Dados do Trabalho

Título

SYNCHRONOUS TESTICULAR SEMINOMA AND NEUROENDOCRINE LUNG TUMOR: AN ATYPICAL PRESENTATION

Apresentação do caso

A 24-year-old patient with no comorbidies and no relevant past medical history or family history noted a mass in his right testicule in March 2020. Computed tomography (CT) scans showed a lung nodule in the right lower lobe, measuring 1.8 cm and a liver nodules in the segments IVa and VIII, measuring up to 2.5 cm, in addition to the testicular mass with 7.5 x 11 cm. Patient was submitted to unilateral radical orchiectomy in 04/25/2020. Pathology report showed a 10.1 x 6.2 cm seminoma of right testicule, pathological staging was pT2. Pre and post operative tumor markers were normal. Patient was staged as IIIc and received systemic therapy with 4 cycles of vimblastin, ifosphamide and cisplatin. Cycle one was 06/23/2020 and cycle 4 was 08/25/2020. Treatment was well tolerated without significant treatment related adverse events.
Post chemotherapy CT scans performed on 10/10/2020 showed reduction of hepatic nodules from 2.5 cm to 2 cm and stability of pulmonary nodule. Due to the poor response to chemotherapy, it was decided to investigate liver and lung nodule with a biopsy, which was done in 11/24/2020. Pathological reports revealed solid neoplasia of small cells with organoid areas and immunohistochemistry characterizing small cell neoplasia with neuroendocrine differentiation in lung and liver with Ki 67 of 2%. A PET-CT DOTATOC was obtained to stage this neuroendocrine tumor and the results showed right pulmonary nodule, hepatic nodule and right pulmonary hilar lymph nodes presenting marked hyperexpression of somatostatin receptors, consistent with implants secondary to neoplasm of neuroendocrine origin in liver two nodule, the bigger with 2 cm. In view of a metastatic neuroendocrine tumor, the patient started treatment with sandostatim on 02/19/2021. Last CT scans done in 07/02/2021 showed stable disease in lung and liver.

Discussão

Seminoma is the most common testicle tumor in adults, accounting for about one-third of all germ cell malignancies. It is commonly treated with radical orchiectomy via inguinal route with a high chance of cure, even in advanced stages of the disease. In metastatic intermediate risk tumors the recommendation is for systemic treatment with the VIP or BEP scheme. However, low grade neuroendocrine tumors do not respond to this type of therapy, and other treatments are then indicated.

Comentários finais

The association between two distinct primary ones is uncommon and should be suspected when there is no response to the therapy of choice for germ cell tumors.

Palavras-chave

Testicular seminoma; neuroendocrine tumor