LATE RELAPSE OF TESTICULAR CANCER PRESENTING AS DIFFERENTIATED TERATOMA - REPORT OF A CASE AND DISCUSSION OF THE CLINICAL IMPLICATIONS

This report describes the unusual case of a patient with late relapse of testicular cancer, histologically defined as differentiated teratom a occurring 76 months after primary therapy for metastatic non-seminom atous germ cell cancer. During initial treatment the patient received 4 cycles of cisplatin-based chemotherapy followed by secondary resecti on of residual retroperitoneal and pulmonary metastases which had hist ologically revealed necrotic tissue. The patient had been without evid ence of disease during the follow-up until May 1994 when a cystic mass was noted in the left fossa obturatoria. There was no concomitant ele vation of serum tumour markers, while alpha-fetoprotein (AFP) could be detected in fluid gained by fine-needle aspiration from inside the cy stic structure. Histological resection showed a differentiated teratom a. Late relapses defined as tumour recurrences later than 24 months af ter primary chemotherapy for metastatic testicular cancer are rather r are and affect only 2-5% of patients. However, the prognosis of patien ts with late relapse is poor with only 20-30% of patients achieving a second remission after chemotherapy +/- surgery. Patients presenting w ith only differentiated teratoma at late relapse and in whom the tumou r can be completely surgically resected have the best prognosis among the subgroup of patients with late relapses with a long-term survival in approximately 50% of patients. The incidence and clinical implicati ons of late relapses after chemotherapy for testicular cancer are disc ussed in the current report.