睾丸生殖细胞肿瘤（tGCT）接受睾丸切除术已有4个月，现因急腹症和血流动力学不稳定就诊于急诊科。紧急计算机断层扫描显示一个约13×11.4×15厘米的腹膜后肿块以及大量腹腔内出血。怀疑是腹膜后转移肿块自发破裂导致腹腔积血。与COVID-19大流行相关的肿瘤监测标准偏差，再加上与COVID-19相关的患者情绪困扰和自我忽视，导致失去了进行适当辅助化疗的机会，显然导致了这种严重并发症的发生。决定进行紧急手术探查。经卡特-布劳施手术充分暴露出血肿块，通过极具挑战性的约80%淋巴结肿块体积切除控制了活动性出血。标本的病理评估显示为畸胎瘤，伴有少量卵黄囊瘤成分和广泛坏死，这些发现与患者病史相符。术后恢复顺利，随后尽早开始辅助化疗。术后两年患者情况良好，无疾病复发迹象。
大量腹腔积血是一种严重事件，极少会使晚期tGCT患者的临床病程复杂化。紧急手术干预通常是必要的，然而，为了获得良好且顺利的结果，需要合理的判断和精细的手术技巧。在COVID-19大流行期间，一线医务人员不仅要进一步突破自身极限以确保医疗服务标准，还要应对与COVID-19相关的偏离适当肿瘤监测和护理导致的不可预测的、危及生命的癌症相关并发症。
