Testicular Embry - PDF document

1 Testicular Embry onal Carcinoma Yohanes Putra Mbama 1 , Gede Budhi Setiawan 2 , Tjakra Wibawa Manuaba 2 , 1 General Surgery Resident, Medical Faculty, Udayana University , Denpasar, Indonesia 2 D ivision of Oncology, Department of Surgery , Medical Faculty, Udayan a University - Sanglah Hospital, Denpasar , Indonesia Abstract Embryonal cell carcinoma of testis is a rare case commonl y found in younger males , aged 15 – 35 years old. M ajority of t umours already having metastas ed at the time of diagnosis. Ethiology of t esticular cancer are not well understood, mostly derive d from germinative cells. A 35 - year - old male with left testicular carcinoma were reported. The patient underwent orchidectomy and the patology result was an embryonal cell carcinoma. Four series of TA P regi ment chemotherapy were administered. A left paraaortic node enlargement was identified from abdominal C t - scan 5 months after chemotherapy . R etroperitoneal lymph node dissection (RPLND) were performed and the pathology result show ed a mucinous cyst ad enocarcinoma. Keyword: testicular embryional carcinoma, metastasis 2 INTRODUCTION Testicular cancer is a very rare kind, making up 1%

of all malignancies in male. Although it occurs at any age, two third of testicular cancers occur at 25 – 35 years of age . Survival rate have been changed dramatically due to combination of many factors, including proper diagnostic techniques, increased serum tumor markers, multi - drug chemotherapy regimens , which claimed to decrease the mortality rate from 50% in the 70’s int o less than 5% at the end of 90’s. Seminoma is the most common type of histopathology with the incidence of 30 – 60%, followed by pure embryonal carcinoma 3 – 4% that include 40% of nonseminoma, 5 - 10% teratoma and 1% pure choriocarcinoma. While mixed germ cell tumor may reach 60% of all germinal tumor cell . 1 Study from Dharmais Cancer Hospital in 2002 - 2004 showed similar incidence of such histopathological types, i.e. seminoma (47.5 %), non - seminoma (40 %) and mixed germ cell tumor (12.5%) . 2 A study in two hospitals in Jakarta found 149 new cases of testicular cancer in a 10 - year period . 3 CASE REPORT A 34 - year - old male came to outpatient clinic for regular follow - up after left orchiectomy 6 months earlier. He had an operative history of left orchidectomy 6 months earlier back. Histopathological re port s

howed embryonal carcinoma with a clinical stage of pT3pNxpMx. Four series of TAP chemotherapy regiment was administered. On p hysical examination , he had a single right testes with scar on the left scrotum. B lood investigations were within norm al limits, except a leukocytes of 27,7 x 10 3 /uL . Alp ha - feto - protein levels were 2,0 IU/mL, serum lact ate dehydrogenase (LDH) was 320 U/L (160 – 420) and serum beta human chorioni c gonadotropin (HCG) was 1,2 m IU/mL (5.3 0m IU/mL). Chest radiograph (postero - anterior view) showed no lesions on the lungs or heart. Ultrasonography revealed a solid, lobulated nodule on the left abdominal para - aortic . Computed tomography (CT) of the abdomen revealed a cystous nodule on the left abdominal para - aortic – at the level of left renalis artery, with the size of 6x5x5 cm 3 (lymphenode with fluid density) (Picture no.1). Under the impressi on of metastatic 3 embryional carcinoma , the patient was readmitted and received a left retroperitoneal lymph node dissection (RPLND) (Picture no.2). The pathology report indicated mucinous cyst adeno carcinoma. Picture no.1 . MSCT of the abdomen – axial slice Picture no.2 . Macroscopic image of enlarged lef

t para - aortic lymphnode DISCUSSION Malignant t esticular tumors are rare in men, but in most patients they ar e discovered in early phase. Ninety - five percents of all testicular tumors come from the germinative 4 epithelium . 4 These are the cells that make sperm. The 2 main types of germ cell tumors (GCTs) in men are Seminomas and Non - seminomas, which are made up of embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and/or teratoma. 6 These 2 types occur about equally. Many testicular cancers contain both seminoma and nonseminoma cells. These mixed ge rm cell tumors are treated as non - seminomas because they grow and spread like non - seminomas. 5 Testicular cancer is not common; about 1 of every 263 males will develop testicular cancer at some point during his life. The average age at the time of diagnosis of testicular cancer is about 33. This is largely a disease of young and middle - aged men, but about 7% of cases occur in children and teens, and about 7% occur in men over the age of 55. Because testicular cancer usually can be treated successfully, a man ’s lifetime risk of dying from this cancer is very low: about 1 in 5,000. 5 There have been substantial advances in the treatment of testicul

ar cancer. Fifty years ago, a diagnosis of metastatic testicular cancer meant a 90% chance of death within 1 year. T oday, a cure is expected in 95% of all patients who have received a diagnosis of testicular cancer and in 80% of patients with metastatic disease. 7 REFERENCES 1. Richie JP, Steele GS. Neoplasm of testis. In: Walsh PC, Retik AB, Vaughan ED Jr, et al, eds. C ampbell’s urology. 8th ed. Philadelpia: WB Saunders; 2002. 2. Andayani YD, Syafei S. Pattern of germ cell testicular carcinoma in Dharmais Cancer Hospital between January 2000 – December 2004. Acta Med Indones - Indones J Intern Med. 2008;40(1):11 – 3. 3. Suprabawat i TE, Umbas R. Karakteristik dan faktor - faktor prediktif tumor testis dewasa di Jakarta. Jakarta 2006. 4. Slađana Živković et al. Testicular cancer with distant metastases – case report . Acta Medica Medianae 2011, Vol.50(3) . 5 5. American Cancer Society. Testicular Cancer. http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular - cancer - pdf23 6. European Association of Urology . Guidelines on Testicular Cancer . March 2015 7. Dan L. Longo, M.D., Editor. Testicular Cancer — Discoveries and Updates. N Engl J Med 2 014;371:2005 - 1