Retroperitoneal germinomas (seminomas) without evidence of testicular involvement

Abstract

T neoplasms derived from germ cells-germinoma (seminoma or dysgerminoma), embryonal teratoma (carcinoma), teratoma, choriocarcinoma and mixtures of these (tera-tocarcinomal2)-c1early indicates that they may exist as primary lesions in the gonads,3.9~ 12 in the anterior mediastinurn117 17, zl, 25, 34 and in the region of the pineal body.lO927 Friedman11 stated: "The retroperitoneum represents 'unused urogenital ridge and is therefore the most likely site for extragonadal germinal neoplasms."There is often a reluctance, however, to accept such neoplasms as primary when they are located in this area.The dictum has developed that no germ cell neoplasm in the retroperitoneum, particularly in males, should be considered primary in that area until the gonads have been thoroughly examined and excluded as a possible source.The scepticism that exists in regard to primary malignant germ cell tumors of the retroperitoneum is probably greatest for seminomas which tend to spread by lymphatic channels to retroperitoneal lymph nodes and often remain restricted to the area for considerable time.The only evidence of primary testicular origin for certain retroperitoneal germ cell tumors may be a small occult and regressing neoplasm or an intertubular scar referred to in the literature as a "burned out primary."llp 24, 26, 28 In view of such statements it requires courage to suggest that primary retroperitoneal seminomas may exist.Recently a patient with retroperitoneal seminoma without testicular involvement and with complete regression of the neoplasm following radiation therapy was presented in our Pathology-Radiation Therapy Confer-ence2 and this case supplied the impetus for critically assessing similar lesions that have From the Departments of Pathology and Radiology,