Extragonadal mixed germ cell tumor of the right arm: description of the first case in the literature
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Extragonadal mixed germ cell tumor of the right arm: description of the first case in the literature Hicham Ait Benali1†, lssam Lalya2*†, Mohamed Allaoui3, Aniss Benmansour4, Basma Elkhanoussi3, Samir Benjelloun4, Noureddine Benjaafar2 and Mourad Elyaacoubi1
Abstract Background: Extragonadal localization of germ cell tumors (GCTs) is rare; to the best of our knowledge, a location in the soft tissue of the arm has never been previously reported in the literature. Case presentation: We report the case of a 37-year-old man who presented with a primary malignant mixed non-seminomatous GCT (teratocarcinoma variety) in the right arm, treated by a combination of cisplatin-based chemotherapy and surgery. After 18 months of close follow-up, no locoregional recurrence or distant metastases have been detected. Conclusions: A combination of chemotherapy and surgery is the most appropriate treatment strategy for extragonadal GCTs, to ensure both local and systemic control. Keywords: Chemotherapy, Embryonic carcinoma, Extragonadal, Mixed germ cell tumors, Surgery, Teratoma
Background Germ cell tumors (GCTs) are classified as extragonadal if there is no evidence of a primary tumor in either the testes or ovaries [1]; they typically arise in midline locations. In adults, the most common sites, in order of frequency, are the anterior mediastinum, retroperitoneum, and the pineal and suprasellar regions. To date, there have been no reported cases of germ cell tumors arising in the arm. The aim of the present work was not only to report what is to the best of our knowledge the first observation of a mixed non-seminomatous GCT of the arm, but to also increase exposure of the various hypotheses that could explain this unusual location. We also discuss the diagnosis, treatment, and prognosis of this entity. Case presentation A 37-year-old man presented with a 2-year history of painless swelling of the right arm with a gradual increase in size. A physical examination was normal except for a well circumscribed non-tender mass in the upper twothirds of the right arm and multiple lymph nodes in the * Correspondence: [email protected] † Equally contributed 2 Department of Radiation Oncology, National Institute of Oncology, Mohamed V University, Rabat, Morocco Full list of author information is available at the end of the article
right axilla. Imaging revealed a 53 × 40 mm diameter soft tissue mass that was hyperintense on T2-weighted MRI in the posterior compartment of the right arm, with no bone or vascular invasion (Figures 1 and 2). Surgical biopsy of the mass and axillary lymph node excision were performed; the laboratory received two fragments with soft consistency, measuring 2 × 1 × 0.3 cm and 2.5 × 1 × 0.5 cm. Histopathological examination showed a desembryoplastic multitissular tumor, containing a sarcomatous component constituted by spindle cells and organized in bundles with rhabdomyoblastic differentiation. There was also an immature and malignant neuroglial compone
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