Spinal cord metastasis from testicular seminoma detected by F-18 FDG PET/CT study prior to neurological symptoms: An unusual presentation

Document Type: Case Report

Authors

Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

A 60-year-old patient with testicular seminoma was referred for F-18 FDG PET/CT Study to evaluate recurrence. In addition to hypermetabolic cervical, mediastinal and hilar lymph node tumoral metastases, segmental intense FDG uptake along the lumbar spinal cord suggestive of tumoral metastasis was noted which quite an unusual presentation is.  At the time of PET study the patient was symptomless, and neurological symptoms and signs associated with spinal cord metastasis developed only several days afterwards, emphasizing the role of FDG PET study in early detection of spinal cord metastasis. The patient underwent radiotherapy of the spinal cord with consequent clinical improvement.

Keywords

Main Subjects


  1. Groll RJ, Warde P, Jewett MA. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol. 2007 Dec;64(3):182-97. 
  2. Khan O, Protheroe A. Testis cancer. Postgrad Med J. 2007 Oct;83(984):624-32.
  3. Motzer RJ, Jonasch E, Agarwal N, Beard C, Bhayani S, Bolger GB, Chang SS, Choueiri TK, Costello BA, Derweesh IH, Gupta S, Hancock SL, Kim JJ, Kuzel TM, Lam ET, Lau C, Levine EG, Lin DW, Michaelson MD, Olencki T, Pili R, Plimack ER, Rampersaud EN, Redman BG, Ryan CJ, Sheinfeld J, Shuch B, Sircar K, Somer B, Wilder RB, Dwyer M, Kumar R. Testicular Cancer, Version 2.2015. J Natl Compr Canc Netw. 2015 Jun;13(6):772-99.
  4. Boujelbene N, Cosinschi A, Boujelbene N, Khanfir K, Bhagwati S, Herrmann E, Mirimanoff RO, Ozsahin M, Zouhair A. Pure seminoma: a review and update. Radiat Oncol. 2011 Aug 8;6:90.
  5. Aparicio J, García del Muro X, Maroto P, Paz-Ares L, Alba E, Sáenz A, Terrasa J, Barnadas A, Almenar D, Arranz JA, Sánchez M, Fernández A, Sastre J, Carles J, Dorca J, Gumà J, Yuste AL, Germà JR; Spanish Germ Cell Cancer Cooperative Group (GG). Multicenter study evaluating a dual policy of postorchiectomy surveillance and selective adjuvant single-agent carboplatin for patients with clinical stage I seminoma. Ann Oncol. 2003 Jun;14(6):867-72.
  6. Warde P, Specht L, Horwich A, Oliver T, Panzarella T, Gospodarowicz M, von der Maase H. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol. 2002 Nov 15;20(22):4448-52.
  7. Chung P, Parker C, Panzarella T, Gospodarowicz MK, Jewett S, Milosevic MF, Catton CN, Bayley AJ, Tew-George B, Moore M, Sturgeon JF, Warde P. Surveillance in stage I testicular seminoma - risk of late relapse. Can J Urol. 2002 Oct;9(5):1637-40.
  8. Dearnaley D, Huddart R, Horwich A. Regular review: Managing testicular cancer. BMJ. 2001 Jun 30;322(7302):1583-8.
  9. Schmoll HJ, Jordan K, Huddart R, Pes MP, Horwich A, Fizazi K, Kataja V; ESMO Guidelines Working Group. Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010 May;21 Suppl 5:v140-6.
  10. Ambrosini V, Zucchini G, Nicolini S, Berselli A, Nanni C, Allegri V, Martoni A, Rubello D, Cricca A, Fanti S. 18F-FDG PET/CT impact on testicular tumours clinical management. Eur J Nucl Med Mol Imaging. 2014 Apr;41(4):668-73.
  11. Cook GJ, Sohaib A, Huddart RA, Dearnaley DP, Horwich A, Chua S. The role of 18F-FDG PET/CT in the management of testicular cancers. Nucl Med Commun. 2015 Jul;36(7):702-8. 
  12. Nirmal TJ, Kekre NS. Management of urological malignancies: Has positron emission tomography/computed tomography made a difference? Indian J Urol. 2015 Jan-Mar;31(1):22-7.
  13. Becherer A. PET in testicular cancer. Methods Mol Biol. 2011;727:225-41.
  14. Rioja J, Rodríguez-Fraile M, Lima-Favaretto R, Rincón-Mayans A, Peñuelas-Sánchez I, Zudaire-Bergera JJ, Parra RO. Role of positron emission tomography in urological oncology. BJU Int. 2010 Dec;106(11):1578-93.
  15. Jamal-Hanjani M, Karpathakis A, Kwan A, Mazhar D, Ansell W, Shamash J, Harper P, Rudman S, Powles T, Chowdhury S. Bone metastases in germ cell tumours: lessons learnt from a large retrospective study. BJU Int. 2013 Jul;112(2):176-81.
  16. Mencel PJ, Motzer RJ, Mazumdar M, Vlamis V, Bajorin DF, Bosl GJ. Advanced seminoma: treatment results, survival, and prognostic factors in 142 patients. J Clin Oncol. 1994 Jan;12(1):120-6.
  17. Gómez FJ, Bánez IA, González RL, Jiménez-Granero P, Dorado IB. 18F-FDG PET/CT with unusual bone and CNS metastases from testicular seminoma. Int Braz J Urol. 2015 Mar-Apr;41(2):393-4.