RESUMEN
OBJECTIVE: To describe a case of retroperitoneal metastasis of a gonadal germ cell tumour with the "burned-out" phenomenon in a 35 year old patient with a suspected diagnosis of retroperitoneal tumour of neurogenic origin. METHODS: With the clinical and radiological suspicion of retroperitoneal tumour of neurogenic origin the tumour was removed, via the retroperitoneal space. RESULTS: Pathology showed classic seminoma with foci of atypical or anaplastic seminoma, confined to the tissue sample. After a genital examination showing no alterations, a scrotal ultrasound was requested. This revealed a badly delimited hypoechogenic mass with microcalcifications in the left testis and a heterogeneous echostructure in the right testis, with hypoechogenic areas and some microcalcification. Bilateral orchiectomy was performed, with a pathological study compatible with residual scar tissue in the left testicle and focal findings of germ cell neoplasia, with no intratubular seminoma in the right testis. CONCLUSIONS: The suspicion of an extragonadal germ cell tumour with the "burned-out" phenomenon modifies the therapeutic attitude, which should begin with orchiectomy, followed by systemic chemotherapy and the surgery kept in reserve for those cases where residual malignant tissue persists.
Asunto(s)
Neoplasias de Células Germinales y Embrionarias/patología , Neoplasias Retroperitoneales/secundario , Neoplasias Testiculares/patología , Adulto , Terapia Combinada , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/cirugía , Orquiectomía , Neoplasias Retroperitoneales/tratamiento farmacológico , Neoplasias Retroperitoneales/cirugía , Seminoma/patología , Seminoma/cirugía , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/cirugía , Tomografía Computarizada por Rayos XRESUMEN
OBJETIVO: Describir un caso de metástasis retroperitoneal de un tumor de células germinales gonadal con fenómeno "burned-out" en un paciente de 35 años con sospecha diagnóstica de tumor retroperitoneal de estirpe neurogénico. MÉTODOS: Con la sospecha clínico-radiológica de tumor retroperitoneal de estirpe neurogénico se realiza exéresis de la tumoración, mediante abordaje por vía retroperitoneal. RESULTADOS: La histología demostró seminoma clásico con focos de seminoma atípico o anaplásico, confinado a la pieza quirúrgica. Tras comprobar exploración genital sin alteraciones, se solicita Ecografía escrotal, que evidencia en teste izquierdo una masa mal delimitada hipoecogénica con microcalcificaciones y en teste derecho ecoestructura heterogénea, con áreas hipoecogéncias y alguna microcalcificacion. Se realiza orquiectomía bilateral, con resultado histológico de restos cicatriciales en teste izquierdo y hallazgos focales de neoplasia de células germinales, no seminoma intratubular en teste derecho. CONCLUSIONES: Sospechar un tumor de células germinales extragonadal con fenómeno "burned-out" modifica la actitud terapéutica, que debería comenzar por orquiectomía, siguiendo con la quimioterapia sistémica y reservando la cirugía para los casos de persistencia de tejido maligno residual (AU)
OBJECTIVE: To describe a case of retroperitoneal metastasis of a gonadal germ cell tumour with the "burned-out" phenomenon in a 35 year old patient with a suspected diagnosis of retroperitoneal tumour of neurogenic origin. METHODS: With the clinical and radiological suspicion of retroperitoneal tumour of neurogenic origin the tumour was removed, via the retroperitoneal space. RESULTS: Pathology showed classic seminoma with foci of atypical or anaplastic seminoma, confined to the tissue sample. After a genital examination showing no alterations, a scrotal ultrasound was requested. This revealed a badly delimited hypoechogenic mass with microcalcifications in the left testis and a heterogeneous echostructure in the right testis, with hypoechogenic areas and some microcalcification. Bilateral orchiectomy was performed, with a pathological study compatible with residual scar tissue in the left testicle and focal findings of germ cell neoplasia, with no intratubular seminoma in the right testis. CONCLUSIONS: The suspicion of an extragonadal germ cell tumour with the "burned-out" phenomenon modifies the therapeutic attitude, which should begin with orchiectomy, followed by systemic chemotherapy and the surgery kept in reserve for those cases where residual malignant tissue persists (AU)