Burned-out testicular tumor with retroperitoneal lymph node metastasis: a case report

Abstract:

Introduction:
A burned-out seminoma of the testis is an exceptionally rare clinical entity, with few reports found in the literature.

Case presentation:
A case of burned-out tumor of the testis in a 31-year-old man is reported. The tumor presented as a retroperitoneal mass with histological characteristic of a seminoma. The testes on clinical examination were normal, and a suspicious lesion in the scrotum was only identified after ultrasound. Incision of the abdominal mass was decided, followed by orchectomy. Histological examination of the testis revealed a suspicious lesion with characteristics of spontaneous regression of germ cell tumors.

Conclusion:
We describe one of very few cases worldwide, where spontaneous regression of a primary testicular tumor occurred after demonstration of retroperitoneal lymph node metastasis, a phenomenon known as burned-out seminoma, which is hard to recognize and incompletely characterized by physicians.

Introduction
Seminoma is the most frequent carcinoma of the testicle in he fourth decade of life and constitutes 60% to 65% of germ cell neoplasias. Several histopathologic characteristics of the tumor have been evaluated and three types of pure seminoma have been described as follows: a) classic, b) anaplastic and c) spermatocytic. Internationally, three clinical stages for the determination of the extension of the tumor are admissible. Stage I is where the tumor is limited to the testis with or without invasion of epididymis or the spermatic cord. In Stage II the tumor has retroperitoneal lymph node metastases. Finally, in Stage III the tumor has distant metastases.

The germ cell tumor often gives lymph node metastasis, except from choriocarcinoma, which in an aggressive fashion is characterized by early hematogenous spread. We describe one of the very few cases worldwide where the spontaneous regression of a primary testicular tumor occurred after demonstration of retroperitoneal lymph node metastasis, a phenomenon known as burned-out seminoma.
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