Akut bat�n ile ba�vuran burned-out germ h�creli t�m�r olgusu

Cimen, Sanem Guler; �zen�, G�rkem; Do�an, Ahmet Emin; Yeti�gin, Efe; �imen, Serta�; Han, �nsal

Cilt : 30 Say� : 12 Y�l : 2024

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Akut bat�n ile ba�vuran burned-out germ h�creli t�m�r olgusu [Ulus Travma Acil Cerrahi Derg]

Ulus Travma Acil Cerrahi Derg. 2022; 28(11): 1650-1654 | DOI: 10.14744/tjtes.2021.68792

Akut bat�n ile ba�vuran burned-out germ h�creli t�m�r olgusu

Sanem Guler Cimen¹, G�rkem �zen�², Ahmet Emin Do�an², Efe Yeti�gin³, Serta� �imen², �nsal Han³
¹Sa�l�k Bilimleri �niversitesi, D��kap� Y�ld�r�m Beyaz�t E�itim ve Ara�t�rma Hastanesi, Genel Cerrahi Anabilim Dal�, Ankara
²Sa�l�k Bilimleri �niversitesi, D��kap� Y�ld�r�m Beyaz�t E�itim ve Ara�t�rma Hastanesi, �roloji Anabilim Dal�, Ankara
³Sa�l�k Bilimleri �niversitesi, D��kap� Y�ld�r�m Beyaz�t E�itim ve Ara�t�rma Hastanesi, Patoloji Anabilim Dal�, Ankara

Akut kar�n, acil serviste s�kl�kla kar��la��lan ciddi bir durumdur. Akut kar�na neden olan �e�itli etiyolojiler vard�r, en s�k g�r�len akut apandisittir, ancak nadir akut kar�n nedenleri de vard�r ve ola�and�� klinik �zelliklere sahip bir hastayla ilgilenirken bunlar� ak�lda tutmak gerekir. Bu yaz�da, akut kar�n a�r�s� ve distansiyon ile acil servise ba�vuran, 26 ya��nda bir erkek hastay� sunuyoruz. Bilgisayarl� tomografide duodenumu invaze ederek perfore etmis ve akut karina neden olan b�y�k bir vask�ler retroperitoneal kitlesi oldu�u bulundu. Cerrahi tedavi olarak, duodenal perforasyon onar�m� ve kitle �rneklenmesi uyguland�. Patoloji sonucu testis kaynakl� embriyonal karsinom bile�enli yolk sac t�m�r� olarak raporland�. Orijinal t�m�r testiste tamamen gerilemi� olmas�na ra�men, retroperitoneal b�lgedeki metastaz� klinik duruma neden olmu�tu. Bu antite, regrese olmu� bir testis t�m�r�n�n retrope-ritoneal metastaz� olarak tan�mlan�r. Retroperitoneal metastaz invazyonuna sekonder gastrointestinal kanama ile ba�vuran az say�da olgu bildirilmi�tir. Bildirdigimiz olgu literat�rde duodenal perforasyon ve akut kar�n ile prezente olan ilk olgudur. Acil cerrahi m�dahale s�ras�nda histopatolojik tan� i�in retroperitoneal t�m�r�n �rneklenmesi, bu olgularda tan�y� kolayla�t�r�r. Testis t�m�r� belirte�leri ile kombine skrotal muayene hasta y�netimi i�in gerekli olmas�na ra�men, normal skrotal muayene mevcudiyetinde testis t�m�r�nun tam regrese olma olas�l�� ak�lda tutulmal�d�r.

Anahtar Kelimeler: Akut kar�n, intestinal perforasyon, retroperitoneal t�m�rler, testis t�m�rleri.

Burned-out germ cell tumor presenting with acute abdomen

Sanem Guler Cimen¹, G�rkem �zen�², Ahmet Emin Do�an², Efe Yeti�gin³, Serta� �imen², �nsal Han³
¹Department of General Surgery, University of Health Sciences, D��kap� Y�ld�r�m Beyaz�t Training and Research Hospital, Ankara-T�rkiye
²Department of Urology, University of Health Sciences, D��kap� Y�ld�r�m Beyaz�t Training and Research Hospital, Ankara-T�rkiye
³Department of Pathology, University of Health Sciences, D��kap� Y�ld�r�m Beyaz�t Training and Research Hospital, Ankara-T�rkiye

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.

Keywords: Acute abdomen, intestinal perforation, neoplasm invasion, retroperitoneal neoplasms; testicular neoplasms.

Sorumlu Yazar: Sanem Guler Cimen, T�rkiye
Makale Dili: �ngilizce

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