Burned-out germ cell tumor presenting with acute abdomen

Acute abdomen is a serious condition frequently encountered in the emergency departments (ED). There are various etiologies causing acute abdomen, most common being acute appendicitis; however, there are rare causes of acute abdomen as well and one should keep them in mind while handling a patient with unusual clinical features. We herein present a 26-year-old male, with no past medical or surgical history, presenting with acute abdominal pain and distension to the ED. He was found to have a large vascular retroperitoneal mass on computed tomography which had invaded and perforated the duodenum thus causing the acute presentation. Repair of the duodenal perforation and sampling of the mass were performed in terms of surgical management. Pathology results revealed the mass originating from a burned out testis yolk sac tumor with embryonal carcinoma component. Although the original tumor had regressed at the testis, its metastasis at the retroperitoneal area had caused the clinical condition. This entity is described as the retroperitoneal metastasis of a burned-out testicular tumor. Few cases presenting with gastrointestinal bleeding secondary to invasion of the retroperitoneal metastasis have been reported. However, this is the first case in the literature presenting with duodenal perforation and acute abdomen. Sampling of the retroperitoneal tumor for histopathological diagnosis during the immediate surgical intervention facilitates the diagnostic management in these cases. Although scrotal examination combined with testis tumor marker assessments is essential for optimal patient management, the possibility of a burned-out testicular tumor with normal scrotal examination should always be kept in mind.

Akut batýn ile baþvuran burned-out germ hücreli tümör olgusu

Akut karýn, acil serviste sýklýkla karþýlaþýlan ciddi bir durumdur. Akut karýna neden olan çeþitli etiyolojiler vardýr, en sýk görülen akut apandisittir, ancak nadir akut karýn nedenleri de vardýr ve olaðandýþý klinik özelliklere sahip bir hastayla ilgilenirken bunlarý akýlda tutmak gerekir. Bu yazýda, akut karýn aðrýsý ve distansiyon ile acil servise baþvuran, 26 yaþýnda bir erkek hastayý sunuyoruz. Bilgisayarlý tomografide duodenumu invaze ederek perfore etmis ve akut karina neden olan büyük bir vasküler retroperitoneal kitlesi olduðu bulundu. Cerrahi tedavi olarak, duodenal perforasyon onarýmý ve kitle örneklenmesi uygulandý. Patoloji sonucu testis kaynaklý embriyonal karsinom bileþenli yolk sac tümörü olarak raporlandý. Orijinal tümör testiste tamamen gerilemiþ olmasýna raðmen, retroperitoneal bölgedeki metastazý klinik duruma neden olmuþtu. Bu antite, regrese olmuþ bir testis tümörünün retrope-ritoneal metastazý olarak tanýmlanýr. Retroperitoneal metastaz invazyonuna sekonder gastrointestinal kanama ile baþvuran az sayýda olgu bildirilmiþtir. Bildirdigimiz olgu literatürde duodenal perforasyon ve akut karýn ile prezente olan ilk olgudur. Acil cerrahi müdahale sýrasýnda histopatolojik taný için retroperitoneal tümörün örneklenmesi, bu olgularda tanýyý kolaylaþtýrýr. Testis tümörü belirteçleri ile kombine skrotal muayene hasta yönetimi için gerekli olmasýna raðmen, normal skrotal muayene mevcudiyetinde testis tümörünun tam regrese olma olasýlýðý akýlda tutulmalýdýr.