IntroductionTesticular tumours are rare, but still the most common malignant tumour in males between 15 and 35 years [1]. The great majority of testis neoplasms are germ cell tumours and seminomas make up about 40% of this group [2]. The most common site of metastasis is the retroperitoneal region, followed by the mediastinum, the lungs, the brain and solid organs, and the bones [3]. Approximately 5% of germ cell tumours originate at extragonadal sites, most commonly mediastinum and retroperitoneum. Testicular tumour metastasis to the bladder is very rare [4].
DiscussionMore than 95% of testicular neoplasms are germ cell tumours, which contain seminoma, non-seminoma and mixed tumours. Germ cell tumours (GCTs) are a relatively rare malignancy, accounting for 1% to 2% of cancers among adult males [1].
About 95% of germ cell tumours arise in the testis, approximately 5% of postpubertal GCTs are extragondal in origin, and most develop in midline anatomic locations (retroperitoneum and mediastinum are most common) [2]. With the development of cisplatin-based chemotherapy and the integration of surgery, GCTs have become a model of a curable neoplasm and serve as a paradigm for the multidisciplinary treatment of cancer [5]. Currently, the long-term survival for men with metastatic GCT is 80% to 90% [6].
The most common presentation of testis cancer is a painless testis mass.
Regional or distant metastasis at diagnosis is present in approximately two-thirds of NSGCTs and 15% of pure seminomas, and symptoms related to metastatic disease are the presenting complaint in 10% to 20% of patients [7]. Bulky retroperitoneal metastasis may cause a palpable mass, abdominal or flank pain, or lower extremity swelling. Testis cancer is associated with serum tumour markers (LDH, AFP, and beta-HCG) that are essential in its diagnosis and management. Seminomas do not produce AFP. Serum tumour marker levels should be obtained at diagnosis, after orchiectomy, to monitor for response to chemotherapy.
Similar reported cases include: A.R. Türkoğlu et al. (2015) reported a case of rare late metastasis of testicular seminoma to the bladder [8], Y.S. Gürbüz et al. (2001) reported a case with simultaneous bladder carcinosarcoma and testicular seminoma [9]. A. Alsolamı et al. (2014) reported a case with concurrent bladder and testicular seminoma [10]; Another patient was diagnosed with extragonadal germ cell tumour with lymph node biopsy after retroperitoneal and cervical lymphadenopathy was detected, Chemotherapy was administered and the beta-HCG level increased during follow-up, The patient developed hematuria with bladder and right ureter metastasis followed by liver and mesenteric lymph node metastasis leading to his death [11]. Another case is present where orchiectomy was performed for testis seminoma and biopsy of the paraaortic and inguinal lymph nodes during a kidney transplant later in this kidney recipient revealed seminoma again. The patient underwent radiotherapy and received immunosuppressives, but a bladder metastatic seminoma was found three years later [12]. Another article reported a patient who underwent bilateral orchiectomy, retroperitoneal lymph node dissection, and chemotherapy for seminoma; the patient then developed a retrovesical 8 × 6 × 5 cm primary seminoma of the prostate 16 years later [13]. J.D. Khandekar et al. (1993) reported a case involving the prostate and bladder neck [14]. T. Hashimoto et al. (2009) reported a primary seminoma involving the prostate [15]. Renal, adrenal gland, psoas muscle, gastric, seminal vesicle, bladder, prostate and pericardial involvement are very rare (< 1%) [4]. Most metastases develop within the first two years [7].