Metastatic testicular germ cell tumor

Case contributed by Mohamed Mahmoud Elthokapy , 20 Jun 2021
Diagnosis certain
Changed by Mostafa Elfeky, 4 Jul 2021

Updates to Case Attributes

Status changed from pending review to published (public).
Published At was set to .
Body was changed:

Lab values -Alpha-FetoproteinAlpha-fetoprotein: 10314 ng/mL & Beta HCG: 89937 mIU/mLLDH: 580 U/L.

The patient underwent surgical excision (left orchiectomy) that pathologically proven as a mixed germ cell tumor.

In contrast to seminomas, non-seminomatous germ cell tumors tend to be more heterogeneous on ultrasound with frequent cystic areas. The appearance of an individual tumor will, of course, vary depending on the location.

Case contributed by Dr. Reem Yehia

  • -<p>Lab values -Alpha-Fetoprotein: 10314 ng/mL &amp; Beta HCG: 89937 mIU/mL LDH: 580 U/L</p><p>The patient underwent surgical excision (left orchiectomy) that pathologically proven as a mixed germ cell tumor</p><p>In contrast to seminomas, non-seminomatous germ cell tumors tend to be more heterogeneous on ultrasound with frequent cystic areas. The appearance of an individual tumor will, of course, vary depending on the location  </p><p><em>Case contributed by Dr. Reem Yehia</em></p>
  • +<p>Lab values: <a title="Alpha-fetoprotein" href="/articles/alpha-fetoprotein-1">Alpha-fetoprotein</a>: 10314 ng/mL &amp; <a title="Beta HCG" href="/articles/beta-hcg-1">Beta HCG</a>: 89937 mIU/mL, <a title="Elevated LDH" href="/articles/lactate-dehydrogenase">LDH</a>: 580 U/L.</p><p>The patient underwent surgical excision (left orchiectomy) that pathologically proven as a mixed germ cell tumor.</p><p>In contrast to seminomas, non-seminomatous germ cell tumors tend to be more heterogeneous on ultrasound with frequent cystic areas. The appearance of an individual tumor will, of course, vary depending on the location.</p><p><em>Case contributed by Dr. Reem Yehia</em></p>

References changed:

  • 1. Brezina R, Schramek S, Kazár J. Selection of chlortetracycline-resistant strain of Coxiella burnetii. (1975) Acta virologica. 19 (6): 496. <a href="https://www.ncbi.nlm.nih.gov/pubmed/1997">Pubmed</a> <span class="ref_v4"></span>
  • 2. https://www.sjkdt.org/article.asp?issn=1319-2442;year=2012;volume=23;issue=6;spage=1238;epage=1240;aulast=Salehipour
  • 3. William D. Middleton, Sharlene A. Teefey, Cynthia S. Santillan. Testicular Microlithiasis: Prospective Analysis of Prevalence and Associated Tumor1. (2002) Radiology. <a href="https://doi.org/10.1148/radiol.2242011137">doi:10.1148/radiol.2242011137</a> <span class="ref_v4"></span>
  • 4. Teruko Ueno, Yumiko Oishi Tanaka, Michio Nagata, Hajime Tsunoda, Izumi Anno, Shigemi Ishikawa, Koji Kawai, Yuji Itai. Spectrum of Germ Cell Tumors: From Head to Toe1. (2004) RadioGraphics. <a href="https://doi.org/10.1148/rg.242035082">doi:10.1148/rg.242035082</a> <span class="ref_v4"></span>
  • Brezina R, Schramek S, Kazár J. Selection of chlortetracycline-resistant strain of Coxiella burnetii. (1975) Acta virologica. 19 (6): 496. <a href="https://www.ncbi.nlm.nih.gov/pubmed/1997">Pubmed</a> <span class="ref_v4"></span>
  • https://www.sjkdt.org/article.asp?issn=1319-2442;year=2012;volume=23;issue=6;spage=1238;epage=1240;aulast=Salehipour
  • William D. Middleton, Sharlene A. Teefey, Cynthia S. Santillan. Testicular Microlithiasis: Prospective Analysis of Prevalence and Associated Tumor1. (2002) Radiology. <a href="https://doi.org/10.1148/radiol.2242011137">doi:10.1148/radiol.2242011137</a> <span class="ref_v4"></span>
  • Teruko Ueno, Yumiko Oishi Tanaka, Michio Nagata, Hajime Tsunoda, Izumi Anno, Shigemi Ishikawa, Koji Kawai, Yuji Itai. Spectrum of Germ Cell Tumors: From Head to Toe1. (2004) RadioGraphics. <a href="https://doi.org/10.1148/rg.242035082">doi:10.1148/rg.242035082</a> <span class="ref_v4"></span>

Updates to Study Attributes

Caption was changed:
Ultrasound and dopplerDoppler
Findings was changed:

The Left Hemileft hemi-scrotum is the seat of large poorly defined heterogenous partly cystic partly solid mass lesion, the latter showing internal vascularity on color dopplerDoppler mapping.

Complementary abdominal ultrasound revealed left para-aortic large complex cystic-solid masses.

Updates to Study Attributes

Findings was changed:

Left Hemihemi-scrotal poorly defined heterogeneous complex mass lesion of partly cystic and partly solid components the latter shows enhancement in the post-contrast study, the cystic component appears as multilocular 

Left retro-peritoneal mainly para-aortic region huge fairly defined complex heterogeneous mass lesion of partly cystic and partly enhanced solid components -of, of nearly similar consistency of the aforementioned left testicular mass, is seen abutting the aorta with small pre-aortic and aortocaval components, this. This mass is seen resting on the left psoas muscle with no invasion, abutting the left renal hilum indenting its surface and displacing the left ureter laterally, superiorly it also exerts mass effect on the surrounding bowel loops and their mesenteric vessels displacing them anterolaterally with no infiltration.

The left renal vein is likely compressed with subsequent dilatation of the left testicular vein and left pelvic varicosities are also seen.

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