Primary Nonseminomatous Germ Cell Tumor of Kidney: An Uncommon Renal Neoplasm

Main Article Content

Sonu Plash
Deepti Soni
Sramana Mukhopadhyay
Moorat Singh Yadav
Devashish Kaushal
Ketan Mehra

Keywords

extragonadal germ cell tumor, germ cell tumor, kidney tumor, nonseminomatous tumor, renal neoplasm

Abstract

Germ cell tumor (GCT) is a neoplasm typically found in childhood, commonly originating from the testis or ovary. While there have been reported cases of GCT occurring in various extragonadal sites, primary intrarenal GCT is exceptionally rare. We present a case of 37-year-old male who presented with right upper abdomen pain. Imaging revealed a sizable mass within the right kidney. The patient underwent surgical resection of the renal mass during which there was perirenal infiltration into the duodenum and dense desmoplastic reaction all around. Subsequent histopathology confirmed the diagnosis of primary intrarenal nonseminomatous germ cell tumor (NSGCT). The patient underwent four cycles of adjuvant bleomycin, etoposide, and cisplatin (BEP) chemotherapy; at 6 months of follow-up, he is fine. The objective of this case report is to underscore the importance of considering NSGCT as a potential rare differential diagnosis in cases of renal neoplasms and further plan for the management.

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References

1. Garnick MB, Canellos GP, Richie JP. Treatment and surgical staging of testicular and primary extragonadal germ cell cancer. JAMA. 1983;250:1733–41.

2. Wada S, Yoshimura R, Nishisaka N, Kishimoto T, Ikehara T, Masuda C, et al. Primary retroperitoneal pure yolk-sac tumor in an adult male. Scand J Urol Nephrol. 2001 Dec;35(6):515–7. 10.1080/003655901753367659

3. Shinagare AB, Jagannathan JP, Ramaiya NH, Hall MN, Van den Abbeele AD. Adult extragonadal germ cell tumors. AJR Am J Roentgenol. 2010;195:W274–80. 10.2214/AJR.09.4103

4. Thakur S, Kakkar A, Jana M, Das P, Agarwala SP, Iyer VK. Pediatric primary yolk sac tumour of the kidney: Recommendations for pretreatment diagnosis. Fetal Pediatr Pathol. 2023 Feb;42(1): 55–62. 10.1080/15513815.2022.2042631

5. Kumar Y, Bhatia A, Kumar V, Vaiphei K. Intrarenal pure yolk sac tumor: An extremely rare entity. Int J Surg Pathol. 2007;15:204–6. 10.1177/1066896906295776

6. Radhika S, Bakshi A, Rajwanshi A, Nijhawan R, Das A, Kakkar N, et al. Cytopathology of uncommon malignant renal neoplasms in the pediatric age group. Diagn Cytopathol. 2005;32:281–6. 10.1002/dc.20242

7. Liu YC, Wang JS, Chen CJ, Sung PK, Tseng HH. Intrarenal mixed germ cell tumor. J Urol. 2000;164:2020–1.

8. Lin S, Li X, Sun C, Feng S, Peng Z, Huang S, et al. CT findings of intrarenal yolk sac tumor with tumor thrombus extending into the inferior vena cava: A case report. Korean J Radiol. 2014;15:641–5. 10.3348/kjr.2014.15.5.641

9. Ragavan N, Kunal PD, Annapurneshwari S. Primary intrarenal yolk sac tumor. Indian J Urol. 2017;33:167–8. 10.4103/0970-1591.203410

10. Maclean E, Barns M, McDermott K. Pure primary renal yolk sac tumour in an adult: Extremely rare clinical finding. BMJ Case Rep. 2023;16:e254024. 10.1136/bcr-2022-254024

11. McAleer JJ, Nicholls J, Horwich A. Does extragonadal presentation impart a worse prognosis to abdominal germ-cell tumours? Eur J Cancer. 1992;28A:825–8. 10.1016/0959-8049(92)90123-j

12. Logothetis CJ, Samuels ML, Selig DE, Dexeus FH, Johnson DE, Swanson DA, et al. Chemotherapy of extragonadal germ cell tumors. J Clin Oncol. 1985 Mar;3(3):316–25.

13. Bokemeyer C, Nichols CR, Droz J-P, Schmoll HJ, Horwich A, Gerl A, et al. Extragonadal germ cell tumors of the mediastinum and retroperitoneum: Results from an international analysis. JCO. 2002;20:1864–73. 10.1200/JCO.2002.07.062

14. Hong WK, Bhutani R, Gerzof SG, Doos WG. Chemotherapy for primary retroperitoneal yolk SAC tumor: Report of a case. Cancer. 1981;47:19–21. 10.1002/1097-0142(19810101)47:1<19::aid-cncr2820470104>3.0.co;2-g

15. Hainsworth JD, Einhorn LH, Williams SD, Stewart M, Greco FA. Advanced extragonadal germ-cell tumors. Successful treatment with combination chemotherapy. Ann Intern Med. 1982;97:7–11. 10.7326/0003-4819-97-1-7

16. Williams S, Blessing JA, Liao SY, Ball H, Hanjani P. Adjuvant therapy of ovarian germ cell tumors with cisplatin, etoposide, and bleomycin: A trial of the gynecologic oncology group. J Clin Oncol. 1994;12:701–6. 10.1200/JCO.1994.12.4.701

17. Gershenson DM, Morris M, Cangir A, Kavanagh JJ, Stringer CA, Edwards CL, et al. Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin. J Clin Oncol. 1990;8:715–20. 10.1200/JCO.1990.8.4.715

18. Albany C, Einhorn LH. Extragonadal germ cell tumors: Clinical presentation and management. Curr Opin Oncol. 2013;25:261–5. 10.1097/CCO.0b013e32835f085d

19. Nair VG, Kiran HS, Shanthala PR. Pure primary extragonadal retroperitoneal yolk sac tumour in a young child: A case report. J Clin Diagn Res. 2017;11:ED09–11. 10.7860/JCDR/2017/24892.9781