Extragonadal germ cell tumour with the "burned out" phenomenon mimicking a retroperitioneal tumour of neurogenic origin.

OBJECTIVE: To describe a case of retroperitoneal metastasis of a gonadal germ cell tumour with the "burned-out" phenomenon in a 35 year old patient with a suspected diagnosis of retroperitoneal tumour of neurogenic origin. METHODS: With the clinical and radiological suspicion of retroperitoneal tumour of neurogenic origin the tumour was removed, via the retroperitoneal space. RESULTS: Pathology showed classic seminoma with foci of atypical or anaplastic seminoma, confined to the tissue sample. After a genital examination showing no alterations, a scrotal ultrasound was requested. This revealed a badly delimited hypoechogenic mass with microcalcifications in the left testis and a heterogeneous echostructure in the right testis, with hypoechogenic areas and some microcalcification. Bilateral orchiectomy was performed, with a pathological study compatible with residual scar tissue in the left testicle and focal findings of germ cell neoplasia, with no intratubular seminoma in the right testis. CONCLUSIONS: The suspicion of an extragonadal germ cell tumour with the "burned-out" phenomenon modifies the therapeutic attitude, which should begin with orchiectomy, followed by systemic chemotherapy and the surgery kept in reserve for those cases where residual malignant tissue persists.

Tumor de células germinales extragonadal con fenómeno "burned-out" simulando tumor retroperitoneal de estirpe neurogénico / Extragonadal germ cell tumour with the "burned out" phenomenon mimicking aretroperitioneal tumour of neurogenic origin

OBJETIVO: Describir un caso de metástasis retroperitoneal de un tumor de células germinales gonadal con fenómeno "burned-out" en un paciente de 35 años con sospecha diagnóstica de tumor retroperitoneal de estirpe neurogénico. MÉTODOS: Con la sospecha clínico-radiológica de tumor retroperitoneal de estirpe neurogénico se realiza exéresis de la tumoración, mediante abordaje por vía retroperitoneal. RESULTADOS: La histología demostró seminoma clásico con focos de seminoma atípico o anaplásico, confinado a la pieza quirúrgica. Tras comprobar exploración genital sin alteraciones, se solicita Ecografía escrotal, que evidencia en teste izquierdo una masa mal delimitada hipoecogénica con microcalcificaciones y en teste derecho ecoestructura heterogénea, con áreas hipoecogéncias y alguna microcalcificacion. Se realiza orquiectomía bilateral, con resultado histológico de restos cicatriciales en teste izquierdo y hallazgos focales de neoplasia de células germinales, no seminoma intratubular en teste derecho. CONCLUSIONES: Sospechar un tumor de células germinales extragonadal con fenómeno "burned-out" modifica la actitud terapéutica, que debería comenzar por orquiectomía, siguiendo con la quimioterapia sistémica y reservando la cirugía para los casos de persistencia de tejido maligno residual (AU)

OBJECTIVE: To describe a case of retroperitoneal metastasis of a gonadal germ cell tumour with the "burned-out" phenomenon in a 35 year old patient with a suspected diagnosis of retroperitoneal tumour of neurogenic origin. METHODS: With the clinical and radiological suspicion of retroperitoneal tumour of neurogenic origin the tumour was removed, via the retroperitoneal space. RESULTS: Pathology showed classic seminoma with foci of atypical or anaplastic seminoma, confined to the tissue sample. After a genital examination showing no alterations, a scrotal ultrasound was requested. This revealed a badly delimited hypoechogenic mass with microcalcifications in the left testis and a heterogeneous echostructure in the right testis, with hypoechogenic areas and some microcalcification. Bilateral orchiectomy was performed, with a pathological study compatible with residual scar tissue in the left testicle and focal findings of germ cell neoplasia, with no intratubular seminoma in the right testis. CONCLUSIONS: The suspicion of an extragonadal germ cell tumour with the "burned-out" phenomenon modifies the therapeutic attitude, which should begin with orchiectomy, followed by systemic chemotherapy and the surgery kept in reserve for those cases where residual malignant tissue persists (AU)

Leiomioma en divertículo de Meckel / Leiomyoma in Meckel's diverticulum

Resumen El divertículo de Meckel (DM) es un remanente de la persistencia del conducto onfalomesentérico presente en un 2% de la población general. Normalmente cursa de forma silente y solo se descubre ante la presencia de complicaciones. El diagnóstico preoperatorio es infrecuente. En general se acepta que el tratamiento más adecuado ante un DM sintomático es la resección quirúrgica. El manejo del DM asintomático sigue sin estar claro. Se presenta un caso clínico que no solo engloba algunas de las complicaciones que puede presentar un DM, sino que además tiene la peculiaridad de que un leiomioma es el origen de las mismas. La presencia de enfermedad neoplásica a nivel del DM representa un 3,2% de sus complicaciones. El tumor carcinoide es el más frecuente. Existen pocas publicaciones que hagan referencia a las neoplasias benignas albergadas en los DM debido a su baja incidencia (AU)

Abstract Meckel's diverticulum (MD) is a persistent embryonic remnant occurring in 2% of the general population. This entity is usually clinically silent and is only discovered when complications occur. Diagnosis is rarely made preoperatively. Surgical resection of symptomatic MD is widely accepted but the most appropriate management of asymptomatic MD remains unclear. We present a case of MD that summarizes some of the complications that may occur. The peculiarity of this case was that the complications were caused by a leiomyoma. The presence of tumoral disease in MD accounts for 3.2% of complications. The most common neoplasm is carcinoid tumor. Few publications have reported benign neoplasms in MD, probably due to their low incidence (AU)

[Leiomyoma in Meckel's diverticulum]. / Leiomioma en divertículo de Meckel.

Meckel's diverticulum (MD) is a persistent embryonic remnant occurring in 2% of the general population. This entity is usually clinically silent and is only discovered when complications occur. Diagnosis is rarely made preoperatively. Surgical resection of symptomatic MD is widely accepted but the most appropriate management of asymptomatic MD remains unclear. We present a case of MD that summarizes some of the complications that may occur. The peculiarity of this case was that the complications were caused by a leiomyoma. The presence of tumoral disease in MD accounts for 3.2% of complications. The most common neoplasm is carcinoid tumor. Few publications have reported benign neoplasms in MD, probably due to their low incidence.