Journal Article

Poor prognosis of retroperitoneal mixed extragonadal germ cell tumors in an HIV-infected man with severe immunosuppression and bilateral cryptorchidism: a case report

Li, Hongjun, Li, Ruili

2019

Overview

Background Nonseminomatous germ cell tumors (NSGCTs) represent one of the main groups of germ cell tumors (GCTs), and they have a more invasive course than seminomatous GCTs. Human immunodeficiency virus (HIV) positivity is considered to be a risk factor for testicular seminoma patients, but reports about HIV-infected individuals with NSGCTs are rare. Case presentation We report a case of a retroperitoneal mixed extragonadal germ cell tumor in an HIV-infected man who has been diagnosed with bilateral cryptorchidism since birth. A 30-year-old man presented with a large heterogeneously mixed echo mass located in the right lower abdomen according to an abdominal ultrasound; he was HIV-positive and had a low CD4 count of 70 cells/ml in the followed test, which suggested severe immunosuppression, and ultrasound-guided biopsy histology revealed a malignant yolk sac tumor of the testis. First, the patient received combination antiretroviral therapy; then, to relieve his symptoms, an exploratory laparotomy and retroperitoneal neoplasm resection under general anesthesia were performed for subsequent treatment. The postoperative histopathological examination indicated that the patient exhibited malignant mixed GCTs of the undescended testis that were composed predominantly of yolk sac tumors with foci of embryonal cell carcinoma and seminoma; It is a rare type in various GCTs, especially in HIV-infected patients. After the operation, the patient underwent computed tomography follow-up scans at 1 week and 2 weeks, and the results showed that the size of the right inguinal mass gradually increased, which suggested a poor outcome. To limit the growth of the tumors, right inguinal mass resection under local anesthesia was performed 17 days after the initial operation, and pathological examination revealed mixed GCT metastasis. Subsequently, the patient received salvage chemotherapy with a regimen of cisplatin, etoposide, and ifosfamide. Unfortunately, the patient died 1 week after the first cycle of chemotherapy because of severe immunosuppression, a low platelet count and cancer cachexia. Conclusions Because of severe immunosuppression, the treatment of advanced extragonadal NSGCTs in an HIV-infected patient resulted in a poor prognosis. This outcome should be considered in further research, and appropriate management for achieving long-term survival needs to be established.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abdomen / Adult / Anesthesia / Anti-HIV Agents - therapeutic use / Antineoplastic Combined Chemotherapy Protocols - therapeutic use / Antiretroviral agents / Antiretroviral therapy / Biomedical and Life Sciences / Biomedicine / Biopsy / Cachexia / Cancer / cancer imaging / Cancer metastasis / Cancer Research / Cancer therapies / Carcinoma / Case Report / Case reports / CAT scans / CD4 antigen / Chemotherapy / Chemotherapy, Adjuvant - methods / Cisplatin / Complications and side effects / Computed tomography / Cryptorchidism / Cryptorchidism - complications / Cryptorchidism - pathology / Cryptorchidism - therapy / Diagnostic imaging / Drug therapy / Etoposide / Extragonadal / Fatal Outcome / Germinoma / Health aspects / Health Promotion and Disease Prevention / Hemoglobin / Highly active antiretroviral therapy / HIV / HIV infections / HIV Infections - complications / HIV Infections - drug therapy / HIV Infections - virology / HIV patients / Human immunodeficiency virus / Humans / Ifosfamide / Immunocompromised Host / Immunosuppression / Immunotherapy / interventional therapeutics / Invasiveness / Laparotomy / Male / Medical prognosis / Medicine/Public Health / Metastases / Metastasis / Neoplasia / Neoplasms, Germ Cell and Embryonal - complications / Neoplasms, Germ Cell and Embryonal - diagnosis / Neoplasms, Germ Cell and Embryonal - therapy / Neoplasms, Germ Cell and Embryonal - virology / Nonseminomatous germ cell tumor / Oncology / Patients / Poor prognosis / Prognosis / Retroperitoneal Neoplasms - complications / Retroperitoneal Neoplasms - diagnosis / Retroperitoneal Neoplasms - therapy / Retroperitoneal Neoplasms - virology / Risk factors / Salvage Therapy - methods / Seminoma / Surgery / Surgical Oncology / Testicular Neoplasms - complications / Testicular Neoplasms - diagnosis / Testicular Neoplasms - therapy / Testicular Neoplasms - virology / Testis - pathology / Testis - surgery / Tomography / Tumors / Ultrasonic imaging / Ultrasound / Undescended testes / Yolk / Yolk sac