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Computed tomography scan demonstrating a multitude of large retroperitoneal masses in a young man following chemotherapy for testicular cancer.
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A 32-year-old man is found to have a growing right testicular mass. Orchiectomy is performed, demonstrating a pT2 mixed germ cell tumor. Staging scans reveal bulky retroperitoneal lymphadenopathy. Tumor markers are markedly elevated with AFP >1,300 and beta-HCG of >1,000. The patient receives cisplatin-based chemotherapy. Restaging scans demonstrates little change in retroperitoneal lymphadenopathy. Tumor markers normalize.
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In patients with non-seminomatous germ cell tumor and residual mass (>1cm in any dimension) whose tumor markers normalize following chemotherapy, retroperitoneal lymph node dissection (bilateral template) is mandatory. This patient’s pathology revealed large volume metastatic teratoma. Teratoma is entirely resistant to chemotherapy and thus must be resected. PET imaging has no role in managing patients with non-seminomatous germ cell malignancy.
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