Rapid progression of a germ cell tumor encasing the inferior vena cava and aorta following a radical orchiectomy

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Abstract

Early stage testicular germ cell tumors are highly curable malignancies, but the need for close radiologic and biomarker surveillance is pivotal. Even in the setting of recurrence, rescue therapy has been successfully implemented. The present report describes a patient that had rapid and aggressive recurrence after radical orchiectomy for a testicular germ cell tumor and presented with bulky disease necessitating reconstruction of the inferior vena cava at the time of salvage retroperitoneal debulking. retroperitoneal lymph node dissection (RLND) in early disease is limited such that in the absence of pathologic enlarged retroperitoneal lymph nodes, RLND is not indicated. However many centers perform staging RPLND for selected high risk patients with stage I disease. Patients are defined as having clinical stage I NSGCT if radiographic studies are negative and serum tumor markers post-orchiectomy are normal. The majority of stage I patients are cured with orchiectomy alone. However, it is difficult to identify which subset of these patients are at highest risk for recurrence and may benefit from adjuvant treatment. Numerous attempts have been made to identify men with clinical stage I NSGCT at high risk for relapse. The risk factors for recurrence include: lymphovascular invasion (LVI), pathologic tumor stage above T2 (LVI or tumor extending through the tunica albuginea with involvement of the tunica vaginalis), and predominance of an embryonal component in the primary tumor. In the present report, we discuss a patient without risk factors who had rapid enlargement of retroperitoneal disease, consisting of primarily teratoma elements with marginal response to chemotherapeutic intervention. Treatment options and outcomes are outlined.

Original languageEnglish (US)
Pages (from-to)79-82
Number of pages4
JournalRare Tumors
Volume5
Issue number2
DOIs
StatePublished - Jun 14 2013

Keywords

  • Retroperitoneal tumor
  • Teratoma
  • Testicular germ cell tumor

ASJC Scopus subject areas

  • Histology
  • Oncology

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