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Case Reports in Oncological Medicine
Volume 2017, Article ID 2457023, 5 pages
https://doi.org/10.1155/2017/2457023
Case Report

Pure Testicular Seminoma Relapsing Late with Somatic Type Malignancy

1Department of Urology, Albertinen-Krankenhaus Hamburg, Süntelstrasse 11a, 22457 Hamburg, Germany
2Department of Diagnostic Radiology, Albertinen-Krankenhaus Hamburg, Süntelstrasse 11a, 22457 Hamburg, Germany
3Institute of Pathology, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany

Correspondence should be addressed to Klaus-Peter Dieckmann; ed.enilno-t@pknnamkceid

Received 15 January 2017; Accepted 27 February 2017; Published 7 March 2017

Academic Editor: Didier Frappaz

Copyright © 2017 Klaus-Peter Dieckmann et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Somatic type malignancy (STM) occurs in 2% of all germ cell tumours (GCTs). The prognosis is unfavourable and the origin is poorly understood. Pathogenetic hypotheses involve direct transformation of teratoma, origin from totipotent cancer cells, or derivation from yolk sac tumour elements. Case Presentation. A 31-year-old patient was cured from testicular seminoma clinical stage IIc by orchiectomy and cisplatin-based chemotherapy. Nine years later, he experienced a late relapse with a mass sized  cm located at the former metastatic site. As no remission occurred after chemotherapy with three cycles of cisplatin, ifosfamide and etoposide, the mass was surgically resected. Histologically, the specimen consisted of neurofibroma with areas of malignant peripheral nerve sheath tumour and spots with mature bone formation. FISH analysis disclosed isochromosome 12p in the majority of evaluated cells suggesting somatic type malignancy (STM) of GCT. The patient is well 1 year after surgery. Conclusion. The pathogenesis of this STM remains enigmatic. The origin from GCT was evidenced by documentation of isochromosome 12p. Unrecognized teratomatous elements in the primary and totipotent cancer cells surviving the first chemotherapy could be hypothesized to represent the origin. STM developing from seminoma cells would be another novel hypothesis.