Introduction: Testicular germ cell tumors with somatic-type malignancy, wherein teratomas transform into sarcomas, is drug resistant and has a poor prognosis.
Case presentation: A 43-year-old man presented with a left testicular tumor, multiple pulmonary metastases, and mediastinal and para-aortic lymph node metastases. The testicular tumors were diagnosed as germ cell tumors. After bleomycin, etoposide, and cisplatin chemotherapy; right upper lobectomy for the pulmonary metastasis; and paclitaxel, ifosfamide, and cisplatin chemotherapy, rapidly progressing mediastinal lymph node metastasis was observed. It was resected at another specialized center owing to the challenging surgical approach. The histopathological diagnosis of the resected tumor was a teratoma with somatic-type malignancy (rhabdomyosarcoma). Subsequently, left hilar lymph node metastasectomy and left upper lobectomy were performed for the pulmonary metastases. The patient survived for more than 8 years after initial treatment.
Conclusion: Surgery, although challenging, may yield long-term survival for patients with testicular germ cell tumors with sarcomatous transformation.
Keywords: metastasis; rhabdomyosarcoma; surgery; teratoma; testicular germ cell tumor.
© 2023 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.