metastatic “burned out” seminoma causing neurological paraneoplastic syndrome—not quite “burned out”

metastatic “burned out” seminoma causing neurological paraneoplastic syndrome—not quite “burned out”

;Yuval Freifeld;Payal Kapur;Ritika Chitkara;Francesca Lee;Pravin Khemani;Aditya Bagrodia
journal of photochemistry and photobiology a: chemistry 2018 Vol. 9 pp. -
176
freifeld2018frontiersmetastatic

Abstract

A 44-year-old man presented with cerebellar ataxia and limbic encephalitis and was ultimately diagnosed with metastatic germ cell neoplasm resulting from a “burned out” primary testicular tumor. The patient had progressive ataxia, leading to a thorough investigation for infectious, autoimmune, metabolic, and malignant causes of acquired cerebellar ataxia that revealed no significant findings. Testicular sonography demonstrated a possible right testicular lesion that was not confirmed on radical inguinal orchiectomy. F18-FDG positron emission tomography/computerized tomography scan revealed a solitary retroperitoneal lesion, concerning for metastatic disease but not amenable to percutaneous biopsy. A robotic retroperitoneal lymph node dissection was performed and pathology revealed a CD117-positive metastatic seminoma leading to appropriate germ cell tumor-directed chemotherapy. After completing chemotherapy and during 1 year of follow-up, there has been a gradual improvement of the patient’s neurological manifestations.

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