1
Testicular Embryonal Carcinoma
Yohanes Putra Mbama1, Gede Budhi Setiawan2, Tjakra Wibawa Manuaba2,
1
General Surgery Resident, Medical Faculty, Udayana University, Denpasar, Indonesia
2
Division of Oncology, Department of Surgery, Medical Faculty, Udayana University-Sanglah Hospital, Denpasar, Indonesia
Abstract
Embryonal cell carcinoma of testis is a rare case commonly found in younger males, aged 15 – 35 years old. Majority of tumours already having metastased at the time of diagnosis. Ethiology of testicular cancer are not well understood, mostly derived from germinative cells.
A 35-year-old male with left testicular carcinoma were reported. The patient underwent orchidectomy and the patology result was an embryonal cell carcinoma. Four series of TAP regiment chemotherapy were administered. A left paraaortic node enlargement was identified from abdominal Ct-scan 5 months after chemotherapy. Retroperitoneal lymph node dissection (RPLND) were performed and the pathology result showed a mucinous cyst adenocarcinoma.
2 INTRODUCTION
Testicular cancer is a very rare kind, making up 1% of all malignancies in male. Although it occurs at any age, two third of testicular cancers occur at 25 – 35 years of age. Survival rate have been changed dramatically due to combination of many factors, including proper diagnostic techniques, increased serum tumor markers, multi-drug chemotherapy regimens, which claimed to decrease the mortality rate from 50% in the
70’s into less than 5% at the end of 90’s. Seminoma is the most common type of histopathology with the incidence of 30 – 60%, followed by pure embryonal carcinoma 3
– 4% that include 40% of nonseminoma, 5-10% teratoma and 1% pure choriocarcinoma. While mixed germ cell tumor may reach 60% of all germinal tumor cell.1 Study from Dharmais Cancer Hospital in 2002-2004 showed similar incidence of such histopathological types, i.e. seminoma (47.5 %), non-seminoma (40 %) and mixed germ cell tumor (12.5%).2 A study in two hospitals in Jakarta found 149 new cases of testicular cancer in a 10-year period.3
CASE REPORT
A 34-year-old male came to outpatient clinic for regular follow-up after left orchiectomy 6 months earlier. He had an operative history of left orchidectomy 6 months earlier back. Histopathological report showed embryonal carcinoma with a clinical stage of pT3pNxpMx. Four series of TAP chemotherapy regiment was administered.
3 embryional carcinoma, the patient was readmitted and received a left retroperitoneal lymph node dissection (RPLND) (Picture no.2). The pathology report indicated mucinous cyst adenocarcinoma.
Picture no.1. MSCT of the abdomen – axial slice
Picture no.2. Macroscopic image of enlarged left para-aortic lymphnode
DISCUSSION
4 epithelium.4 These are the cells that make sperm. The 2 main types of germ cell tumors (GCTs) in men are Seminomas and Non-seminomas, which are made up of embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and/or teratoma.6 These 2 types occur about equally. Many testicular cancers contain both seminoma and nonseminoma cells. These mixed germ cell tumors are treated as non-seminomas because they grow and spread like non-seminomas.5 Testicular cancer is not common; about 1 of every 263 males will develop testicular cancer at some point during his life. The average age at the time of diagnosis of testicular cancer is about 33. This is largely a disease of young and middle-aged men, but about 7% of cases occur in children and teens, and about 7% occur in men over the age of 55. Because testicular cancer usually can be treated successfully, a man’s lifetime risk of dying from this cancer is very low: about 1 in 5,000.5 There have been substantial advances in the treatment of testicular cancer. Fifty years ago, a diagnosis of metastatic testicular cancer meant a 90% chance of death within 1 year. Today, a cure is expected in 95% of all patients who have received a diagnosis of testicular cancer and in 80% of patients with metastatic disease.7
REFERENCES
1. Richie JP, Steele GS. Neoplasm of testis. In: Walsh PC, Retik AB, Vaughan ED Jr, et al, eds. Campbell’s urology. 8th ed. Philadelpia: WB Saunders; 2002.
2. Andayani YD, Syafei S. Pattern of germ cell testicular carcinoma in Dharmais Cancer Hospital between January 2000 – December 2004. Acta Med Indones-Indones J Intern Med. 2008;40(1):11–3.
3. Suprabawati TE, Umbas R. Karakteristik dan faktor-faktor prediktif tumor testis dewasa di Jakarta. Jakarta 2006.
5 5. American Cancer Society. Testicular Cancer.
http://www.cancer.org/cancer/testicularcancer/detailedguide/testicular-cancer-pdf23
6. European Association of Urology. Guidelines on Testicular Cancer. March 2015 7. Dan L. Longo, M.D., Editor. Testicular Cancer — Discoveries and Updates. N
