ArticleCureus2024
Postpubertal-Type Teratoma of the Retroperitoneal Space as a Late Recurrence of a Testicular Germ Cell Tumor: A Case Report With Clinical Insight.
Article in Cureus, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Postpubertal-type teratomas are rare malignant tumors derived from germ cell neoplasia in situ (GCNIS). This case report presents a rare instance of a retroperitoneal postpubertal-type teratoma as a late recurrence of a testicular germ cell tumor (GCT) that was initially diagnosed as a seminoma. A 48-year-old male who had undergone left inguinal orchidectomy for a testicular mass was diagnosed with a seminoma (stage I) six years prior and presented with an asymptomatic 6-cm retroperitoneal tumor near the left renal hilum. Initial blood tests at presentation for the retroperitoneal tumor were normal, except for a mild elevation of lactate dehydrogenase. Computed tomography (CT), magnetic resonance imaging, and fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT imaging revealed a well-defined tumor with calcification and high glucose metabolic activity. A CT-guided biopsy for the retroperitoneal tumor suggested a high-grade malignant tumor of neuroendocrine origin. The patient underwent neoadjuvant chemotherapy, which resulted in tumor shrinkage and decreased metabolic activity. Subsequent surgical resection and histopathological examination revealed a postpubertal-type teratoma with a concomitant neuroendocrine tumor. A reexamination of the previous testicular tumor specimen revealed a small amount of embryonal carcinoma within the seminoma, indicating that the initial diagnosis should have been a mixed germ cell tumor rather than a pure seminoma. This explains the unusual recurrence pattern observed and highlights the importance of a thorough histological examination for testicular GCTs, as microscopic non-seminomatous components can significantly affect prognosis and recurrence patterns. When encountering suspected recurrences of GCNIS-derived GCTs, clinicians should consider the possibility of an initially undetected mixed GCT, particularly in cases with atypical presentation or recurrence patterns.
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