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Intestinal metastases as an unusual presentation of a burned-out testicular seminoma: PET/CT imaging
Presentación inusual como metástasis intestinales de un seminoma testicular con regresión espontánea
Department of Radiology, Mayo Clinic, Scottsdale, AZ, United States
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Erdemir, T. Elri, H. Sahin, Y. Sami Salihoglu, M. Aras, M. Cabuk" "autores" => array:6 [ 0 => array:2 [ "nombre" => "R.U." "apellidos" => "Erdemir" ] 1 => array:2 [ "nombre" => "T." "apellidos" => "Elri" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Sahin" ] 3 => array:2 [ "nombre" => "Y." "apellidos" => "Sami Salihoglu" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Aras" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Cabuk" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X14002170?idApp=UINPBA00004N" "url" => "/2253654X/0000003400000004/v1_201506220006/S2253654X14002170/v1_201506220006/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2253654X1400208X" "issn" => "2253654X" "doi" => "10.1016/j.remn.2014.11.003" "estado" => "S300" "fechaPublicacion" => "2015-07-01" "aid" => "659" "copyright" => "Elsevier España, S.L.U. and SEMNIM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2015;34:264-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 394 "formatos" => array:3 [ "EPUB" => 15 "HTML" => 271 "PDF" => 108 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "A rare case of clear cell carcinoma of the breast evaluated by <span class="elsevierStyleSup">18</span>F-FDG PET/CT" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "264" "paginaFinal" => "265" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un caso poco frecuente de carcinoma de células claras de la mama evaluado con <span class="elsevierStyleSup">18</span>F-FDG PET/TC" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1087 "Ancho" => 1500 "Tamanyo" => 338358 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Maximum-intensity-projection <span class="elsevierStyleSup">18</span>F-FDG PET image (A), axial non-enhanced CT (B) and fused PET/CT image (C) showing increased tracer uptake corresponding to a 8<span class="elsevierStyleHsp" style=""></span>cm mass located in the left breast (arrows) with a SUV<span class="elsevierStyleInf">max</span> of 22. At hematoxylin and eosin stain the breast mass was composed by large cells arranged into a solid pattern and characterized by abundant vacuolated clear cytoplasm, marked nuclear pleomorphism and high number of mitoses (D). The proliferative index (Ki67%) was 80% (E).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Treglia, U. Perriard, L. Ceriani, L. Giovanella" "autores" => array:4 [ 0 => array:2 [ "nombre" => "G." "apellidos" => "Treglia" ] 1 => array:2 [ "nombre" => "U." "apellidos" => "Perriard" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Ceriani" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Giovanella" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X1400208X?idApp=UINPBA00004N" "url" => "/2253654X/0000003400000004/v1_201506220006/S2253654X1400208X/v1_201506220006/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Intestinal metastases as an unusual presentation of a burned-out testicular seminoma: PET/CT imaging" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "267" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "B.D. Nguyen, M.C. Roarke, M. Yang" "autores" => array:3 [ 0 => array:4 [ "nombre" => "B.D." "apellidos" => "Nguyen" "email" => array:1 [ 0 => "nguyen.ba@mayo.edu" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.C." "apellidos" => "Roarke" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Yang" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Radiology, Mayo Clinic, Scottsdale, AZ, United States" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación inusual como metástasis intestinales de un seminoma testicular con regresión espontánea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 759 "Ancho" => 1900 "Tamanyo" => 255627 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Composite PET/CT image (sequences from left to right: axial, sagittal and coronal views) showing the hypermetabolic proximal duodenal mass with two additional <span class="elsevierStyleSup">18</span>F-FDG-avid lesions at the distal duodenum and jejunum (arrows), not conspicuous on the initial CT.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 64-year-old man had a concentric thickening of the proximal duodenum depicted by CT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Subsequent endoscopic examination and biopsy led to the diagnosis of malignancy. PET/CT confirmed the hypermetabolic proximal duodenal lesion and showed two unexpected additional <span class="elsevierStyleSup">18</span>F-FDG-avid tumors not seen on the initial CT at the distal duodenum and jejunum (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The patient underwent resection of all three lesions, which showed histological evidence of metastases from testicular seminoma. Subsequent ultrasound showed an atrophic right testis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) with areas of hypo-echogenicity and echogenic calcifications. The histology of the resected right testis was consistent with a burned-out seminoma.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Extragonadal germ cell tumors may originate from primary neoplasms or more frequently represent metastases from occult/burned-out primary testicular malignancy. The former category is very rare, with localization mainly in the median line of the body and involving the central nervous system such as pineal body, neurohypophysis and sacrococcygeal regions, thymus, mediastinum and retroperitoneum.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Primary seminomatous lesions account for about half of these tumors.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The pathogenesis of these primary neoplasms includes the migratory failure of primordial germ cells from the urogenital ridge to the scrotum and the persistence of totipotential cells after embryogenesis at future tumoral sites.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Concerning metastases from malignant germ cell tumors of testicles including seminomas, they have an orderly ipsilateral lymphatic dissemination and a less common hematogenous spread.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The right testis tumor usually metastasizes to the interaortocaval nodal chain by L2 level. The left testicular lesion spreads to left retroperitoneal nodes in an area delimited by the left renal vein, abdominal aorta, left ureter and inferior mesenteric artery. Right-to-left crossover nodal involvement may be seen with left supraclavicular metastasis. At advanced stages, tumors may spread to iliac and inguinal nodes, and to distant organs hematogenously. This case showed an atypical hematogenous dissemination to the gastrointestinal tract without the usual lymphatic metastasis. Burned-out testicular germ cell tumors represent spontaneously regressed malignancies by either immunological or ischemic processes with no obvious existing primary neoplasm at the time of diagnosis of related distant metastasis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> When the neoplastic origin of the distant metastasis is established, in-depth clinical, imaging and histological evaluation of testes is necessary for the search of vestigial clues of burned-out testicular malignancy. Sonographic features of burned out testicular tumors include focal atrophy, scarring, echogenic calcifications, hypoechogenic zones and/or a combinations of all these findings.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Histologically, the presence of hematoxyphilic bodies, hemosiderin pigmentation and calcium phosphate deposits constitutes the evidence of tumor cell death and regression.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0015" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1203 "Ancho" => 950 "Tamanyo" => 182361 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal contrast-enhanced CT image showing the thickened proximal duodenum from presumed primary duodenal malignancy (arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 759 "Ancho" => 1900 "Tamanyo" => 255627 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Composite PET/CT image (sequences from left to right: axial, sagittal and coronal views) showing the hypermetabolic proximal duodenal mass with two additional <span class="elsevierStyleSup">18</span>F-FDG-avid lesions at the distal duodenum and jejunum (arrows), not conspicuous on the initial CT.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 761 "Ancho" => 995 "Tamanyo" => 86935 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Composite sonographic image of both testes, for comparison purpose, showing a normal left testicle (right image) and an atrophic right testis with areas of hypo-echogenicity and echogenic calcifications related to burned-out testicular tumor (left image, arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Metastases of clinically occult testicular seminoma mimicking primary extragonadal retroperitoneal germ cell tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. Coulier" 1 => "Y. Lefebvre" 2 => "L. de Visscher" 3 => "A. Bourgeois" 4 => "L. Montfort" 5 => "M. Clausse" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "JBR-BTR" "fecha" => "2008" "volumen" => "91" "paginaInicial" => "139" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18817085" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "‘Burned-out’ primary testicular cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Fabre" 1 => "H. Jira" 2 => "V. Izard" 3 => "S. Ferlicot" 4 => "Y. Hammoudi" 5 => "C. Theodore" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1464-410X.2004.04904.x" "Revista" => array:6 [ "tituloSerie" => "BJU Int" "fecha" => "2004" "volumen" => "94" "paginaInicial" => "74" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15217435" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burned-out primary testicular cancer: sonographic and pathological characteristics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.V. Comiter" 1 => "A.A. Renshaw" 2 => "C.B. Benson" 3 => "K.R. Loughlin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "1996" "volumen" => "156" "paginaInicial" => "85" "paginaFinal" => "88" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8648846" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2253654X/0000003400000004/v1_201506220006/S2253654X1400211X/v1_201506220006/en/main.assets" "Apartado" => array:4 [ "identificador" => "7907" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imágenes de interés" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/2253654X/0000003400000004/v1_201506220006/S2253654X1400211X/v1_201506220006/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X1400211X?idApp=UINPBA00004N" ]
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