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Case Reports in Urology
Volume 2013 (2013), Article ID 495743, 2 pages
http://dx.doi.org/10.1155/2013/495743
Case Report

A Case of Adrenal Metastasis in Seminoma

1Department of Urology, Paris Saint Joseph Hospital Group, 185 Rue Raymond Losserand, 75014 Paris, France
2Department of Pathology, Paris Saint Joseph Hospital Group, 185 Rue Raymond Losserand, 75014 Paris, France

Received 15 May 2013; Accepted 15 June 2013

Academic Editors: J. P. Gearhart, C. Liao, and F. M. Solivetti

Copyright © 2013 Bouabdallah Zakaria 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

We report an uncommon case of testicular cancer with adrenal metastasis without retroperitoneal or distant metastatic disease. This situation is highly unusual. In fact, no similar case was reported in the literature. Our case is the first adrenalectomy that has been performed for secondary localization of testicular cancer. After eighteen-month followup, the patient was doing well, with no evidence of disease.

1. Case

A 53-year-old patient underwent a right radical orchiectomy after he noted a testicular mass on self-examination. Pathology revealed a testicular seminoma. He received 3 cycles of bleomycin, etoposide, and cisplatin associated with radiotherapy of iliac and retroperitoneal lymph nodes. Five years later, he presented a contralateral seminoma, which was treated by radical orchiectomy and 4 cycles of etoposide and cisplatin. A CT scan Nine years later showed a mass of the right adrenal gland with fixation at PET scan associated with a preaortic lymph node fixation. Tumor markers were negative (alpha-fetoprotein and beta-human chorionic gonadotrophin). No evidence was found for other distant metastases. A right adrenalectomy with lymph node dissection was performed by laparoscopy. Pathologic examination showed an adrenal metastasis of a testicular seminoma without lymph node metastasis (Figures 1, 2, and 3). The patient is disease free at last followup 18 months after surgery.

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Figure 1: Macroscopic aspect of the tumor.
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Figure 2: Standard coloration with hematoxylin and eosin showing both tumor and normal adrenal glands (×20).
fig3
Figure 3: Seminoma cells markers expression (a) CD 117 and (b) PLAP.

2. Comment

Testicular cancer is the first solid tumor in young men between 20 and 30 years old [1]. Seminoma has a high metastatic capacity. Metastases initially occur in the retroperitoneal nodes before additional systemic involvement [2]. The most common metastatic sites of germinal tumors are the lungs, liver, central nervous system, and bone [2, 3]. Other localizations are atypical. Cases of isolated metastases were reported in the literature: spleen, skin, prostate [46], and so forth. Isolated adrenal metastasis of seminoma is uncommon, and, to our knowledge, this is the first case reported. PET scan can help diagnose difficult cases [7]. The treatment of metastasis is based on chemotherapy. However, surgery may be indicated in the following cases: diagnostic doubt, functional repercussion, or residual mass [3].

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