Segundo primario en un paciente con antecedente de tumor germinal seminomatoso de testículo. Reporte del caso y revisión de la literatura

The testicular germ cell tumour is the most curable solid tumour, with a relative overall survival rate of more than the 95% after 10 years. The cure rate and long term survival of the majority of the patients has led to an interest in the side effects related to the treatment. Second malignant tumours are one of the most serious side effects that compromise the prognosis of the survivors. The aim of the present study is describe the case of one patient with seminomatous type testicular cancer, who presented with a second primary after 20 years. A literature review is also presented.

The case concerns a 68 year-old patient, with a smoking history with a tobacco index of 45, bilateral cryptorchidism, and an orchidopexy at 39 years old. Cancer was diagnosed in the right testicle with an 8 × 8 cm retroperitoneal tumour. In 1993, a radical orchiectomy was performed, followed by chemotherapy, with full response to the treatment. Twenty years later, he had oral intolerance, epigastralgia, with endoscopic evidence of a Bormann III gastric tumour. The histopathological report described a poorly differentiated adenocarcinoma, diffuse with signet ring cells. The computed tomography showed evidence of peritoneal carcinomatosis.

Surviving patients of germ cell cancer, cured with chemotherapy and/or radiotherapy, face the long-term effects of the treatment, including chemotherapy related toxicity and the appearance of a second primary, including a risk up to 30 years after diagnosis of primary tumour.