Bilateral and synchronous testicular teratoma: a case report and literature review

BackgroundTesticular germ-cell carcinoma is the most frequent neoplasm in males aged 15–35 years old. It is bilateral in 2–3%, and synchronous in 20–25% of the cases.Clinical caseThe case is presented of a 19 year-old male, with abdominal pain. Physical examination revealed abdominal mass in the umbilical region, and the computed tomography scan showed a retroperitoneal tumor, with α-fetoprotein, lactate dehydrogenase, and human chorionic gonadotropin above limits. Testicular ultrasound showed bilateral lesions. Exploratory laparotomy was performed, identifying an unresectable retroperitoneal tumor. Biopsies were taken, reporting mixed germ cell tumor composed of choriocarcinoma and embryonal carcinoma. Six cycles of chemotherapy were given, based on bleomycin, etoposide and cisplatin, with partial tumor response. Later on, the patient underwent bilateral radical orchiectomy, with pathology reporting a synchronous bilateral testicular teratoma. A second line of chemotherapy was given, based on vincristine, etoposide, ifosfamide and cisplatinum. Nevertheless, the disease progressed, with metastatic dissemination and the patient died.DiscussionGerm cells tumors can be presented in primary extra-gonadal locations. It is difficult to distinguish a retroperitoneum primary germ cell tumor from metastatic disease of a clinically undetected gonadal tumor or one that has regressed, like the situation described in the case presented.ConclusionsNinety percent of patients diagnosed with germ cell tumors can be cured. However, delay in diagnosis correlates with an advanced clinical stage and poor prognosis