Teratoma testicular bilateral sincrónico: reporte de un caso y revisión de la literatura

ResumenAntecedentesEl cáncer testicular de células germinales es la neoplasia más frecuente en hombres de 15 a 35años de edad; es bilateral en el 2 al 3%, y sincrónico en el 20 al 25% de los casos.Caso clínicoMasculino de 19años de edad, con dolor abdominal y tumor palpable en mesogastrio. En la tomografía se encontró un tumor retroperitoneal, y por laboratorio se detectó elevación de α-fetoproteína, deshidrogenasa láctica y gonadotropina coriónica humana. En el ultrasonido testicular se identifican lesiones bilaterales. Se realizó laparotomía exploradora, identificándose tumor retroperitoneal irresecable, y se tomaron biopsias incisionales compatibles para tumor de células germinales mixto, con áreas de coriocarcinoma y carcinoma embrionario. Se administraron 6ciclos de quimioterapia con bleomicina, etopósido y cisplatino, obteniéndose una respuesta tumoral parcial. Posteriormente se realizó orquiectomía radical bilateral, con reporte patológico de teratoma bilateral sincrónico. Se inició segunda línea de quimioterapia con vincristina, etopósido, ifosfamida y platino; sin embargo, la enfermedad progresó, presentando diseminación metastásica y provocando el deceso del paciente.DiscusiónLos tumores de células germinales pueden presentarse en sitios primarios extragonadales. Es difícil distinguir un tumor de células germinales primario del retroperitoneo, de una enfermedad metastásica derivada de un tumor gonadal no detectado clínicamente, o que ha involucionado, situación que se describe en el caso clínico presentado.ConclusiónEl 90% de los pacientes diagnosticados con tumor de células germinales pueden ser curados; sin embargo, un retraso en el diagnóstico se correlaciona con una etapa clínica más avanzada y un pronóstico desfavorable.AbstractBackgroundTesticular germ-cell carcinoma is the most frequent neoplasm in males aged 15 to 35 years old. It is bilateral in 2% to 3%, and synchronous in 20% to 25% of the cases.Clinical caseThe case is presented of a 19 year-old male, with abdominal pain. Physical examination revealed abdominal mass in the umbilical region, and the computed tomography scan showed a retroperitoneal tumour, with α-fetoprotein, lactate dehydrogenase, and human chorionic gonadotropin above limits. Testicular ultrasound showed bilateral lesions. Exploratory laparotomy was performed, identifying an unresectable retroperitoneal tumour. Biopsies were taken, reporting mixed germ cell tumour composed of choriocarcinoma and embryonal carcinoma. Six cycles of chemotherapy were given, based on bleomycin, etoposide and cisplatin, with partial tumour response. Later on, the patient underwent bilateral radical orchiectomy, with pathology reporting a synchronous bilateral testicular teratoma. A second line of chemotherapy was given, based on vincristine, etoposide, ifosfamide and cisplatinum. Nevertheless, the disease progressed, with metastatic dissemination and the patient died.DiscussionGerm cells tumours can present in primary extra-gonadal locations. It is difficult to distinguish a retroperitoneum primary germ cell tumour from metastatic disease of a clinically undetected gonadal tumour or one that has regressed, like the situation described in the case presented.ConclusionsNinety percent of patients diagnosed with germ cell tumours can be cured. However, delay in diagnosis correlates with an advanced clinical stage and poor prognosis

Tolerability assessment of a lectin fraction from Tepary bean seeds (Phaseolus acutifolius) orally administered to rats

Our previous studies have shown that a lectin rich fraction (TBLF) extracted from Tepary bean seeds differentially inhibits cancer cells proliferation in vitro. Before testing the in vivo anticancer effect, the acute and subchronic toxicological assays in rats were conducted, where an oral dose of 50 mg/body weight kg was determined as the NOAEL. This study evaluated the resistance to digestion and complete blood count (CBC) after 24 h of the orally administered 50 mg/kg TBLF. The digestion resistance test showed lectins activity retention after 72 h and the CBC study showed a high level of eosinophils, suggesting an allergic-like response. Tolerability was assayed after 6 weeks of treatment by dosing with an intragastric cannula every third day per week. It was observed a transient reduction in food intake and body weight in the first weeks, resulting in body weight gain reduction of 10% respect to the control group at the end of the study. Additionally, organs weight, histopathological analysis and blood markers for nutritional status and for liver, pancreas and renal function were not affected. Our results suggest that 50 mg/kg TBLF administered by oral route, exhibit no toxicity in rats and it was well tolerated. Further studies will focus on long-term studies