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IMAGE IN EUS
Year : 2014  |  Volume : 3  |  Issue : 1  |  Page : 66-67

A rare case of incidental retroperitoneal seminoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration


1 Department of Gatroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Texas; Department of Gastroenterology and Hepatology, Stanford University, Stanford, CA 94305, USA
2 Department of Internal Medicine, The University of Texas Medical School at Houston, Texas, USA
3 Department of Pathology, The University of Texas Medical School at Houston, Texas, USA
4 Department of Surgery, The University of Texas Medical School at Houston, Texas, USA
5 Department of Gatroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Texas, USA

Date of Submission13-Sep-2013
Date of Acceptance22-Oct-2013
Date of Web Publication14-Feb-2014

Correspondence Address:
Nirav Thosani
Department of Gatroenterology, Hepatology and Nutrition, The University of Texas Medical School at Houston, Texas; Department of Gastroenterology and Hepatology, Stanford University, Stanford, CA 94305
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.127129

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How to cite this article:
Thosani N, Ferguson K, Buryanek J, Lesslie D, Spinn MP. A rare case of incidental retroperitoneal seminoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration . Endosc Ultrasound 2014;3:66-7

How to cite this URL:
Thosani N, Ferguson K, Buryanek J, Lesslie D, Spinn MP. A rare case of incidental retroperitoneal seminoma diagnosed by endoscopic ultrasound-guided fine-needle aspiration . Endosc Ultrasound [serial online] 2014 [cited 2020 Feb 26];3:66-7. Available from: http://www.eusjournal.com/text.asp?2014/3/1/66/127129

A 55-year-old Caucasian male patient presented after a fall from his bicycle. In addition to fractured ribs and left pneumothorax, he was found to have incidental 5.1 cm × 5.3 cm × 7.6 cm homogenous, well-circumscribed retroperitoneal mass [Figure 1]a, on cross-sectional imaging studies. On endoscopic ultrasound (EUS) mass was hypoechoic, heterogenous, abutting but not involving the wall of the second duodenum with clear demarcation between the mass and the head of the pancreas [Figure 1]b and c]. EUS guided fine-needle aspiration (EUS-FNA) showed large tumor cells with prominent nucleoid and some binucleated forms [Figure 2]a. The immunohistochemistry identified positive CD117 and OCT-3/4 expression in the tumor cell nuclei suggesting a metastatic germ cell tumor [Figure 2]b and c]. Testicular ultrasound showed 2.2 cm × 1.2 cm × 1.6 cm hypoechoic mass in right testis and tumor markers revealed alpha-fetoprotein of 1.7, lactate dehydrogenase of 341, normal beta-human chorionic gonadotropin. He was diagnosed with seminoma with retroperitoneal metastasis and was treated with four cycles of chemotherapy with etoposide and cisplatin with excellent response and subsequently underwent orchiectomy.
Figure 1. (a) Contrast enhanced computed tomography image showing well-circumscribed retroperitoneal mass; (b and c) radial and linear echoendoscopic image showing hypoechoic, heterogenous mass, abutting the wall of the second duodenum

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Figure 2. (a) Diff-quick stain showing large tumor cells with prominent nucleoid and some binucleated forms; (b) positive immunohistochemistry CD117 staining; (c) positive OCT-3/4 expression in the tumor cell nuclei suggesting a metastatic germ cell tumor

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The majority of retroperitoneal germ cell tumors are metastases from gonadal germ cell tumors. [1] Accurate diagnosis of these tumors is critical as the current therapy can be highly curative. EUS can be utilized for the precise location of a retroperitoneal mass both adjacent to the gastrointestinal tract and/or involving surrounding organs. [2] EUS-FNA is a minimally invasive procedure that allows obtaining sufficient tissue for immunostaining and reaching an accurate diagnosis. [3] Our patient was referred to us by institutional surgeon and EUS-FNA completely changed the management of this patient. Similarly, Erickson and Tretjak reported that EUS-FNA completely changed management of 16/18 (90%) of patients with retroperitoneal lesions. [2] We recommend that EUS-FNA should be included in the diagnostic algorithm of the retroperitoneal tumors.

 
  References Top

1.Shinagare AB, Jagannathan JP, Ramaiya NH, et al. Adult extragonadal germ cell tumors. AJR Am J Roentgenol 2010;195:W274-80.  Back to cited text no. 1
[PUBMED]    
2.Erickson RA, Tretjak Z. Clinical utility of endoscopic ultrasound and endscopic ultrasound-guided fine needle aspiration in retroperitoneal neoplasms. Am J Gastroenterol 2000;95:1188-94.  Back to cited text no. 2
[PUBMED]    
3.Womeldorph CM, Zalupski MM, Knoepp SM, et al. Retroperitoneal germ cell tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration. World J Gastrointest Oncol 2010;2:443-5.  Back to cited text no. 3
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]


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