RESUMO
If a testicular cancer patient has a mass in the retroperitoneum, a metastasis is often the first suspicion, probably leading to improper diagnosis and overtreatment. Here we report a case of retroperitoneal schwannoma mimicking metastatic seminoma. A 29-year-old man, who had a history of seminoma, presented with a single retroperitoneal mass suspected to be a metastasis. Because the patient refused radiotherapy, 3 cycles of cisplatin, etoposide, and bleomycin were offered. Post-chemotherapy computed tomography scan revealed persistence of the retroperitoneal mass, with no change in tumor size or characteristics. Subsequently, retroperitoneal lymph node dissection was performed. The dissected tissue contained negative lymph nodes but a single mass in the attached fat. Pathology revealed retroperitoneal schwannoma, which was confirmed by immunohistochemistry. Thus, clinicians should be aware of retroperitoneal schwannoma and its distinction from metastatic seminoma to avoid misdiagnosis and ensure proper treatment.
Assuntos
Adulto , Humanos , Masculino , Antibióticos Antineoplásicos , Usos Terapêuticos , Antineoplásicos , Usos Terapêuticos , Antineoplásicos Fitogênicos , Usos Terapêuticos , Bleomicina , Usos Terapêuticos , Cisplatino , Usos Terapêuticos , Erros de Diagnóstico , Etoposídeo , Usos Terapêuticos , Excisão de Linfonodo , Linfonodos , Patologia , Metástase Linfática , Neoplasias Primárias Múltiplas , Neurilemoma , Diagnóstico por Imagem , Tratamento Farmacológico , Patologia , Radiografia , Neoplasias Retroperitoneais , Diagnóstico por Imagem , Tratamento Farmacológico , Patologia , Espaço Retroperitoneal , Seminoma , Cirurgia Geral , Neoplasias Testiculares , Cirurgia GeralRESUMO
<p><b>OBJECTIVE</b>To evaluate the predictive value of serum inhibin B (INH B) levels as an indicator of the presence of testicular spermatozoa in nonobstructive azoospermia.</p><p><b>METHODS</b>Forty patients with nonobstructive azoospermia (NOA), 20 patients with obstructive azoospermia (OA), and 10 fertile volunteers were involved in this study. A chemoluminescence method was used to measure the levels of FSH; Inhibin B was analysed by using sandwich enzyme-linked immuno-sorbent assay.</p><p><b>RESULTS</b>Patients with nonobstructive azoospermia has significantly higher levels of serum FSH [(21.34 +/- 12.15) IU/L] and significantly lower levels of inhibin B [(53.15 +/- 58.74) ng/L] than patients with obstructive azoospermia [FSH: (3.94 +/- 1.52) IU/L, INH B: (162.49 +/- 78.38) ng/L, P < 0.01] and fertile volunteers [FSH: (4.27 +/- 2.84) IU/L, INH B: (228.49 +/- 110.68) ng/L, P < 0.01]. Mean serum inhibin B were significantly higher in patients with nonobstructive azoospermia who had spermatozoa on TESE than in those in whom no spermatozoa was found on TESE [INHB: (90.31 +/- 72.18) ng/L vs (19.54 +/- 20.38) ng/L, r = 0.528, P < 0.01], but mean FSH levels did not have similar predictive power (P > 0.05).</p><p><b>CONCLUSION</b>Serum INH B level seems to be more accurate than serum FSH in the prediction of presence of testicular spermatozoa in patients with nonobstructive azoospermia. Serum inhibin B determination may be substitute of TESE as a diagnostic index.</p>