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Annals of Oncology 13:121-124, 2002
© 2002 European Society for Medical Oncology

Extragonadal retroperitoneal germ cell tumor: evidence of origin in the testis

M. Scholz1, M. Zehender1, G. N. Thalmann1, M. Borner2, H. Thöni3 and U. E. Studer1,+

1Department of Urology, 2Institute of Medical Oncology, 3Institute of Diagnostic Radiology, University of Berne, Berne, Switzerland

Received 21 May 2001; revised 20 July 2001; accepted 17 August 2001.

Background

The origin of extragonadal retroperitoneal germ cell tumors remains controversial. Whether they develop primarily in the retroperitoneum or whether they are metastases of a primary testicular tumor has long been debated.

Patients and methods

We retrospectively analyzed 26 patients treated as having primary extragonadal retroperitoneal germ cell tumors based upon the findings of testicular palpation by the referring physician. Testicular evaluation was then extended with ultrasonographical and histological examinations.

Results

Biopsy of the extragonadal tumor was performed in 25 patients, confirming diagnosis of extragonadal retroperitoneal germ cell tumor. Prior to treatment patients were clinically evaluated by several physicians and the testes were not considered suspicious for testicular cancer. At urological workup, testes were found to be atrophic and/or indurated in 14 (54%) patients, enlarged in one (4%) and unremarkable in 11 (42%). Ultrasound examination of the testes in 20 patients showed pathological findings in all of them. Histology of the testis was available in 25 of 26 patients and revealed active tumor in three, intratubular germ cell neoplasia in four, scar tissue in 12, sclerosis in three, sclerosis and fibrosis in one, and fibrosis alone in two.

Conclusions

So-called primary extragonadal germ cell tumors in the retroperitoneum are very likely a rare or non-existing entity and should be considered as metastases of a viable or burned-out testicular cancer until proven otherwise. All of our patients with histologically examined testes had pathological finding, 76% of which were either viable tumor or scars.

Key words: burned-out tumor, germ cell tumor, retroperitoneal, testicular tumor


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