Semra DEMİRLİ ATICI, Yasemin KIRMIZI, Dilek KUZUKIRAN, Halit Batuhan DEMİR, Emel Ebru PALA, Cengiz AYDIN

Retroperitoneal Metastaz ile Bulgu Veren Burned-Out Seminomatöz Testiküler Tümör, Nadir Bir Olgu

"Burned-out testis tümörü" nadir görülen bir tümör türüdür. Burned out fenomeni, testisteki germ hücreli tümörün parsiyel ya da tamamen regrese olup, mediastinel, servikal, aksiller, retroperitoneal lenf nodları veya retroperitonal bölgeye metastaz ile bulgu vermesi olarak tanımlanır. Yapılan fizik muayenede testis muayenesi olağandır. 31 yaşında erkek hasta sırt ve karın ağrısı yakınması ile başvurdu. Yapılan fizik muayenesinde patolojik bulguya rastlanılmadı. Çekilen abdomen tomografide retroperitoneal kitle saptandı. Retroperitonela kitle eksizyonu, paraaortik, parakaval ve retroperitoneal lenf nodu diseksiyonu uygulandı. Hastanın postoperatif dönemi komplikasyonsuz olup, postoperatif beşinci gün taburcu edilmiştir. Patoloji sonucu, seminom metastazı olarak raporlanmıştır. Retroperitoneal kitle ile karşımıza çıkan genç hastalarda burned out tümörlerin metastazları olabileceği akılda tutulmalıdır. Burned-out tümörlerin tedavi seçenekleri zamanla değişebilir. Farklı risk faktörlerini tanımlamak ve tedavinin optimize edilmesine yardımcı olabilmek için daha geniş olgu serileri yayınlanmalıdır.

Anahtar Kelimeler:

burned-out, retroperitoneal kitle, lenf nodu diseksiyonu, orşiektomi

'Burned-out' Seminomatous Testicular Tumour Diagnosed as Retroperitoneal Metastasis, A Rare Case

"Burned-out testicular tumour" is extremely rare. Burned-out phenomenon describes partially or completely regressed germ cell tumours of the testes diagnosed after metastases in several parts of the body; including the mediastinum, cervical and axillary lymph nodes, retroperitoneal lymph nodes, and the retroperitoneal region. Physical examination of the testicles reveals non-specific findings. A 31-year-old male presented with abdominal and back pain. The physical examination findings were unremarkable. Imaging with computerized tomography showed a retroperitoneal mass. Excision of the retroperitoneal mass and the paraaortic, paracaval, and retroperitoneal lymph nodes was performed. The postoperative period was uneventfuland he was discharged on the postoperative 5thday. The postoperative pathological examination of the specimen reported a metastatic seminoma. Investigation of the underlying cause of a retroperitoneal mass in young adults requires including metastasis of burned-out germ cell tumours in the differential diagnosis. Further case reports on this rare type of tumour are required so that all potential risk factors will be defined and treatment protocols will be updated to optimize the management of the patients with burned-out germ cell tumours.

Keywords:

burned-out, retroperitoneal mass, lymph node dissection, orchiectomy,

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1. Albany C, Einhorn LH. Extragonadal germ cell tumors: clinical presentation and management.
CurrOpin Oncol 2013;25:261-265
2. Tasu JP, Faye N, Eschwege P, Rocher L, BléryM.,Imaging of burned-out testis tumor: five new cases and review of the literature. J Ultrasound Med 2003;22:515-521.
3. Lehmann D, Muller H. Analysis of the autoimmune response in an ‘in situ’ carcinoma of the testis. Int J Androl 1987;10:163-168.
4. Curigliano G, Magni E, Renne G, De Cobelli O, Rescigno M, Torrisi R, et al. “Burned out” phenomenon of the testis in retroperitoneal seminoma. Acta Oncol 2006;45:335-336
5. Ojea Calvo A, Rodríguez Alonso A, Pérez García D, Domínguez Freire F, Alonso Rodrigo A, Rodríguez Iglesias B, et al. Tumor extragonadal de célulasgerminales con fénomeno“burned-out” entestí- culo. ActasUrolEsp, 1999; 23(10):880-884.
6. Setchell BP. The functional significance of the blood-testis barrier. J Androl 1980;1:3-11
7. Scholz M, Zehender M, Thalmann GN, Borner M, Thoni H, Studer UE., Extragonadal retroperitoneal germ cell tumor: evidence of origin in the testis. Ann Oncol 2002;13:121-124
8. Simmonds PD, Mead GM, Lee AH, Theaker JM, Dewbury K, Smart CJ , Orchiectomy after chemotherapy in patients with metastatic testicular cancer. Is it indicated? Cancer 1995;75:1018-1024.
9. Fuchs E, Hatch T, Seifert A. Extragonadal germ cell tumor: the preoperative urological evaluation. J Urol 1987;137:993-995.
10. Medini E, Levitt SH, Jones TK, Y. Rao, The management of extratesticularseminoma without gonadal involvement. Cancer 1979;44:2032-2038