V11-08: Laparoscopic Adrenal Metastatectomy in Testicular Seminoma: First Case in America
Video
INTRODUCTION
Testicular germ cell tumours are the most common neoplasias presenting in young men; most of which are seminomas. The most common sites of metastasis in seminoma are the retroperitoneum, lung, liver, bones, bowel and central nervous system. Furthermore, there are unusual sites of metastases reported in the literature such as prostate, skin and adrenal gland. _x000D_ _x000D_ We describe the first case report of a metastatic adrenal seminoma treated with salvage laparoscopic adrenal metastatectomy_x000D_
METHODS
To our knowledge there are no case reports in America of Adrenal metastasis in testicular seminoma. We performed a systematic search in PubMed and a critical analysis of the literature
RESULTS
26 year-old man with a pT1N0M0S0 right testicular seminoma. He underwent right radical orchidectomy and adjuvant external para-aortic radiation therapy. Three years later he presents mediastinal metastasis treated with PEB (bleomycin, etoposide and CDDP). Relapses with mediastinal, tracheal and lung metastasis; initiating treatment with TIP (paclitaxel, ifosfamide and CDDP), but could only receive 3 cycles due to febrile neutropenia. Salvage mediastinal radiotherapy was done._x000D_ He persist with lung lessions and a new onset right adrenal mass was found; he received one cycle of gemcitabine and paclitaxel with partial response to treatment. A PET/CT scan was performed in where the adrenal size increase, hence we offered salvage surgical therapy with a laparoscopic adrenal metastatectomy using a transperitoneal approach. There were no intraoperative or postoperative complications. The pathology report confirmed the presence of metastatic seminoma with negative margins. After 12 months of followup no recurrence has been found._x000D_
CONCLUSION
Adrenal metastasis are an atypical presentation of seminoma. PET/CT scan focuses therapy in patients presenting with residual masses to assess their viability. _x000D_ The laparoscopic approach for metastatic adrenal lesions is a feasible and safe procedure; Offering an optimal oncologic results and an adequate vascular control and resection margins. _x000D_ This procedure Should be done by experienced surgeons. ?
Funding: None