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Regression of metastatic seminoma in a patient referred for carcinoma of unknown primary origin

Nature Reviews Urology volume 7, pages 466–470 (2010)Cite this article

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Abstract

Background. A 63-year-old man presented to an emergency department with abdominal and back pain. A 5 × 3 × 2 cm para-aortic mass was found adjacent to the left kidney, but the location of the primary tumor could not be identified. He was referred to a tertiary center with a diagnosis of retroperitoneal carcinoma of unknown primary origin. Atrophy of the left testicle was noted. Review of the biopsy material obtained at the first presentation showed histology characteristic of seminoma, and imaging revealed the presence of small intratesticular lesions. Repeat CT showed complete resolution of the metastatic para-aortic mass. The patient underwent left orchiectomy and adjuvant radiation therapy, and showed no signs of disease 6 months later.

Investigations. CT of the chest, abdomen and pelvis, measurement of serum tumor markers, upper gastrointestinal endoscopy, colonoscopy, PET–CT and percutaneous needle biopsy of the para-aortic mass at the first presentation; physical examination, review of biopsy specimen with immunohistochemical staining for tumor markers, testicular ultrasonography and repeat CT of the chest, abdomen and pelvis at the second presentation.

Diagnosis. Metastatic seminoma with spontaneous regression of the metastatic lesion.

Management. Radical orchiectomy and adjuvant radiation therapy.

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Figure 1: CT scan demonstrating 5 × 3 × 2 cm mass adjacent to the left kidney.
Figure 2
Figure 3: Photomicrographs showing histology of the metastatic and primary tumors, both of which are compatible with seminoma.

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Authors and Affiliations

  1. Department of Urology, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, 96859, HI, USA

    John E. Musser

  2. Department of Pathology, Memorial Sloan–Kettering Cancer Center, 1275 York Avenue, New York, 10065, NY, USA

    Christopher G. Przybycin

  3. Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan–Kettering Cancer Center, 353 E 68th St, New York, 10021, NY, USA

    Paul Russo

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Correspondence to Paul Russo.

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Musser, J., Przybycin, C. & Russo, P. Regression of metastatic seminoma in a patient referred for carcinoma of unknown primary origin. Nat Rev Urol 7, 466–470 (2010). https://doi.org/10.1038/nrurol.2010.99

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