A Case of Metastatic Seminoma Mimicking a Primary Pancreatic Tumor

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Am J Gastroenterol

Abstract

Introduction: Patients who present with painless jaundice, dark urine, and pruritis immediately spark concern for a primary pancreatic malignant tumor. Alternatively, the patient can present with a malignancy from an unknown origin. We present a rare case of a metastatic seminoma mimicking a primary pancreatic tumor and highlight the importance of biopsy and proper pathology. Case Description/Methods: A 66-year-old male with past medical history of testicular seminoma status post bilateral orchiectomy in 1992/2016 with retroperitoneal lymph node resection who presented with a chief complaint of pruritis, jaundice, and abdominal pain for 3 weeks prior to presentation. His liver profile, computed tomography (CT), and Magnetic Resonance Imaging (MRI) of his abdomen showed concerns of extrinsic biliary compression with internal and external biliary dilation (Figure 1A). Diagnostic imaging did not show additional areas of metastasis. For diagnostic sampling an endoscopic ultrasound was performed which re-demonstrated the pancreatic head mass which was biopsied through fine needle aspiration (FNA). Following this, an endoscopic retrograde cholangiopancreatography was performed with placement of a single plastic 10 Fr by 9cm stent into the common bile duct (Figure 1B). FNA biopsy showed neoplastic cells positive for D2-40, OCT3/4, CD117, and negative for CD45, CK7, SOX10, AE1/AE3, and CD30 which was consistent with a seminoma that was thought to be a distant metastasis from patients primary seminoma. Prior to discharge the patient's liver biochemistry panel was shown to downtrend after biliary decompression. Patient was planned to begin chemotherapy in the outpatient setting after tumor board discussion. Discussion: The presenting symptoms of painless jaundice with imaging showing a pancreatic head mass raised concerns for pancreatic adenocarcinoma, however on pathologic review it was shown to be a solitary metastatic germ cell tumors. This delineation through proper sampling and histopathologic review was critical for proper diagnosis and treatment of a curable malignancy. This case is unique that patient had suspected cured testicular seminoma with now new metastasis 7 years after orchiectomy and retroperitoneal lymph node resection along with the pancreas being the sole area of distant metastasis. This highlights the importance for a broad differential diagnosis and the importance of having trained gastroenterologists available for biopsies of pancreatic masses.

Volume

118

Issue

10

First Page

S1539

Last Page

S1540

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