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Braz J Otorhinolaryngol. 2009;75(5):766. CASE REPORT

Neck of the testicular in an adult: a case report Dr. Aziz Mustafa, Mr. Sc. 1, Ilona Schwentner 2, Joachim Schmutzhard 3, Hannes Strasser 4, Georg M. Sprinzl 5 Keywords: neck dissection, neck metastasis, testicular tera- toma.

INTRODUCTION CT scans after one month detected enlar- testicular can metastasize2,3 ged conglomerate of cervical lymph nodes Fine needle aspiration cytology Testicular teratomas may present along the left jugular vein (Figure 1.). Selec- (FNAC) presents a useful procedure in in both prepubertal and adult males. The tive neck dissection of the regions II-VI was cases of metastatic cervical lymph nodes differs greatly between these performed. All lymph nodes were removed of GCTs, but the use of FNAC for the two groups. In children, teratomas most and sent for pathological examination. diagnosis of the primary testicular tumor often occur before the age of four. They The histopathological findings revealed is not advocated.4 In our case the FNAC are seen in their pure form, and behave a metastatic testicular teratoma: germ cells was not used. The diagnosis of the neck benign behavior. In adults, teratomas are in the seminiferous tubules, atypical, with metastasis was established in the base of usually part of a mixed GCTs, and have the occasional cells showing enlargement or imaging procedures. potential to metastasize. The presence of multinucleation. The introduction of -based neck metastasis in patients with testicular for treatment of testicular germ cell is a rare but well GCTs led to dramatic improvement in the known phenomenon. The incidence of survival of patients with these neoplasms. neck metastasis in testicular has Modern chemotherapy (PEB protocol: cis- been reported to be present in up to 5% 1 platin, and ), together of the cases. Late relapses have been seen with surgical excision of primary tumor and in many different locations, including the metastases, results in survival in more than retroperitoneum, , pelvis, liver, 90% of patients with non-seminomatous mediastinum, lung, bone (femur, vertebra, testicular GCTs (NSGCT). Because most and rib), lymph nodes outside the retrope- relapses occur during the first two years ritoneum and mediastinum, and after diagnosis, recurrence after two years inguinal regions, adrenal gland, chest wall, 2 2 of complete remission is considered rare. and buttocks. . Weisberger and McBride showed THE CASE that patients suffering from neck metastasis of NSGCTs have a surprisingly favourable A 30 year old man was referred to Figure 1. Enlarged conglomerate of cervical lymph nodes along prognosis if treated with PEB protocol our Department from Urological Clinic of the left jugular vein. chemotherapy and a specific technique the University Hospital, Medical Univer- of modified neck dissection. The levels of sity, Innsbruck, Austria. The patient had serologic tumor markers (hCG and AFP) enlarged left supraclavicular lymph nodes, DISCUSSION have a high correlation with the presence after surgical and chemotherapeutical Testicular germ cell tumours are or absence of residual malignant germ- treatment for retroperitoneal metastatic rare . They account 1% of all cell tumor components. Surveillance for testicular teratoma. Six months before he in males. Their peak incidence is recurrence is facilitated by the availability was admitted to the department, between the age of 25-35 years. There is of serologic tumor markers.5 because of a painful swollen right testis. a distinctive geographical and racial varia- After CT-scan, immunohystochemistry tion. The highest incidence is among white REFERENCES (positive tumor markers: α-fetoprotein-AFP men in northern Europe. Both genetic 1. Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal and human chorionic gonadothropin-hCG) and environmental factors are important C, Thun MJ. statistics, 2006. CA Cancer and pathohistological diagnostic procedu- in the development of testicular germ cell J Clin. 2006 Mar-Apr;56(2):106-30. res, the diagnosis of a testicular teratoma tumours. The age distribution suggests that 2. Michael H, Lucia J, Foster RS, Ulbright TM. The pa- was established. After right testis semicas- an initiating event occurs prenatally and thology of late recurrence of testicular germ cell tratio, three cycles of chemotherapy with that the tumour develops until adolescence. tumours. Am J Surg Pathol. 2000 Feb;24(2):257- cisplatine, etoposide and bleomycin were The histopathology of testicular cancers is 73. performed. The patient suffered from a complex and the most important discri- 3. Dearnaley DP, Huddart RA, Horwich A. Ma- prolonged agranulocytosis during the last mination is between , which naging testicular cancer. BMJ. 2001 Jun cycles of chemotherapy. Four months later, 30;322(7302):1583-8. account for about 50% of the total, and 4. Highman WJ, Oliver RTD. Diagnosis of metas- the control CT-scans detected suspicious teratomas or non-seminomatous germ cell metastatic lymph nodes of the retroperito- tases from testicular germ cell tumours using tumours. Furthermore mixed tumours can fine needle aspiration cytology. J Clin Pathol. neal region. Retroperitoneal laparoscopic be found in about 10% of the testicular 1987;40:1324-33. dissection was performed. neoplasms.3 5. Weisberger E, McBride L. Modified neck dissec- The histopathological results showed an The supraclavicular region of the tion for metastatic nonseminomatous testicular infiltration of bilateral para-aortal lymph neck is one of the possible places where carcinoma. Laryngoscope. 1999;109(8):1241-4. nodes with testicular teratoma. The control 1 M.D. (ENT specialist) 2 M.D. (ENT resident) 3 M.D. (ENT resident) 4 M.D. (Urologist) 5 M.D., Ph.D. (ENT specialist) ENT Clinic, University Clinical Centre of Kosovo, Prishtina, Kosovo 2) Department of Otorhinolaryngology, University Hospital, Innsbruck, Austria 3) Department of Urology, University of Innsbru- ck, Innsbruck, Austria Send Correspondence to: Aziz Mustafa M.D. ENT Clinic University Clinical Centre of Kosovo Rrethi I Spitalit pn. 10000 Prishtina Kosovo/UNMIK Tel: +37744144582 e-mail: aziz_mustafa2000@ yahoo.com Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on April 28, 2007; and accepted on July 14, 2007. cod. 4479

Brazilian Journal of Otorhinolaryngology 75 (5) September/October 2009 http://www.bjorl.org / e-mail: [email protected] 766