Testicular Embryonal Carcinoma.
Testicular Embryonal Carcinoma
1
2
2
Yohanes Putra Mbama , Gede Budhi Setiawan , Tjakra Wibawa Manuaba ,
1
General Surgery Resident, Medical Faculty, Udayana University, Denpasar, Indonesia
2
Division of Oncology, Department of Surgery, Medical Faculty, Udayana University-Sanglah
Hospital, Denpasar, Indonesia
Abstract
Embryonal cell carcinoma of testis is a rare case commonly found in younger males, aged 15 –
35 years old. Majority of tumours already having metastased at the time of diagnosis. Ethiology
of testicular cancer are not well understood, mostly derived from germinative cells.
A 35-year-old male with left testicular carcinoma were reported. The patient underwent
orchidectomy and the patology result was an embryonal cell carcinoma. Four series of TAP
regiment chemotherapy were administered. A left paraaortic node enlargement was identified
from abdominal Ct-scan 5 months after chemotherapy. Retroperitoneal lymph node dissection
(RPLND) were performed and the pathology result showed a mucinous cyst adenocarcinoma.
Keyword: testicular embryional carcinoma, metastasis
1
INTRODUCTION
Testicular cancer is a very rare kind, making up 1% of all malignancies in male.
Although it occurs at any age, two third of testicular cancers occur at 25 – 35 years of
age. Survival rate have been changed dramatically due to combination of many factors,
including proper diagnostic techniques, increased serum tumor markers, multi-drug
chemotherapy regimens, which claimed to decrease the mortality rate from 50% in the
70’s into less than 5% at the end of 90’s. Seminoma is the most common type of
histopathology with the incidence of 30 – 60%, followed by pure embryonal carcinoma 3
– 4% that include 40% of nonseminoma, 5-10% teratoma and 1% pure choriocarcinoma.
While mixed germ cell tumor may reach 60% of all germinal tumor cell.1 Study from
Dharmais Cancer Hospital in 2002-2004 showed similar incidence of such
histopathological types, i.e. seminoma (47.5 %), non-seminoma (40 %) and mixed germ
cell tumor (12.5%).2 A study in two hospitals in Jakarta found 149 new cases of testicular
cancer in a 10-year period.3
CASE REPORT
A 34-year-old male came to outpatient clinic for regular follow-up after left orchiectomy
6 months earlier. He had an operative history of left orchidectomy 6 months earlier back.
Histopathological report showed embryonal carcinoma with a clinical stage of
pT3pNxpMx. Four series of TAP chemotherapy regiment was administered.
On physical examination, he had a single right testes with scar on the left scrotum. Blood
investigations were within normal limits, except a leukocytes of 27,7 x 103/uL. Alphafeto-protein levels were 2,0 IU/mL, serum lactate dehydrogenase (LDH) was 320 U/L
(160 – 420) and serum beta human chorionic gonadotropin (HCG) was
1
2
2
Yohanes Putra Mbama , Gede Budhi Setiawan , Tjakra Wibawa Manuaba ,
1
General Surgery Resident, Medical Faculty, Udayana University, Denpasar, Indonesia
2
Division of Oncology, Department of Surgery, Medical Faculty, Udayana University-Sanglah
Hospital, Denpasar, Indonesia
Abstract
Embryonal cell carcinoma of testis is a rare case commonly found in younger males, aged 15 –
35 years old. Majority of tumours already having metastased at the time of diagnosis. Ethiology
of testicular cancer are not well understood, mostly derived from germinative cells.
A 35-year-old male with left testicular carcinoma were reported. The patient underwent
orchidectomy and the patology result was an embryonal cell carcinoma. Four series of TAP
regiment chemotherapy were administered. A left paraaortic node enlargement was identified
from abdominal Ct-scan 5 months after chemotherapy. Retroperitoneal lymph node dissection
(RPLND) were performed and the pathology result showed a mucinous cyst adenocarcinoma.
Keyword: testicular embryional carcinoma, metastasis
1
INTRODUCTION
Testicular cancer is a very rare kind, making up 1% of all malignancies in male.
Although it occurs at any age, two third of testicular cancers occur at 25 – 35 years of
age. Survival rate have been changed dramatically due to combination of many factors,
including proper diagnostic techniques, increased serum tumor markers, multi-drug
chemotherapy regimens, which claimed to decrease the mortality rate from 50% in the
70’s into less than 5% at the end of 90’s. Seminoma is the most common type of
histopathology with the incidence of 30 – 60%, followed by pure embryonal carcinoma 3
– 4% that include 40% of nonseminoma, 5-10% teratoma and 1% pure choriocarcinoma.
While mixed germ cell tumor may reach 60% of all germinal tumor cell.1 Study from
Dharmais Cancer Hospital in 2002-2004 showed similar incidence of such
histopathological types, i.e. seminoma (47.5 %), non-seminoma (40 %) and mixed germ
cell tumor (12.5%).2 A study in two hospitals in Jakarta found 149 new cases of testicular
cancer in a 10-year period.3
CASE REPORT
A 34-year-old male came to outpatient clinic for regular follow-up after left orchiectomy
6 months earlier. He had an operative history of left orchidectomy 6 months earlier back.
Histopathological report showed embryonal carcinoma with a clinical stage of
pT3pNxpMx. Four series of TAP chemotherapy regiment was administered.
On physical examination, he had a single right testes with scar on the left scrotum. Blood
investigations were within normal limits, except a leukocytes of 27,7 x 103/uL. Alphafeto-protein levels were 2,0 IU/mL, serum lactate dehydrogenase (LDH) was 320 U/L
(160 – 420) and serum beta human chorionic gonadotropin (HCG) was