Metachronous Testicular Mixed Germ Cell Tumour and Gastric Marginal Zone Lymphoma: A Case Report with An Unusual Association

  • Mayur Parkhi Department of Histopathology, Post Graduate Institute of Medical and Education Research, Sector-12, Chandigarh, India
  • Saumya Sahu Department of Histopathology, Post Graduate Institute of Medical and Education Research, Sector-12, Chandigarh, India
  • Uttam Kumar Mete Department of Histopathology, Post Graduate Institute of Medical and Education Research, Sector-12, Chandigarh, India
  • Uma Nahar Saikia Department of Urology, Post Graduate Institute of Medical and Education Research, Sector-12, Chandigarh, India
DOI: https://doi.org/10.21276/apalm.3234
Keywords: Second primary malignancy, mixed germ cell tumor, testis, marginal zone lymphoma, stomach

Abstract

Background 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.

References

Warren S, Gates O. Multiple primary malignant tumours: A survey of the literature and statistical study. Am J Cancer. 1932;16:1358-1414.

Li F, Zhong WZ, Niu FY, et al. Multiple primary malignancies involving lung cancer. BMC Cancer. 2015; 15:696.

Yang Y, Yang Y, Yan S. Risk and survival of second primary malignancies following diagnosis of gastric mucosa-associated lymphoid tissue lymphomas: A population-based study. Curr Probl Cancer. 2021;45(6):100735.

Amiot A, Jooste V, Gagniere C, et al. Second primary malignancies in patients treated for gastric mucosa-associated lymphoid tissue lymphoma. Leuk Lymphoma. 2017 Sep;58(9):1-11.

Tajika M, Matsuo K, Ito H, et al. Risk of second malignancies in patients with gastric marginal zone lymphomas of mucosa associate lymphoid tissue (MALT). J Gastroenterol. 2014 May;49(5):843-52.

Zucca E, Pinotti G, Roggero E, et al. High incidence of other neoplasms in patients with low-grade gastric MALT lymphoma. Ann Oncol. 1995 Sep;6(7):726-8.

Montalbàn C, Castrillo JM, López-Abente G, et al. Other cancers in patients with gastric MALT lymphoma. Leuk Lymphoma. 1999 Mar;33(1-2):161-8.

Au WY, Gascoyne RD, Le N, et al. Incidence of second neoplasms in patients with MALT lymphoma: no increase in risk above the background population. Ann Oncol. 1999 Mar;10(3):317-21.

Vogt A, Schmid S, Heinimann K, et al. Multiple primary tumours: challenges and approaches, a review. ESMO Open. 2017 May 2;2(2):e000172.

Raderer M, Kiesewetter B, Ferreri AJ. Clinicopathologic characteristics and treatment of marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). CA: Cancer J. 2016;66(2):153–171.

Stathis A, Bertoni F, Zucca E. Treatment of gastric marginal zone lymphoma of MALT type. Expert Opin Pharmacother. 2010;11(13):2141–2152.

Morris LG, Sikora AG, Hayes RB, Patel SG, Ganly I. Anatomic sites at elevated risk of second primary cancer after an index head and neck cancer. Cancer Causes Control. 2011; 22:671-679.

Gilligan T, Lin DW, Aggarwal R, et al. Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019 Dec;17(12):1529-1554.

Zhang L, Hemminki O, Chen T, et al. Second cancers and causes of death in patients with testicular cancer in Sweden. PLoS One. 2019 Mar 28;14(3):e0214410.

Published
2023-11-01
Issue
Vol 10 No 7 (2023)
Section
Case Report

Copyright (c) 2023 Mayur Parkhi, Saumya Sahu, Uttam Kumar Mete, Uma Nahar Saikia

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).