Metachronous Testicular Mixed Germ Cell Tumour and Gastric Marginal Zone Lymphoma: A Case Report with An Unusual Association
AbstractBackground Second primary malignancies (SPMs), irrespective of location, are characterized by two or more distinct neoplasms in the same patient. Gastric marginal zone lymphoma of mucosa-associated lymphoid tissue (MZL) shows a higher risk of developing a second primary malignancy and exhibits inferior overall survival. Case Report and Discussion We report a case of a 55-year-old male who presented with a painless, hard, right testicular mass, which progressively grew over 3 months. He was diagnosed with gastric MZL on biopsy 4 years back and was treated by CHOP regime; 6 cycles. At the time of testicular mass diagnosis, the contrast-enhancing computed tomography imaging revealed metastasis involving both lungs and retroperitoneal lymph nodes with inferior vena cava thrombus. He underwent right inguinal orchidectomy and showed histopathological features of the mixed germ cell tumour composed of seminomatous and non-seminomatous components (embryonal and yolk sac tumours). This morphology was confirmed using a wide panel of immunohistochemistry markers (OCT3/4, PLAP, c-KIT, CD30, AFP, Glypican 3, β-HCG, and EMA). He received 4 cycles of the BEP (bleomycin, etoposide, and cisplatin) regime and was doing well at 13 months of follow-up. Conclusion The index case highlights an exceedingly rare association of gastric MZL with testicular mixed germ cell tumour with rare age presentation. Thus, surgeons, radiologists and pathologists should be aware of considering the differential of non-lymphoid malignancy at the distant site apart from the systemic spread of primary extranodal non-Hodgkin lymphoma. This will help in deciding and providing the appropriate treatment to the patient on time.
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