An Unusual Transformation of a Nonseminomatous Germ Cell Tumor to Adenocarcinoma

Jennifer N. Leibovitch, Poornima Ramadas, Yelena Fudym, Sam Benjamin

Abstract


Transformation of germ cell tumor to an alternate malignancy is rare; and it is believed to be secondary to teratomatous elements of the initial tumor surviving chemotherapy and subsequently proliferating. Here, we describe a patient with transformation of a nonseminomatous germ cell tumor to adenocarcinoma. A 55-year-old male with history of nonseminomatous germ cell tumor of the left testicle, previously resected, followed by four cycles of BEP chemotherapy, on active surveillance, presented nearly 20 years later with nausea and rising alpha-fetoprotein levels. Computed tomography (CT) abdomen revealed bulky retrocrural lymphadenopathy with increased fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan. Biopsy revealed metastatic adenocarcinoma, staining strongly positive for SALL4 and CDX2, with focal rare positivity for CK20 in the tumor cells, consistent with germ cell origin. FOLFOX therapy was therefore initiated. This is one of few documented cases showing transformation of nonseminomatous germ cell tumor to adenocarcinoma, for which surgical resection is favored as primary therapy. However, aggressive adjuvant chemotherapy may be considered and should be directed towards the most aggressive found histology.




J Med Cases. 2019;10(5):123-125
doi: https://doi.org/10.14740/jmc3301

Keywords


Nonseminomatous germ cell tumor; Transformation; Metastatic adenocarcinoma; SALL4; CDX2; CK20; Germ cell; Isochromosome 12p

Full Text: HTML PDF
 

Browse  Journals  

     

Journal of clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.            
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.