Primary testicular teratoma with cystic retroperitoneal metastases

Czech version

Authors: Martin Šabík ^1,2; Alice Hlobilková ³; Radek Lakomý ⁴; Roman Hrabec ^1,2; Michal Staník ^1,2
Authors‘ workplace: Oddělení urologické onkologie, MOÚ, Brno ¹; Klinika operační onkologie LF MU a MOÚ, Brno ²; Oddělení onkologické patologie, MOÚ, Brno ³; Klinika komplexní onkologické péče LF MU a MOÚ, Brno ⁴
Published in: Ces Urol 2025; 29(1): 29-33
Category: Case report
doi: https://doi.org/10.48095/cccu2025001

Overview

We report a rare case of primary post-pubertal testicular teratoma with
retroperitoneal cystic metastases and negative serum tumor markers. Primary retroperitoneal lymph node dissection is preferred over chemotherapy, minimizing morbidity, as retroperitoneal metastases are likely composed of teratoma in such scenarios.

Pure testicular teratomas are exceptionally rare among nonseminomatous germ cell tumors (NSGCT). Despite their limited chemosensitivity, upfront chemotherapy is recommended for metastatic patients due to the potential presence of another NSGCT subtype alongside teratoma in metastases. We present a case report of a patient with primary post-
-pubertal teratoma and retroperitoneal cystic metastases, along with negative serum tumor markers – an exceedingly rare clinical scenario. In such cases, cystic retroperitoneal metastases are highly likely to be formed by teratoma, making primary retroperitoneal lymph node dissection a preferred option over chemotherapy, which would be ineffective in such a patient.

Keywords:

lymph node metastasis, teratoma, testicular cancer

Sources

1. Patrikidou A, Cazzaniga W, Berney D et al. European Association of Urology Guidelines on testicular cancer: 2023 Update. Eur Urol 2023; 84(3): 289– 301. doi: 10.1016/ j.eururo.2023.04.010.

2. Heidenreich A, Moul JW, McLeod DG et al. The role of retroperitoneal lymphadenectomy in mature teratoma of the testis. J Urol 1997; 157(1): 160– 163.

3. Rabbani F, Farivar-Mohseni H, Leon A et al. Clinical outcome after retroperitoneal lymphadenectomy of patients with pure testicular teratoma.
Urology 2003; 62(6): 1092– 1096. doi: 10.1016/ s0090-4295(03)00770-2.

4. Leibovitch I, Foster RS, Ulbright TM et al. Adult primary pure teratoma of the testis. The Indiana experience. Cancer 1995; 75(9): 2244– 2250.
doi: 10.1002/ 1097-0142(19950501)75:9<2244::aid-cncr2820750909>3.0.co;2-i.

5. Neuenschwander A, Lonati C, Antonelli L et al. Treatment outcomes for men with clinical stage II nonseminomatous germ cell tumours treated with primary retroperitoneal lymph node dissection: a systematic review. Eur Urol Focus 2023; 9(3): 541– 546. doi: 10.1016/ j.euf.2022.11.003.

6. Cary C, Kern SQ, Jacob JM et al. Management of metastatic pure teratoma in chemotherapy naive patients with testicular primaries. Am J Clin Oncol 2020; 43(10): 690– 693. doi: 10.1097/ COC.0000000000000731.

7. Howitt BE, Berney DM. Tumors of the testis: morphologic features and molecular alterations. Surg Pathol Clin 2015; 8(4): 687– 716. doi: 10.1016/
j.path.2015.07.007.

8. Liu NW, Cary C, Strine AC et al. Risk of recurrence for clinical stage I and II patients with teratoma only at primary retroperitoneal lymph node dissection. Urology 2015; 86(5): 981– 984. doi: 10.1016/ j.urology.2015.06.004.

9. Stella M, Gandini A, Meeus P et al. Retroperitoneal vascular surgery for the treatment of giant growing teratoma syndrome. Urology 2012; 79(2): 365– 370. doi: 10.1016/ j.urology.2011.08.076.

10. Hiester A, Nettersheim D, Nini A et al. Management, treatment, and molecular background of the growing teratoma syndrome. Urol Clin North Am 2019; 46(3): 419– 427. doi: 10.1016/ j.ucl.2019.04.008.