ABSTRACT
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.
Subject(s)
Neoplasms, Germ Cell and Embryonal/secondary , Retroperitoneal Space/diagnostic imaging , Testicular Neoplasms/pathology , Vena Cava, Inferior/pathology , Adult , Drug Therapy/methods , Humans , Hydronephrosis/etiology , Male , Neoplasms, Germ Cell and Embryonal/drug therapy , Neoplasms, Germ Cell and Embryonal/surgery , Neoplasms, Unknown Primary/pathology , Orchiectomy/methods , Retroperitoneal Space/pathology , Scrotum/diagnostic imaging , Scrotum/pathology , Soft Tissue Neoplasms/complications , Syndrome , Testicular Neoplasms/drug therapy , Testicular Neoplasms/embryology , Testicular Neoplasms/secondary , Testicular Neoplasms/surgery , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography/methods , Venous Thrombosis/etiologyABSTRACT
We present a case of haemophagocytic lymphohistiocytosis (HLH) in the context of disseminated cytomegalovirus (CMV) viraemia in a 50-year-old man with well-controlled HIV infection and ulcerative colitis (UC), for which he was receiving azathioprine. Peak CMV viral load was 371 000 copies/ml with evidence of end-organ CMV in the lungs and colon. A bone marrow biopsy showed evidence of haemophagocytosis of platelets, neutrophils and erythrocytes. The azathioprine was stopped, and he received intravenous ganciclovir and corticosteroids with suppression of the CMV viral load and resolution of the HLH.