Seminoma appearing as a retroperitoneal mass Seminoma associated with a testicular scar
EDWARD M. COHEN, D.O. Detroit, Michigan
lesions. The purpose of this paper is to report a case in Seminoma usually presents as a primary which a widespread retroperitoneal seminoma was tumor of a testis. Germ cell tumors, present without a clinically evident primary gonadal including seminoma, have also been tumor, but associated with a testicular scar. A discus- reported as having origin from pineal sion of the possible embryogenesis and pathogenesis gland, anterior mediastinum, and will attempt to shed some light on the controversy retroperitoneal areas. Retroperitoneal regarding this type of lesion. seminomas also have been reported in association with "burned out" testicular Report of case lesions. A case of retroperitoneal A 26-year-old white man was admitted to the hospi- seminoma associated with a testicular tal with a chief complaint of colicky pain in the right scar is presented. An elevated urinary flank, with radiation to the right lower quadrant of chorionic gonadotropin level (16,000 the abdomen. This had been present for approxi- units/L.) developed during the course of mately 8 weeks. The patient s previous health had the disease. The patient died and autopsy been good, and he had had no complaints referable showed massive tumor involvement of to the genitourinary or gastrointestinal system, ex- the retroperitoneum, liver, and pelvis as cept constipation. A tender mass was palpable in the well as invasion of the stomach and midabdominal region. Palpation of the testicles mesentery of the small intestine. The showed them to be in the scrotal sacs and apparently portal vein showed thrombosis secondary of normal size and contour. Laboratory studies gave to tumor. Possible modes of pathogenesis results within normal limits except for increases in include displaced germ cells during the alkaline phosphatase (AP), lactic dehydrogenase embryogenesis as well as primary (LDH), and glutamic oxaloacetic transaminase testicular seminoma with retroperitoneal (GOT) levels of the serum. X-ray study of the chest metastasis and regression of the primary showed no abnormality. An intravenous pyelogram tumor in the testis. showed a soft tissue mass displacing the right ureter laterally to the right. An aortogram and superior mesenteric angiogram showed displacement of ves- sels about the lesion. A cavagram demonstrated ob- struction of the right iliac vein at its junction with the In 1927 Prym l reported observing at autopsy of a vena cava inferior. The latter vein was not vis- 51-year-old man a widespread chorioepithelioma ualized, and drainage of the lower extremities by associated with atrophy of the right testicle, which way of the collateral circulation via the ascending supported a 1 cm. fibrous scar. Since that report lumbar veins was noted. A lymphangiogram showed there have been other reports of germ cell tumors, displacement of the paravertebral lymphatic vessels involving the retroperitoneum particularly, without to the left side. At surgery, a large retroperitoneal evidence of associated gonadal tumors. In several of mass was noted adjacent to the medial border of the these cases burned-out primary lesions within the right kidney. The tumor compressed and distorted testes have been described, 2- 4 but in other cases 5-10 the vena cava inferior and extended to the iliac ves- no clinically evident lesion was seen in the gonads. sels, to which it was fixed. The tumor was considered These observations lead to certain questions regard- unresectable, and therefore only an incisional ing the embryogenesis and pathogenesis of such biopsy specimen of the mass was removed. Examina-