A 20-year-old patient presented to the emergency department with a large right testicular tumor of several months duration.
The patient reported back pain and no other symptoms.
Examination and ultrasound demonstrate the existence of a large testicular tumor with retroperitoneal lymph node involvement.
The simple chest X-ray shows the presence of multiple pulmonary metastases that are confirmed by CT, as well as multiple inguinal and paratracheal lymphadenopathies.
Analytical analysis showed a β-HCG of 17702 mIU/ml and an α-FP of 28025 ng/ml.
In October 2002, right radical orchiectomy was performed with an anatomopathological result of mixed germ cell tumor (composite of embryonal carcinoma, yolk sac tumor, mature and immature teratoma and seminomatous carcinoma).
Tumor stage was T3N3M1a (stage IIIC).
After several cycles of aggressive chemotherapy according to the BOMP/EPI scheme, there is a partial response to it with a reduction in lung metastases, but there is a large residual mass in the CAT scan performed, which requires the same surgical approach.
1.
After adequate preoperative study, we proceeded to perform retroperitoneal lymphadenectomy and excision of residual mass by mid-xiphopoubic laparotomy approach.
The mass encompassed, as can be seen in the CT scan, the great vessels from the left renal vein to the bifurcation of the superficial and deep left iliac arteries and to a lesser extent on the right side.
After a complex intervention, complete excision of the mass was achieved, resulting in the images shown in Figs.
3 and 4.
1.
Pathological study of the mass revealed a mature teratomatous tumor.
Currently, the patient is assessed by on-demand chemotherapy if new cycles of post-surgery are required to remit pulmonary metastases.
