Testicular mixed germ cell tumour with isolated skip metasta
Testicular neoplasms although are very rare, accounting for 1% of the malignancies in men. The majority of the germ cell tumours metastasize to the lymph nodes in a characteristic pattern, although choriocarcinoma preferentially has hematogenous spread.

21-year-old male with history of left sided testicular swelling with increased alfa fetoprotein levels (10,789 IU/ml) and beta-human chorionic gonadotropin levels (66.05 mIU/ml) with normal chest radiograph, underwent left high inguinal orchidectomy in December 2016 in the outside hospital. Histopathology report of the specimen was suggestive of “Mixed seminomatous and non seminomatous germ cell tumour with yolk sac tumour (40%), mature teratoma (55%) and seminoma (5%)”. Positron emitted tomography was done 1 month later post orchidectomy suggestive of “Diffuse metabolic activity seen in the left hemi-scrotum is secondary to recent surgery. There is no metabolically active lymph node, pleural, peritoneal, omental, solid visceral, osseous lesion, ascites or pleural effusion. Isolated non metabolic nodule in the left upper lobe and left lower lobe of the lung would need serial follow up”.

Patient was asymptomatic for next 9 months and didn’t come for the regular follow-ups until he developed chest pain, breathlessness and severe back pain.

Computed tomography of the chest done in September 2017 suggestive of “Area of collapse-consolidation in the periphery of apical-posterior segment of left upper lobe of lung and another well-defined oval radiopacity with sharp borders is noted in superior segment of lower lobe of left lung with left hydropneumothorax- nonspecific morphology probably of benign aetiology”.

Source: Intenational journal of surgery case reports

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