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CASE REPORT
Year : 2012  |  Volume : 1  |  Issue : 2  |  Page : 122-123

Primary extragenital retroperitoneal seminoma in an HIV positive man


Department of General Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India

Date of Web Publication11-Jul-2012

Correspondence Address:
Bhavani R Reddi
Associate Professor of Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.98362

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  Abstract 

Germ cell tumors in the male usually present as a swelling in the testis. Approximately, 1-2% of germ cell tumors arise in extragonadal locations. These tumors often grow to a considerable size before symptoms arise. A mass of primary extragenital retroperitoneal seminoma in the hypogastric region causing intestinal obstruction is rare. Though intracranial primary seminoma in an HIV person reported before, we believe this is the first case of retroperitoneal primary seminoma reported in an HIV positive man.

Keywords: HIV positive, primary retroperitoneal seminoma, germ cell tumours


How to cite this article:
Korukonda B, Reddi BR. Primary extragenital retroperitoneal seminoma in an HIV positive man. J NTR Univ Health Sci 2012;1:122-3

How to cite this URL:
Korukonda B, Reddi BR. Primary extragenital retroperitoneal seminoma in an HIV positive man. J NTR Univ Health Sci [serial online] 2012 [cited 2019 Oct 24];1:122-3. Available from: http://www.jdrntruhs.org/text.asp?2012/1/2/122/98362


  Introduction Top


Germ cell tumors in the male are usually present as a swelling in the testis. Approximately, 1-2% of germ cell tumors arise in extragonadal locations. Though intracranial primary seminoma in an human immunodeficiency virus (HIV) person reported before, we believe this is the first case of primary extragenital retroperitoneal seminoma reported in an HIV positive man.


  Case Report Top


A 30-year-old man arrived with colicky abdominal pain and a lump in lower abdomen of 1 month duration. He was constipated for the last 2 days. Clinical examination revealed an ill-defined large, irregular, fixed mass in the hypogastric region. Both testes appeared normal.

Plain abdominal radiograph showed few fluid levels. He was tested positive for HIV. Abdominal ultrasonography revealed a well-defined solid mass in the infraumbilical region measuring 110 mm × 115 mm. It is compressing ureter causing mild hydronephrosis, suggesting its retroperitoneal position. The cause for subacute intestinal obstruction was revealed at the rectosigmoid junction in the form of extrinsic pressure. Subsequent CT scan confirmed the ultrasonic findings. FNAC suggested a germ cell tumor.

Blood tumor markers revealed a raised LDH, mildly raised β HCG, and normal alpha feta protein levels. The CD4 count was 465 cells/mm 3 . Staging investigations showed no evidence of metastases. The patient underwent exploratory surgery in view of the subacute intestinal obstruction. [Figure 1] and [Figure 2] Peroperatively, the mass was noticed in the lower abdomen, with adhesions between bowels and the tumor. Tumor was excised, thus relieving the pressure over the rectosigmoid junction. Biopsy demonstrated the features of seminoma. The patient has been treated with 4 cycles of etoposide and cisplatin, from which he had a good response. At 1 year follow-up, the patient remains disease free.
Figure 1: Peroperative picture of primary retroperitoneal seminoma

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Figure 2: Postoperative specimen of primary retroperitoneal seminoma

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  Discussion Top


Most of the extragonadal germ cell tumors arise either in the retroperitoneum or in the mediastinum. [1],[2] One case of primary germ cell tumor was reported in the intracranial location in an HIV patient. [3] This paper presents what appears to be the first case report of a primary germ cell tumor in an HIV patient at retroperitoneal site.

Extragonadal germ cell cancer usually presents as a bulky tumor, which has a tendency to wrap around and invade the surrounding vessels. [4],[5],[6] The extragonadal origin is now accepted, although with clinically normal testes occult or spontaneously-regressed testicular primary tumors may be difficult exclude. [7]

As only few cases of extragonadal seminoma with intestinal obstruction have so far been reported, no definite conclusion has been reached regarding the optimal therapy for advanced stage or for bulky local disease. Etoposide and cisplatin chemotherapy instituted postoperatively. [8],[9]


  Acknowledgement Top


Dr. Maithili, Dr. Vijaya Prasad

 
  References Top

1.Takeda S, Miyoshi S, Ohta M, Minami M, Masaoka A, Matsuda H. Primary germ cell tumors in the mediastinum: A 50-year experience at a single Japanese institution. Cancer 2003;97:367-76.  Back to cited text no. 1
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2.Bokemeyer C, Nichols RC, Droz JP, Schmoll HJ, Horwich A, Gerl A, et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum. J Clin Oncol 2002;20:1864-73.  Back to cited text no. 2
    
3.Alimehmeti R, Campanella R, Bauer D, Balbi S, Rampini P, Egidi M, et al. Intracranial metastasis of testicular seminoma in an HIV positive. Case report and review. J Neurooncol 2003;65:135-40.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Patel A, Wilson L, Rane A. Primary retroperitoneal seminoma presenting with Inferior vena caval obstruction. N Z Med J 2005;118:U1758.  Back to cited text no. 4
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5.Iwagaki H, Fuchimoto S, Yunoki S, Higuchi Y, Akagi S, Orita K. Extragonadal sacrococcygeal seminoma -A case report. Jpn J Surg 1990;20:225-8.  Back to cited text no. 5
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6.Sparks D, Chase D, Forsyth M, Ghani A, Segall G. A rare case of primary extragenital retroperitoneal carcinosarcoma with review of the literature. J Gynecol Pathol 2010;13:73-9.  Back to cited text no. 6
    
7.Balzer BL, Ulbright TM. Spontaneous regressio n of testicular germ cell tumors: An analysis of 42 cases. Am J Surg Pathol 2006;30:858-65.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Hainsworth JD, Einhorn LH, Williams SD, Stewart M, Greco FA. Advanced extragonadal germ cell tumors: successful treatment with combination chemotherapy. Ann Intern Med 1982;97:7-11.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Sabin CA, Phillips AN. Should HIV therapy be started at a CD4 cell count above 350 cells/ μ l in asymptomatic HIV-1-infected patients. Curr Opin Infect Dis 2009;22:191-7.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2]



 

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  In this article
   Abstract
  Introduction
  Case Report
  Discussion
  Acknowledgement
   References
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