Bone marrow metastasis from testicular seminoma in a patient with concomitant follicular non-Hodgkin lymphoma: A case report

Abstract

Introduction. Seminomas are the most common testicular tumors. Initial therapy includes orchiectomy with resection of local lymph nodes, followed by adjuvant radiotherapy. Testicular tumors usually metastasize to retroperitoneal and mediastinal lymph nodes, lungs, liver, spleen, gastrointestinal tract, and adrenal glands. Bone metastases from testicular tumors are very rare, while seminoma metastasis to the bone marrow is a curiosity, without any references in the scientific literature. Case Report. A 66-year-old patient, previously treated for follicular non-Hodgkin lymphoma, was admitted due to complaints of malaise, abdominal and back pain, and hepatosplenomegaly. After examination and radiologically verified enlarged retroperitoneal lymph nodes, the patient was referred to a hematologist. Based on the patient?s medical history, a relapse of lymphoma was suspected, and bone marrow biopsy was performed. The hematoxylin-eosin staining of the biopsy sample showed diffuse large cell infiltrates with bright cytoplasm, polygonal nuclei and prominent nucleoli. By immunohistochemical staining, the cells showed positivity for cluster of differentiation 10, cluster of differentiation 117, octamer binding transcription factor 3/4, placental alkaline phosphatase, and cytokeratin 8/18, after which the diagnosis of seminoma metastasis to the bone marrow was made. Shortly after the histopathological diagnosis was made, the patient died. Conclusion. A seminoma is a testicular tumor with a favorable prognosis. Due to suppression of hematopoiesis, bone marrow metastases generally lead to the worst prognosis. The outcome of our patient highlights the importance of timely diagnosis and therapy, which would increase the chances of survival.