University of Missouri Kansas City School of Medicine Overland Park, KS, United States
Adel Muhanna, MD1, Laith Al Momani, MD2, Fadi Hamid, MD3 1University of Missouri Kansas City School of Medicine, Kansas City, MO; 2UMKC, Kansas City, MO; 3University of Missouri Kansas City, Kansas City, MO
Introduction: Testicular malignancies account for 1% of cancers in men, and most commonly affect ages between 15 and 35 1. Testicular cancer usually presents as a painless testicular nodule 3. However, patients can rarely present with symptoms attributable to metastatic disease. Gastrointestinal (GI) involvement with testicular cancer is exceedingly rare. We present a case of a testicular seminoma patient who presented with abdominal pain from intestinal metastases.
Case Description/Methods: A 42-year-old male without significant past medical or surgical history was admitted with complaints of progressive right upper quadrant abdominal pain of 1 month duration. He denied overt GI bleeding but did endorse constipation and weight loss of about 20lbs over the past two months along with intermittent night sweats. Initial laboratory results were unremarkable. Computed tomography of the abdomen and pelvis on admission showed a mass-like thickening of the small bowel with dilated segments and scattered enlarged retroperitoneal and mesenteric lymph nodes (Figure 1A). The patient then underwent a push enteroscopy that revealed (endoscopic description of lesions) (Figure 1B). Pathology results from the intestinal lesions showed malignant proliferation of large polygonal cells in sheet-like arrangements. Immunostains showed expression of SALL-4 and KIT (CD117), supporting the diagnosis of germ cell tumor. Further physical exam revealed tenderness in the right testicle. Scrotal ultrasound was then performed and showed a hypoechoic right testicle. The patient had a lactic dehydrogenase level of 834 IU/L, hCG serum level of 3 mIU/mL, alpha-fetoprotein level of 2.3 ng/mL, and a uric acid level of 5.5 mg/dL The patient was diagnosed with metastatic testicular seminoma to the small bowel and was subsequently scheduled for chemotherapy and outpatient follow up.
Discussion: We described an unusual case of a 42-year-old man, who presented with GI symptoms, as the initial manifestation of testicular seminoma with small bowel metastases. Testicular germ cell tumor metastases to the upper GI tract occur in less than 5% of cases4, and seminomas are even less likely to do so5. Although chemotherapy showed success in the treatment of metastatic seminoma, patients with upper GI metastasis are considered high risk 6 and may require a prompt surgical intervention. The prognosis of metastatic seminomas generally depends on the metastatic site, with the GI having a less favorable prognosis7.
Figure: Figure 1A: Computed tomography scan demonstrating a mass-like thickening of the small bowel with dilated segments and scattered lymph nodes (arrow). Figure 1B: Push enteroscopy showing a mass in the proximal duodenum.
Adel Muhanna indicated no relevant financial relationships.
Laith Al Momani indicated no relevant financial relationships.
Fadi Hamid indicated no relevant financial relationships.
Adel Muhanna, MD1, Laith Al Momani, MD2, Fadi Hamid, MD3. P1990 - Testicular Seminoma With Small Bowel Metastasis as a Presentation, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.