Massive Intra-abdominal Germ Cell Tumors: A Case Series and Review of Literature

Abstract

Intra-abdominal testes are at increased risk of malignant transformation and can manifest as large abdominal masses with a wide variation in presenting symptoms. In the setting of cryptorchid or nonpalpable testes, large abdominal masses are highly suspect for germ cell tumors. Without standard guidelines, management can vary extensively. Surgical management may not be trivial and can entail a major abdominal operation in the context of a multimodal approach. The use of biopsy and serum tumor markers may effectively guide sequence of management based upon expected histology. In advanced cases, neoadjuvant chemotherapy may be pursued, and retroperitoneal lymph node dissection may be accomplished at the time of orchiectomy to minimize morbidity. The development of these massive late stage tumors reaffirms current guidelines on the early correction of cryptorchidism.

Keywords: Nonseminomatous; Seminoma; Testicular.

Figure 1.

Abdominal CT imaging revealing a large multilobulated mass between the bladder and the sigmoid.

Figure 2.

(A) Final pathology of a mixed germ cell tumor. Atrophic right testis showed evidence of tumor invasion. (B) Composition involved 99% seminoma and 1% yolk sac tumor elements.

Figure 3.

(A, B) Intraoperative and surgical specimen photos. (C) Histologic evaluation revealed no viable tumor tissue (ypT0).

Figure 4.

Abdominal CT showed a retroperitoneal mass measuring 11 × 8 × 8.5 cm and lower abdominal anterior mass measuring 11.8 × 16 × 19.3 cm.