Curative approach for solitary liver metastasis presenting as a rare pattern of organ spread in testicular cancer: a case report.

Solitary liver metastasis is an uncommon presentation of metastatic testicular cancer. This report details the case of a 16-year-old boy who presented with high fever and slight enlargement of the left testicle. Imaging revealed para-aortic regional lymph node swelling and a large liver mass occupying most of the left lobe. Left radical inguinal orchiectomy was performed, followed by liver biopsy to distinguish between a primary tumor and distant metastasis. Histopathological analysis confirmed a mixed non-seminomatous germ cell tumor with liver metastasis. The patient underwent four cycles of combination chemotherapy with bleomycin, etoposide, and cisplatin, followed by two additional cycles of etoposide, ifosfamide, and cisplatin, until tumor marker negativity was confirmed. Despite chemotherapy, clinically significant residual masses remained in the regional lymph nodes and liver. Detailed imaging evaluation suggested that liver metastasis had occurred through mesenteric vein infiltration by para-aortic lymph node metastasis. Retroperitoneal lymph node dissection was performed, revealing no evidence of malignancy, followed by liver metastasectomy. The patient achieved complete remission and has remained recurrence-free for 4 years since multimodal therapy. Even in the cases of liver metastases associated with poor prognosis, a comprehensive therapeutic approach that considers the metastatic pathway can achieve curative outcomes.