|
|
Mesenteric metastases from mature teratoma of the testis: A case report |
Zoe Loha,b,Todd G. Manninga,b,*(),Jonathan S. O’Briena,b,Marlon Pereraa,b,c,Nathan Lawrentschuka,c,d,e
|
a Department of Surgery, University of Melbourne, Austin Health, Melbourne, Australia b The Young Urology Researchers Organisation (YURO), Australia c Faculty of Medicine, University of Queensland, Brisbane, Australia d Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia e Olivia Newton-John Cancer Research Institute, Melbourne, Australia |
|
|
Abstract Metastatic spread of testicular cancer has been well documented, with 95% of cases involving para-aortic retroperitoneal lymph nodes. Mesenteric lymphatic basins do not lie within the canonical drainage pathway of the testes and represent a rare site of metastasis. Various mechanisms of spread to the mesentery have been described, including direct extension and haematogenous dissemination. We present a case of a previously-well 43-year-old man who presented with right scrotal discomfort and intermittent lower back pain, who was found to have mesenteric metastases from a non-seminomatous germ cell tumour of the testis. Managing lymphadenopathy that lies outside of standard resection templates remains a complex surgical challenge. Here we present the first case in the English medical literature with co-existing supradiaphragmatic axillary and mediastinal nodal disease.
|
Received: 12 January 2018
Available online: 20 July 2020
|
Corresponding Authors:
Todd G. Manning
E-mail: doctor.tmanning@gmail.com
|
|
|
|
Pre- and postoperative imaging results. (A) Computed tomography (CT) images of the abdomen prior to chemotherapy show markedly enlarged, centrally hypodense lymph nodes in the retroperitoneum and mesentery; (B) Postoperative CT images demonstrate complete resection of abdominal masses.
|
|
Photo of resected mesenteric lymph nodes. The largest was 165 mm in width.
|
|
Intraoperative image of the mesenteric tumour resection.
|
[1] |
Stevenson SM, Lowrance WT. Epidemiology and diagnosis of testis cancer. Urol Clin N Am 2015; 42:269-75.
|
[2] |
Pano B, Sebastia C, Bunesch L, Mestres J, Salvador R, Macias NG, et al. Pathways of lymphatic spread in male urogenital pelvic malignancies. Radiographics 2011; 31:135-60.
|
[3] |
Sheth S, Horton KM, Garland MR, Fishman EK. Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiographics 2003; 23:457-73. quiz 535-6.
|
[4] |
Donkol RH, Monib S, Eltounsi I. Occult testicular teratoma presenting with solid mesenteric metastasis. J Ultrasound Med 2007. 26. 675-8. https://doi.org/10.1016/j.urology.2013.11.003.
|
[5] |
Djaladat H, Movassaghi K, Ahmadi H, Nichols CR, Daneshmand S. Mesenteric lymphadenopathy in testicular germ cell tumor. Urology 2014; 83:e7-8.
|
[6] |
Park JM, Charnsangavej C, Yoshimitsu K, Herron DH, Robinson TJ, Wallace S. Pathways of nodal metastasis from pelvic tumors: CT demonstration. Radiographics 1994; 14:1309-21.
|
[7] |
Sweetenham JW, Whitehouse JM, Williams CJ, Mead GM. Involvement of the gastrointestinal tract by metastases from germ cell tumors of the testis. Cancer 1988; 61:2566-70.
|
[8] |
Chait MM, Kurtz RC, Hajdu SI. Gastrointestinal tract metastasis in patients with germ-cell tumor of the testis. Am J Dig Dis 1978; 23:925-8.
|
[9] |
Heidenreich A, Pfister D. Retroperitoneal lymphadenectomy and resection for testicular cancer: an update on best practice. Ther Adv Urol 2012; 4:187-205.
|
[10] |
Hartmann JT, Schmoll HJ, Kuczyk MA, Candelaria M, Bokemeyer C. Postchemotherapy resections of residual masses from metastatic non-seminomatous testicular germ cell tumors. Ann Oncol 1997; 8:531-8.
|
[1] |
Christian Winter,Andreas Hiester. Treatment of clinical stage I non-seminoma[J]. Asian Journal of Urology, 2021, 8(2): 161-169. |
[2] |
Fangyuan Zhang,Gang Zhao,Pengjie Wu,Qi An,Yang Yang,Xin Chen,Jianye Wang,Dong Wei. Asynchronous abdominal wall and sigmoid metastases in clear cell renal cell carcinoma: A case report and literature review[J]. Asian Journal of Urology, 2019, 6(2): 210-214. |
[3] |
Su Jiarui,Jonathan Aslim Edwin,Aydin Hakan,HoonTan Puay,Sun SienHo Henry. A rare case of isolated castrate resistant bilateral testicular metastases in advanced prostate cancer[J]. Asian Journal of Urology, 2018, 5(2): 127-130. |
[4] |
Marcus Chow, Arianto Yuwono, Ronny Tan. Tumour lysis syndrome: A rare acute presentation of locally advanced testicular cancer-Case report and review of literature[J]. Asian Journal of Urology, 2016, 3(1): 49-52. |
|
|
|
|