Giant seminoma in an undescended testicle metastasizing to the neck and liver

Abstract

Germ cell tumors account for 98% of all testicular malignancies. Delays in seeking treatment are unfortunately common and may lead to metastatic spread. The present study reported a case of a 24-year-old man with a giant 12×10 cm left inguinal mass and a left neck mass that had grown rapidly during recent months. Computed tomography confirmed that the mass measured 12.1×9.4 cm and was a left undescended testicle malignancy, and also revealed widespread metastasis to the liver and a large retroperitoneal mass (12.6×8.2 cm). Immunohistochemical staining confirmed seminoma. The patient was treated with chemotherapy with the VIP protocol (cisplatin, etoposide and ifosfamide). Following courses of chemotherapy, the patient received complete clinical remission and was disease-free at the 6 month follow-up.

Keywords: chemotherapy; complete remission; cryptorchidism; late metastasis; seminoma.

Figure 1.

Computed tomography of the abdomen and pelvis revealed (A) a giant left inguinal testicular tumor with (B) widespread metastasis to liver (red arrow) and a large retroperitoneal mass.

Figure 2.

Histology and immunohistochemistry of the cervical node. (A) Tumor cells were stained with hematoxylin and eosin staining and appeared to be arranged in a nest and cord pattern, with lymphocyte infiltration. Immunohistochemistry revealed that the tumor cells exhibited (B) cytoplasmic and cytomembrane positivity with PLAP, (C) positivity with cluster of differentiation 117, (D) positivity with D2-40 and (E) cytonucleus positivity with OCT3/4. (F) Ki-67 revealed a high (30%) proliferation rate (magnification, ×100).