Malignant epidural spinal cord compression secondary to testicular cancer (mixed choriocarcinoma and seminoma) in the immediate post radical orchidectomy period

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Key Clinical Message

Acute spinal cord compression in the immediate postoperative period from a possible choriocarcinoma syndrome (CCS) on hemorrhagic epidural spinal metastasis has never been described before and needs to be promptly recognized and managed. A low hemoglobin associated with choriocarcinoma should raise suspicion of this syndrome.

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Most cited references 17

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The World Health Organization 2016 classification of testicular germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel.

Sean R. Williamson, Brett Delahunt, Cristina Magi-Galluzzi … (2017)

Since the last World Health Organization (WHO) classification scheme for tumours of the urinary tract and male genital organs, there have been a number of advances in the understanding, classification, immunohistochemistry and genetics of testicular germ cell tumours. The updated 2016 draft classification was discussed at an International Society of Urological Pathology Consultation on Testicular and Penile Cancer. This review addresses the main updates to germ cell tumour classification. Major changes include a pathogenetically derived classification using germ cell neoplasia in situ (GCNIS) as a new name for the precursor lesion, and the distinction of prepubertal tumours (non-GCNIS-derived) from postpubertal-type tumours (GCNIS-derived), acknowledging the existence of rare benign prepubertal-type teratomas in the postpubertal testis. Spermatocytic tumour is adopted as a replacement for spermatocytic seminoma, to avoid potential confusion with the unrelated usual seminoma. The spectrum of trophoblastic tumours arising in the setting of testicular germ cell tumour continues to expand, to include epithelioid and placental site trophoblastic tumours analogous to those of the gynaecological tract. Currently, reporting of anaplasia (seminoma or spermatocytic tumour) or immaturity (teratoma) is not required, as these do not have demonstrable prognostic importance. In contrast, overgrowth of a teratomatous component (somatic-type malignancy) and sarcomatous change in spermatocytic tumour indicate more aggressive behaviour, and should be reported.

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Adolescent and adult risk factors for testicular cancer.

Katherine A McGlynn, Britton Trabert (2012)

The incidence of testicular cancer has been increasing over the past several decades in many developed countries. The reasons for the increases are unknown because the risk factors for the disease are poorly understood. Some research suggests that in utero exposures, or those in early childhood, are likely to be important in determining an individual's level of risk. However, other research suggests that exposure to various factors in adolescence and adulthood is also linked to the development of testicular cancer. Of these, two adult occupational exposures-fire fighting and aircraft maintenance--and one environmental exposure (to organochlorine pesticides) are likely to be associated with increased risk of developing testicular cancer. By contrast, seven of the identified factors--diet, types of physical activity, military service, police work as well as exposure to ionizing radiation, electricity and acrylamide--are unlikely to increase the risk of developing testicular cancer. Finally, seven further exposures--to heat, polyvinyl chloride, nonionizing radiation, heavy metals, agricultural work, pesticides and polychlorinated biphenyls as well as marijuana use--require further study to determine their association with testicular cancer.

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An overview of testicular germ cell tumors.

Alberto G Ayala, Jin Ro, Armita Bahrami (2007)

More than 90% of testicular neoplasms originate from germ cells. Testicular germ cell tumors (GCTs) are a heterogeneous group of neoplasms with diverse histopathology and clinical behavior. To help the readers distinguish various subtypes of GCTs, to highlight the clinical manifestations and pathologic features of these tumors, and to review several newly developed immunohistochemical markers for GCTs. Review of the pertinent literature and our experience. The etiology of GCTs is largely unknown. Cytogenetic studies suggest a different pathogenesis for each group of infantile/prepubertal GCTs, postpubertal GCTs, and spermatocytic seminoma. Unclassified intratubular germ cell neoplasia is the precursor of all GCTs, excluding spermatocytic seminoma and infantile/prepubertal GCTs. Seminoma, the most common GCT in adults, does not occur before 5 years of age. Spermatocytic seminoma, a tumor of elderly men, typically has an indolent clinical behavior, but rarely it undergoes sarcomatous transformation associated with an aggressive behavior. Embryonal carcinoma is the most common component in mixed GCTs. Eighty percent or more of embryonal carcinoma component and vascular invasion are recognized predictors of occult metastasis for clinical stage I mixed GCTs. Most patients with prepubertal yolk sac tumor, the most common pediatric GCT, have stage I disease at presentation. Most choriocarcinomas present with metastatic symptoms because of the propensity for rapid hematogenous dissemination. Teratomas in children regardless of maturity and dermoid cysts in adults are benign; in contrast, teratomas in adults have a malignant behavior. With appropriate therapy, the majority of testicular GCTs are curable.

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Author and article information

Contributors

Alain Mwamba Mukendi:

ORCID: https://orcid.org/0000-0002-3397-1685

alainmwamba2006@yahoo.fr

Journal

Journal ID (nlm-ta): Clin Case Rep

Journal ID (iso-abbrev): Clin Case Rep

Journal ID (doi): 10.1002/(ISSN)2050-0904

Journal ID (publisher-id): CCR3

Title: Clinical Case Reports

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Electronic): 2050-0904

Publication date (Electronic): 02 April 2019

Publication date Collection: May 2019

Volume: 7

Issue: 5 ( doiID: 10.1002/ccr3.2019.7.issue-5 )

Pages: 955-959

Affiliations

[ ¹ ] Urology Department, Chris Hani Baragwanath Academic Hospital University of the Witwatersrand Soweto South Africa

[ ² ] Anatomical Pathology Department, Chris Hani Baragwanath Academic Hospital University of the Witwatersrand Soweto South Africa

Author notes

[*] [* ] Correspondence

Alain Mwamba Mukendi, Urology Department, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.

Email: alainmwamba2006@ 123456yahoo.fr

Author information

Alain Mwamba Mukendi https://orcid.org/0000-0002-3397-1685

Article

Publisher ID: CCR32131

DOI: 10.1002/ccr3.2131

PMC ID: 6509927

SO-VID: b060697f-9d0b-453e-a31b-1ade85edad51

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

History

Date received : 13 November 2018

Date revision received : 21 January 2019

Date accepted : 14 March 2019

Page count

Figures: 5, Tables: 0, Pages: 5, Words: 2221

Custom metadata

source-schema-version-number 2.0

component-id ccr32131

cover-date May 2019

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:10.05.2019

Keywords: choriocarcinoma,choriocarcinoma syndrome,mixed germ cell tumor,seminoma,spinal cord compression

Data availability:

Keywords: choriocarcinoma, choriocarcinoma syndrome, mixed germ cell tumor, seminoma, spinal cord compression

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