RESUMEN
Germ cell tumours (GCT) are the most common testicular neoplasms, seen mainly in young adults. Rarely they can affect extragonadal tissues, either as primary tumours or as metastases, most commonly to retroperitoneal lymph nodes. A 'burned-out' testicular tumour is a metastatic GCT with a relatively occult primary testicular tumour, which has histologically spontaneously regressed. We report a case of a 26-year-old man who presented with an acute history of lower back pain and leg swelling. CT demonstrated a large retroperitoneal soft tissue mass causing right-sided hydronephrosis with inferior vena cava and iliofemoral vein thrombosis. Although clinical examination of the testis was normal, ultrasound imaging of the scrotum identified a burned-out testicular primary. Orchiectomy confirmed the diagnosis and the patient responded well to chemotherapy, with no viable residual tumour on follow-up imaging. However, despite nephrostomy insertion, a dimercaptosuccinic acid (DMSA) scan demonstrated loss of function of the right kidney after treatment.
Asunto(s)
Neoplasias de Células Germinales y Embrionarias/secundario , Espacio Retroperitoneal/diagnóstico por imagen , Neoplasias Testiculares/patología , Vena Cava Inferior/patología , Adulto , Quimioterapia/métodos , Humanos , Hidronefrosis/etiología , Masculino , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/cirugía , Neoplasias Primarias Desconocidas/patología , Orquiectomía/métodos , Espacio Retroperitoneal/patología , Escroto/diagnóstico por imagen , Escroto/patología , Neoplasias de los Tejidos Blandos/complicaciones , Síndrome , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/embriología , Neoplasias Testiculares/secundario , Neoplasias Testiculares/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Ultrasonografía/métodos , Trombosis de la Vena/etiologíaRESUMEN
This case report highlights an unusual presentation of acute adrenal infarction in a Covid-19 patient who presented with abdominal symptoms and hyponatraemia. We discuss the recent literature reviewing how Covid-19 creates a hypercoaguable state, with acute adrenal infarction as a possible prothrombotic complication.
RESUMEN
Primary testicular lymphoma is a rare testicular neoplasm that mainly affects elderly patients, with Human Immunodeficiency Virus (HIV) being a known risk factor in the younger population. Approximately 20% of patients will have disseminated disease with extra-nodal involvement at clinical presentation. Rarely, direct spread along the spermatic cord and gonadal vessels can occur and has been described in the literature. We present two cases of this phenomenon where the primary testicular tumour has spread along the gonadal vein to its origin at the inferior vena cava.