Testicular rhabdomyosarcoma after chemotherapy for metastatic germ cell tumors

Abstract

A 36-year-old male was referred to our hospital with left scrotal swelling. Computed tomography revealed a massive tumor in his left scrotum. The tumor extended along the gonadal vein extraperitoneally forming a massive tumor. Pathological examination showed a mixed-type germ cell tumor. Despite several chemotherapeutic treatments, the tumor continued to grow, and the patient died 28 months later after his first presentation at our institution. Autopsy revealed that the tumor comprised rhabdomyosarcoma and mature teratoma. We could not find useful tumor markers to facilitate the diagnosis of rhabdomyosarcoma. However, we recommend rebiopsy or palliative operation as options for re-diagnosis in case of resistant germ cell tumor. Here, we present a case of testicular tumor that exhibited different pathological examination results before and after treatment.

Keywords: Germ cell tumor; Rhabdomyosarcoma; Testicular tumor.

Fig. 1

Computed tomography showing a massive tumor in the left scrotum, and the tumor continued along the gonadal vein and extraperitoneally formed another tumor (a). The tumor invaded the left iliopsoas muscle and urinary tract (b). Pulmonary metastasis (c)

Fig. 2

Testicular tumor (a). Immature teratoma (b)

Fig. 3

Abdominal massive tumor continued enlargement and adhesion to nearby organs was suspected (a). Progression of inferior vena cava embolism (b). Progression of pulmonary metastasis (c)

Fig. 4

Transition of tumor markers during chemotherapy: AFP level markedly declined during treatment (from 5399.8 to 22.4 ng/mL), whereas that of CA19-9 increased (from 125.3 to 1446.3 U/mL)

Fig. 5

Massive tumor occupying the abdominal cavity and excluding other organs (a). The tumor comprising cystic and solid ingredients and weighing 13 kg (b). Immunostaining was positive for CA19-9 in the glandular epithelium of the cyst (c). Undifferentiated neoplastic cells with high nuclear–cytoplasmic ratio and eosinophilic cells differentiated into a striated muscle (d). A stained structure in the cells visualized using phosphotungstic acid and hematoxylin staining (e)

Fig. 6

Immature teratoma differentiating into striated muscles