Abd-El-Hafez Mahmoud, Johnson Kylie, Cates Joe, Madala Alosh
Menorah Medical Center, Overland Park, KS.
HCA Healthc J Med. 2024 Dec 1;5(6):707-711. doi: 10.36518/2689-0216.1685. eCollection 2024.
Testicular seminoma is the most common malignant tumor of the testis. It occurs at a rate of 5 per 100 000 men, primarily between the ages of 15 to 34. While seminomas typically occur in the testis, other primary sites include the mediastinum, the retroperitoneum, or other extra-gonadal sites. Due to the curable nature of the malignancy (5-year survival rate > 95%), detection at early stages of the disease is key. This case presentation explores the delayed diagnosis and treatments of an atypical presentation of disseminated seminoma.
We present the unusual case of a 56-year-old male who had abdominal pain secondary to a 3.6 × 3.3 × 3.8 cm aortocaval mass. After 3 unsuccessful endoscopic/percutaneous biopsies, the patient consented to an open surgical biopsy that revealed disseminated seminoma abutting the inferior vena cava. The patient subsequently underwent a right radical/inguinal orchiectomy and started on 3 cycles of bleomycin, etoposide, and cisplatin. A positron emission tomography/computed tomography (PET/CT) scan at a 6-month follow-up appointment after treatment showed near complete resolution of the initial aortocaval mass and the interval improvement of accompanying lymphadenopathy. Previously elevated β-human chorionic gonadotropin and lactate dehydrogenase tumor markers are within normal limits to date.
Retroperitoneal masses range from primary neoplasms to solid organ neoplasms to metastatic disease. The challenge with these masses is accurate and prompt diagnosis. Treatment varies for each retroperitoneal mass. A painless lump in the testicle is the most common sign of testicular cancer. Symptoms related to the site of the metastases (ie, back/flank pain) can sometimes occur, making early diagnosis exceedingly challenging. Radical orchiectomy is the mainstay of treatment for seminomatous testicular tumors. Management following surgery is dependent upon staging. Surveillance following treatment requires frequent office visits as well as abdomen/pelvis CT scans and/or serum tumor markers.
睾丸精原细胞瘤是睾丸最常见的恶性肿瘤。其发病率为每10万名男性中有5例，主要发生在15至34岁之间。虽然精原细胞瘤通常发生在睾丸，但其他原发部位包括纵隔、腹膜后或其他性腺外部位。由于这种恶性肿瘤具有可治愈性（5年生存率>95%），因此在疾病早期进行检测至关重要。本病例报告探讨了播散性精原细胞瘤非典型表现的延迟诊断和治疗。
我们介绍了一名56岁男性的罕见病例，该患者因一个3.6×3.3×3.8厘米的主动脉腔静脉肿块而出现腹痛。在3次内镜/经皮活检均未成功后，患者同意进行开放性手术活检，结果显示为毗邻下腔静脉的播散性精原细胞瘤。患者随后接受了右侧根治性/腹股沟睾丸切除术，并开始接受3个周期的博来霉素、依托泊苷和顺铂治疗。治疗后6个月随访时的正电子发射断层扫描/计算机断层扫描（PET/CT）显示，最初的主动脉腔静脉肿块几乎完全消退，伴随的淋巴结病也有改善。之前升高的β-人绒毛膜促性腺激素和乳酸脱氢酶肿瘤标志物目前已恢复到正常范围。
腹膜后肿块范围从原发性肿瘤到实体器官肿瘤再到转移性疾病。这些肿块的挑战在于准确和及时的诊断。每个腹膜后肿块的治疗方法各不相同。睾丸无痛性肿块是睾丸癌最常见的症状。有时会出现与转移部位相关的症状（如背部/侧腹疼痛），这使得早期诊断极具挑战性。根治性睾丸切除术是精原性睾丸肿瘤的主要治疗方法。手术后的管理取决于分期。治疗后的监测需要频繁门诊，以及腹部/盆腔CT扫描和/或血清肿瘤标志物检查。
