Testicular Seminoma Metastasis to the Gastrointestinal Tract and the Necessity of Surgery

Introduction  

Germ cell tumors rarely metastasize to the gastrointestinal (GI) tract with an incidence that is less than 5%. Germ cell tumors can be divided into two groups: pure seminomas and non-seminomas. Pure seminomas are characterized by their profound response to chemoradiation. Within the group of germ cell tumors, pure seminomas are least likely to metastasize to the GI tract with an incidence of less than 1%. The most frequent mode of metastasis to the GI tract is direct extension from the retroperitoneal lymph nodes, which drain the testes. Ileal and jejunal metastasis are more common due to their retroperitoneal locations as well as the fact that the testes have retroperitoneal lymphatic drainage. Due to the concern of retroperitoneal metastasis in germ cell tumors, retroperitoneal lymph node biopsies are advocated for accurate staging and diagnosis due to the possibility of occult involvement in these sites. Thus, amongst the GI sites for metastasis, the duodenum is the most uncommon location. The most common manifestations of GI metastasis are intestinal obstructions via volvulus or intussusception and not acute gastrointestinal bleeding. We present a case of chemoresistant pure testicular seminoma with metastasis to the duodenum with a complication of a massive upper GI bleed requiring emergent surgery.