Late Relapse of Testicular Seminoma Revealed by Gastric Metastasis: A Rare Case

Testicular cancer is the most common neoplasia in young males. For seminoma, 80% are diagnosed with clinical stage I disease and presents excellent survival rate (>99%) with appropriate management plan [1]. Orchiectomy represents the standard of care, with surveillance in low- risk patient (0 or 1 factor) and surveillance versus adjuvant therapy (Carboplatin AUC 7 or 20-30 Gy if chemotherapy not achievable) according to higher-risk patient (both rete testis infiltration and lesion size > 4 cm) [2,3]. Metastases usually concerns retroperitoneal lymph nodes via lymphatic system and lungs, liver and bones via hematogenous spread. Gastric involvement is rare [4]. Late relapse (> 3 years) of clinical stage 1 seminoma is very rare with 0.2% patients only and chemotherapy (+/- surgery) appears to be the treatment of choice [5,6]. In clinical stage 1 non-seminoma testicular tumor, lymphovascular infiltration increases risk of recurrence and vascular invasion alone is considered the most important predictor of relapse and stratifies into low-risk (surveillance) or high-risk (adjuvant chemotherapy with one cycle of BEP) [7].