Pulmonary metastasis: Very late relapse of testicular embryonal carcinoma

Abstract

Testicular carcinoma recurrences represent a rare finding (1-6% in non-seminomatous germ cell tumours). However, cases of recurrence have been described many years later. We report a case of late recurrence of embryonic testicular carcinoma, after 26 years, with pulmonary metastases. Following evidence of increase of alpha-fetoprotein (AFP), the patient underwent a total body computed tomography scan that exhibited two pulmonary nodules, one in upper left lobe and other in left hilar region with multiple mediastinal and retrocrural lymph node enlargements All consolidations showed increased sugar uptake value at PET CT. Biopsies of lung consolidations confirmed diagnosis of recurrence of testicular carcinoma. [1]. However, very late recurrences of testicular cancers that occur even more than 5 years after the treatment are reported. The most frequent location of LR of testicular cancers is the retroperitoneal space, while the lungs and the mediastinal lymphnodes are less frequently involved [1]. When it is located in lung, differential diagnosis with primary lung cancer is required; in these cases, histological assessment and bio-molecular profiling assist diagnosis [2-7]. Chemo-resistance is common in late relapses especially of nonseminomatous germ cell tumours, resulting in poor prognosis [8].