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Endodermal Tumor Sinus : A Case Report.
Apresentação do caso
RMLR, 29 years old, from Nova Iguaçu - RJ, with no previous known comorbidities, admitted on 06/27/2021, referred to the Surgical Clinic complaining of hemoptysis onset three weeks ago and gynecomastia. Trans-scrotal ultrasound showed a solid lesion measuring 12x10 mm in the right testicle with increased flow at Doppler. Skull CT showed occipital nodular lesions to the left suggesting secondary lesions; CT of the chest showed random nodules compatible with secondary implants; abdominal CT demonstrated heterogeneous lesion with irregular and predominantly peripheral enhancement measuring 7.3x3.4x4.6 cm in the intercavoaortic perivascular retroperitoneal. Studies to investigate serum markers showed lactate dehydrogenase 435 U/L, alpha-fetoprotein 6.4 ng/mL and Beta-HCG 249.919 mUI/mL. The case was discussed in clinical session and the diagnosis of germ cell tumors was considered. The Patient underwent right partial orchiectomy on 07/15/2021. He recovered well postoperatively and was discharged on the second postoperative day.The Biopsy revealed endodermal sinus tumor.
Endodermal sinus tumors are a histological type of nonseminomatous germ cell tumors. Endodermal sinus tumors are quite aggressive and highly malignant; they are usually not metastatic in children; nodal and organ metastases are more common in adults. Retroperitoneal lymph nodes are the main site of metastasis in more than 70% of patients with metastatic testicular cancer. In the specific case of our patient, he already had advanced signs and symptoms of the disseminated disease when he was diagnosed, with stage IIIC disease by clinical staging of testicular cancer (TNM Classification AJCC 2018).
Increased alpha-fetoprotein levels are seen in 75% of endodermal sinus tumors and Beta-HCG in 25% of endodermal sinus tumors. Most germ cell tumors have elevated lactate dehydrogenase, which is related to tumor volume. Our patient had altered Beta-HCG levels without having alpha-fetoprotein alterations.
In our patient, we opted for partial orchiectomy, given the presence of multiple distant metastases at the time of surgery.
The present case deals with a rare pathology,highly malignant,diagnosed in our patient in its advanced stage.Interestingly, despite being an endodermal sinus tumor, he does not present alpha-fetoprotein alteration, only human chorionic gonadotropin.Thus,endodermal sinus tumors need further studies mainly on their pathophysiology and therapy to improve survival rate.
endodermal sinus tumor ; yolk sac tumor ; testicular cancer
Uro – Oncologia*
MARIANA ARTIMOS DA MATTA TENORIO, VINÍCIUS MOTTA BORGES, CAROLINA F. ZILLER, FELIPE MACIEL DE LIMA