Transformación somática en tumor de células germinales: reporte de 2 casos

ResumenAntecedentesReportamos 2 casos de tumores de células germinales con transformación somática maligna (TSM), fenómeno raro con baja tasa de sobrevida.Caso 1Varón de 53 años, un mes previo comienza con dolor e induración testicular izquierda diagnosticándose de tumor, realizando orquiectomía radical (OR). Reporte histopatológico: teratoma con TSM en sarcoma neurogénico y rabdomiosarcoma. Desarrolla enfermedad retroperitoneal y se trató con quimioterapia; presentando progresión y crecimiento tumoral retroperitoneal, se decide explorar quirúrgicamente, resultando irresecable, se tomó biopsia con reporte de rabdomiosarcoma fusiforme alto grado con extensión a epiplón mayor.Caso 2Varón de 45 años, ingesta de AINE. En 2004 se le realiza OR y tumorectomía retroperitoneal, reportando tumor germinal en ambos sitios. Recibe quimioterapia y radioterapia adyuvante. En 2014 acude a nuestra institución y se evidencia tumor intercavo-aórtico de 3 × 4 cm en PET-CT. Marcadores tumorales normales. Se realiza tumorectomía del 80% (R2), reportando sarcoma fusocelular. Se administra doxorrubicina/ifosfamida 3 ciclos y radioterapia, permaneciendo en vigilancia con tumor de 16 mm intercavo-aórtico. Presenta sangrado digestivo alto y fallece.ConclusionesLa TSM de tumores germinales es rara y poco conocida.

BackgroundWe describe herein 2 cases of germ cell tumors with somatic malignant transformation (SMT), a rare phenomenon with a low survival rate.Case 1A 53-year-old man had a one-month progression of pain and hardening in the left testis. He was diagnosed with a tumor and underwent radical orchiectomy (RO). The histopathology report stated: teratoma with SMT into neurogenic sarcoma and rhabdomyosarcoma. The patient developed retroperitoneal disease and was treated with chemotherapy. The retroperitoneal tumor progressed and grew and so surgical exploration was carried out, identifying an unresectable tumor. A biopsy was taken and the result was a high-grade fusiform rhabdomyosarcoma extending to the greater omentum.Case 2A 45-year-old man was a user of NSAIDs. He underwent RO and retroperitoneal tumorectomy in 2004 that reported germ cell tumor at both sites. He received chemotherapy and adjuvant radiotherapy. In 2014 he was referred to our institution and a PET-CT scan identified a 3 × 4 cm intercaval-aortic tumor. Tumor markers were normal. Tumorectomy of 80% of the tumor (R2) was performed, reporting fusocellular sarcoma. Three cycles of doxorubicin/ifosfamide and radiotherapy were administered. The patient remained under surveillance with a 16 mm intercaval-aortic tumor. He presented with upper gastrointestinal bleeding and died.ConclusionsSMT of germ cell tumors is rare and insufficiently understood.