Synchronous metastatic seminoma and primary retroperitoneal ganglioneuroma: case report and literature review

Testicular cancer is the most common malignancy in young men with seminomas comprising almost half of all germ cell tumours. Benign ganglioneuromas are rare tumours derived from the sympathetic nervous system. They usually occur in aldolescents and young adults and are predominantly located in the mediastinum and retroperitoneum. We report a case of a patient with synchronous metastatic testicular seminoma with retroperitoneal lymph node involvement and a benign retroperitoneal ganglioneuroma (RGN) which caused diagnostic and management challenges. The patient had a complete response following combination chemotherapy for his seminoma and subsequently underwent complete resection of his ganglioneuroma.     

Primary retroperitoneal seminoma with utrasonically abnormal testes

Primary retroperitoneal seminomas account for approximately 2% of all seminomas. Differentiating the primary retroperitoneal tumor from a metastatic tumor with an occult testicular primary remains difficult despite the availability of ultrasonic examination. We present a case of primary retroperitoneal seminoma with ultrasonically demonstrated abnormalities in both testes. The patient underwent a unilateral orchiectomy and ultrasound-guided biopsy of the opposite testis. All surgical specimens were negative for testis cancer. Controversial issues in the diagnosis and treatment of primary retroperitoneal germ cell tumors are discussed.     

Spermatocytic seminoma: a case report

An 81-year-old man with a painless enlargement of the right testis which developed 11 years ago was treated with right orchiectomy without any combined therapy in 1981. This tumor pathologically proved to be spermatocytic seminoma. The patient has been well and has shown no evidence of recurrence for the past 5 years.     

Sonographically documented stable seminoma: a case report

Seminoma of the testis has a diverse natural history. We report a unique case of histologically confirmed classic seminoma in a 32-year-old patient documented by ultrasound on two occasions one year apart. The tumor size did not change during that time. We explore the possibility of a dichotomy in growth within seminoma and the need to identify molecular methods to predict the subset of tumors that behave biologically less aggressive.     

Treatment of the residual retroperitoneal mass after chemotherapy for advanced seminoma

Although resection of the residual retroperitoneal mass after chemotherapy for nonseminomatous testicular cancer is standard practice, controversy exists as to the appropriate management of the residual mass after chemotherapy for advanced seminoma. A literature review suggests that 15 to 25 per cent of such masses will contain residual cancer, suggesting that retroperitoneal lymph node dissection is appropriate in these patients.     

Primitive seminoma of the mediastinum: a case report

In this study, the case has been reported of a 36-year old male who was treated at the Ibn Rochd Oncology Center in Casablanca for a primary mediastinal seminoma revealed by a symptomatology including cough, dyspnea, laterocervical swelling, rachidial pain and gait disorder. The preliminary investigation showed significant mediastinal enlargement with a right pleuritis and vertebral metastases; tumor markers were normal. The diagnosis of seminoma was confirmed by pathological and immunohistochemical analysis of the cervical adenopathy. Disease management consisted of BEP/cisplatin type chemotherapy and lumbar, mediastinal, and supraclavicular radiotherapy. The response after four courses of combined chemo-/radiotherapy was estimated at 25%, but the patient died from respiratory failure five months after the initiation of treatment.     

腹膜后淋巴管结扎加静脉分流治疗乳糜外瘘六例

目的 探讨乳糜返流导致乳糜外瘘的诊断与治疗。方法 6例患者均采用直接淋巴管造影、核素淋巴显像诊断，其中2例直接淋巴管造影后CT辅助诊断。5例采用腹膜后淋巴管结扎加静脉分流治疗，1例仅腹膜后淋巴管结扎。结果 本组6例患者，术后随访6个月－6年，5例乳白色小疱消失，乳糜外瘘愈合；1例乳糜外瘘未愈，阴囊仍有乳糜液流出。结论 腹膜后淋巴管结扎加分流术治疗下肢及外生殖器乳糜外瘘取得较好效果，但有不能完全阻断返流的病例，故对此术式需进一步改进。     

Lymphovenous anastomosis in severe ascites

The authors dealt with 37 patients suffering from advanced liver cirrhosis with ascites. Eighteen patients out of them underwent Denver peritoneum-jugular shunt as a first choice procedure, the other 19 patients underwent lymphovenous anastomosis. The extremely advanced hepatic damage and the general conditions of these patients discouraged us to perform a portocaval shunt. In the 19 patients who underwent lymphovenous anastomosis we had no mortality rate. Two patients showed post-operative complications: 1 patient complained which hoarseness regressed in 5 months and the other patient suffered from a spleno-mesenteric-portal thrombosis with digestive hemorrhage from gastro-esophageal varices. In 6 patients out of 19 who underwent lymphovenous anastomosis, we did not obtain any immediate positive effects on ascites. In 4 patients, after 3 months, the ascites came back ingravescent and in the other 9 patients the positive effects on ascites were still evident after 1 year. Despite failure to obtain very comforting results, they suggest to employ this technique at any rate, as the first procedure, to make ascites more "manageable", because of its safety.     

Mixed gonadal dysgenesis with seminoma: a case report

A case of mixed gonadal dysgenesis with anaplastic seminoma is reported. A 43-year-old, female, who was brought up as a female, was admitted to our hospital for swelling of left inguinal region. The physical examination revealed a short stature, ambiguous external genitalia but no Turner's stigmata. A child's head-sized tumor was noticed in the left inguinal region by CT scan. The histopathological diagnosis of this tumor was anaplastic seminoma. The right gonad was removed at laparotomy with lymph node dissection in the pelvis. Histological examination of right gonad revealed streak gonad and immature uterine with fallopian tube. In the Japanese literature, 7 cases including our case of mixed gonadal dysgenesis with gonadal tumor have been reported.     

A case of primary mediastinal seminoma

Primary mediastinal seminoma is a rare clinical entity. Because of its high malignancy, we often find it only when it grows very large so we can't resect it completely. Our patient came with asthma attack and abnormal shadow on chest X-ray was pointed out. Germinal cell tumor was diagnosed by thoracoscopy and resection of the tumor was performed. Postoperative radiation therapy also was performed. Our case is alive in good health for 1 year postoperatively and good prognosis will be expected.     

Extragonadal seminoma with testicular microlithiasis: a case report

A 43-year-old men presented with left supraclavicular growing mass. Ultrasonography revealed a 31 x 21 mm solid mass with a homogeneous echoic pattern. Lymph node metastasis of some malignant neoplasms was highly suspected. However, whole body evaluation with computed tomographic scan revealed no findings in the primary region. In addition, tumor markers including alpha fetoprotein, human chorionic gonadotropin and carcinoembryonic antigen were within normal limits. Then, extirpation of supraclavicular mass was performed and pathological diagnosis was made as pure seminoma. Evaluation of testicle by ultrasonography revealed a diffuse calcification. However, histological examination of biopsy specimen of testicle revealed no malignancy. The mass was finally diagnosed as extragonadal or "burned-out" pure seminoma. The patient received two courses of Peplomycin, vinblastine and cisplatin (PVP) therapy, and there has been no evidence of recurrence for 34 months.