Lütfi CANAT, Osman CAN, Hasan Anıl ATALAY, İlter ALKAN, SÜLEYMAN SAMİ ÇAKIR, FATİH ALTUNRENDE

Seminom tedavisi sonrası metakron testiküler embryonal karsinom gelişimi. Benzer iki vakanın sunumu

Giriş: Testiküler germ hücreli tümör öyküsü olan hastalar metakron testiküler tümör gelişimi için yüksek risklidir. Seminom, bilateral testiküler germ hücreli hastalığın en yaygın tipidir. Burada, seminom tedavisi sonrası nadir görülen metakron embryonal karsinom gelişen iki vaka sunulmuştur. Vaka 1: Ocak 2011’de 25 yaşında, sol testiküler kitle nedeniyle orşiektomi yapılan hastanın patoloji sonucu klasik seminom, evre pT1’dir. Operasyon sonrası batın ve toraks bilgisayarlı tomografi (BT) incelemesinde patoloji saptanmamıştır. Profilaktik amaçlı para-aortik alana radyoterapi uygulanmıştır. Aralık 2015’de yapılan sağ testiküler ultrasonda12 x 9 x 11 mm heterojen, hipoekoik alan saptanmıştır. BT ve serum tümör belirteçlerinde patoloji izlenmemiştir. Sperm dondurma sonrası sağ testiküler eksplorasyon yapılmış, frozen biyopsi patolojisi embryonal karsinom rapor edilmesi üzerine de sağ radikal orşiektomi yapılmıştır. Onkoloji kliniği ile konsülte edilen hastaya tek doz karboplatin verilmiştir. Operasyon sonrası 11. ayda hastada tümörsüz olarak takip edilmektedir. Vaka 2: Ocak 2011’de 26 yaşında, sağ atrofik testis ve sol testiküler kitle nedeniyle sperm dondurma sonrası sol orşiektomi yapılan hastanın patolojisi klasik seminom, evre pT1’dir. Operasyon sonrası kontrol BT’de sol para-aortik ve sol renal hiler lenf nodlarına radyoterapi uygulanmıştır. Ekim 2015’e kadar nükssüz takip edilen hastada, bu tarihte yapılan kontrol sağ testiküler ultrasonda 6 x 5.5 x 5 mm heterojen, solid lezyon saptanmıştır. BT ve serum tümör belirteçlerinde patoloji olmayan hastaya sağ radikal orşiektomi yapılmıştır. Patolojisi teratom ve ITGCN ile birlikte embryonal hücreli karsinom olarak rapor edilen hasta, tedavi sonrası 12. ayda nükssüz olarak takip edilmektedir. Yorum: Testiküler germ hücreli tümör tedavisi sonrası metakron testis tümörü gelişim riski nedeniyle karşı taraf testise fizik muayene ile birlikte testiküler ultrason yapılması, ikincil tümörlerin erken tanısına katkı sağlamaktadır.

Anahtar Kelimeler:

Metakron testis tümörü, embryonal karsinom, seminom, radyoterapi

Metachronous testicular embryonal carcinoma after the treatment of seminoma. A report of two similar cases

Introduction: Patients diagnosed with testicular germ cell tumors have higher risk of developing metachronous testicular tumors. Seminoma is the most prevalent type of bilateral testicular germ cell disease. We report the cases of two patients with metachronous testicular embryonal carcinoma after the treatment of seminoma. Case 1: A 30-year-old patient underwent left orchiectomy for a testicular classical seminoma stage pT1 at the age of 25 years on January 2011. A postoperative computed tomography (CT) scan of the chest and abdomen were normal. He underwent prophylactic radiotherapy to para-aortic field. He remained well until December 2015 when an ultrasound scan of the right testis showed an 12 x 9 x 11 mm heterogeneous hypoechogenic areas. A CT scan of the chest and abdomen and the blood serum tumor markers were normal. After the sperm cryopreservation, the patient underwent right testicular exploration of the palpable lesion and excisional biopsy. Analysis of frozen biopsy sections revealed an embryonal carcinoma and radical orchiectomy was performed. Following consultation at an oncology clinic, the patient consented to treatment with a single dose of carboplatin. The patient is free from recurrence 11 months after the treatment. Case 2: A 31-year-old patient with a history of left testicular seminoma stage pT1 and right atrophic testis (8 cc), underwent left orchiectomy after the sperm cryopreservation on January 2011. A postoperative CT scan of abdomen revealed that the presence of left paraaortic and renal hilar lymph nodes. The patient underwent radiotherapy to paraaortic field and left renal hilum. The patient remained well until October 2015 when an ultrasound scan of the right atrophic testis showed an 6 x 5.5 x 5 mm heterogeneous solid lesion. A CT scan of the chest and abdomen and the blood serum tumor markers were normal. The patient underwent radical right orchiectomy. The pathological diagnosis was embryonal carcinoma combined with teratoma and ITGCN. The patient remained under surveillance and he is free from recurrence 12 months after the right orchiectomy. Conclusion: A closely follow-up protocol included physical examination and scrotal ultrasound evaluation of the contralateral testis made possible early diagnosis of the second tumor.

Keywords:

Metachronous testicular tumor, embryonal carcinoma, seminoma, radiotherapy,

PDF

___

1. La Vecchia C, Bosetti C, Lucchini F, Bertuccio P, Negri E, Boyle P, Levi F. Cancer mortality in Europe, 2000- 2004, and an overview of trends since 1975. Ann Oncol 2010;21:1323-60.
2. Zequi Sde C, da Costa WH, Santana TB, Favaretto RL, Sacomani CA, Guimaraes GC. Bilateral testicular germ cell tumours: a systematic review. BJU Int 2012;110:1102-9.
3. Di Gregorio M, Nollevaux MC, Lorge F, D’Hondt L. Metachronous testicular seminoma after radiotherapy and chemotherapy: a case report. World J Surg Oncol. 2016;14:147.
4. Holzbeierlein JM, Sogani PC, Sheinfeld J. Histology and clinical outcomes in patients with bilateral testicular germ cell tumors: the Memorial Sloan Kettering Cancer Center experience 1950 to 2001.J Urol 2003;169:2122-5.
5. Fossa SD, Chen J, Schonfeld SJ, McGlynn KA, McMaster ML, Gail MH, Travis LB.Risk of contralateral testicular cancer: a population-based study of 29,515 U.S. men.J Natl Cancer Inst 2005;97:1056-66.
6. Andreassen KE, Grotmol T, Cvancarova MS, Johannesen TB, Fossa SD. Risk of metachronous contralateral testicular germ cell tumors: a population-based study of 7,102 Norwegian patients (1953-2007).Int J Cancer 2011;129:2867-74.
7. Schaapveld M, van den Belt-Dusebout AW, Gietema JA, de Wit R, Horenblas S, Witjes JA, Hoekstra HJ, Kiemeney LA, Louwman WJ, Ouwens GM, Aleman BM, van Leeuwen FE. Risk and prognostic significance of metachronous contralateral testicular germ cell tumours.Br J Cancer 2012;107:1637-43.
8. Sun BL, Pearl R, Sharifi R, Guzman G. Metachronous bilateral testicular seminoma developing after an interval of 31 years: case report and review of the literature. Int J Surg Pathol 2015;23:156-60.
9. Jones DA, Ester EC, Leavitt D, Sweet R, Konety B, Jha G, Cho LC. Adjuvant radiotherapy for synchronous bilateral testicular seminoma: a case report and a review of the pertinent literature. Case Rep Urol 2013;2013:241073.
10. Oliver RT, Mason MD, Mead GM, von der Maase H, Rustin GJ, Joffe JK, de Wit R, Aass N, Graham JD, Coleman R, Kirk SJ, Stenning SP. Radiotherapy versus single-dose carboplatin in adjuvant treatment of stage I seminoma: a randomised trial.Lancet 2005;366:293-300.
11. James FV, Kumar A, Jayaprakash PG, Mathews A. Metachronous bilateral testicular germ cell tumors: report of two cases. J Cancer Res Ther 2009;5:206-7.
12. Jørgensen N, Rajpert-De Meyts E, Main KM, Skakkebaek NE. Int Testicular dysgenesis syndrome comprises some but not all cases of hypospadias and impaired spermatogenesis.J Androl 2010;33:298-303.
13. Lip SZ, Murchison LE, Cullis PS, Govan L, Carachi R. A meta-analysis of the risk of boys with isolated cryptorchidism developing testicular cancer in later life. Arch Dis Child 2013;98:20-6.
14. Peng X, Zeng X, Peng S, Deng D, Zhang J. The association risk of male subfertility and testicular cancer: a systematic review. PLoS One 2009;4:e5591.
15. Harland SJ, Cook PA, Fossa SD, Horwich A, Mead GM, Parkinson MC, Roberts JT, Stenning SP. Intratubular germ cell neoplasia of the contralateral testis in testicular cancer: defining a high risk group.J Urol 1998;160:1353-7.