The Debulking of Recurrent Right Testicular Seminoma with Anterolateral Thigh Flap Reconstruction
Introduction: Radical orchidectomy is considered both a therapy and a part of the staging procedure. Stage I seminoma may be treated with orchiectomy alone while the remaining 15% to 20% may have a relapse if they receive no additional treatment during the five-year surveillance. Most recurrences occur within the first 2 years after diagnosis, and the location of the recurrence is typically in the retroperitoneum. This article aims to share the experience in the management of testicular seminoma recurrence in a multidisciplinary approach.
Case Presentation: We are reporting a case of a 26-year-old male with a growing mass at the right scrotum just two months after right radical orchidectomy. This patient was previously treated with a stage I seminoma and underwent surveillance. Tumor debulking and right inguinoscrotal reconstruction using a pedicled anterolateral thigh (ALT) flap were done through collaborative surgery between urology and plastic surgery. However, according to National Comprehensive Cancer Network (NCCN), with the relapsed mass, this patient can be classified as having a stage III seminoma and considered as having a good-risk disease due to no evidence of non-pulmonary visceral metastasis. With the risk of bleomycin causing lung fibrosis, four cycles of etoposide and cisplatin can be considered the chemotherapy regimens for this patient. Evaluation after chemotherapy should be done by checking tumor markers and imaging studies.
Conclusions: The reappearance of testicular seminoma in this patient unexpectedly occurred quite in a short period, that is in two months after surgery. Immediate multidisciplinary intervention by a urologist and plastic surgeon was done through tumor debulking with a wide incision margin and ALT flap reconstruction. Unfortunately, however, after the second month of follow-up, there was a bulging mass growing beneath the flap which needed further evaluation with ultrasonography to confirm the possibility of tumor recurrence or seroma. If tumor recurrence is confirmed, chemotherapy should be scheduled as soon as possible.
Laguna MP, Albers P, Algaba F, et al. EAU Guidelines on Testicular Cancer [Internet]. Arnhem:Uroweb; 2022 [cited 9 March 2022]. Available from: https://uroweb.org/guideline/testicular-cancer/
Cedeno J, Light D, Leslie S. Testicular Seminoma [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 9 March 2022]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448137/
LoGiudice JA, Haberman K, Sanger JR. The anterolateral thigh flap for groin and lower abdominal defects: a better alternative to the rectus abdominis flap. Plast Reconstr Surg. 2014 Jan;133(1):162-8.
Petrelli F, Coinu A, Cabiddu M, et al. Surveillance or Adjuvant Treatment With Chemotherapy or Radiotherapy in Stage I Seminoma: A Systematic Review and Meta-Analysis of 13 Studies. Clin Genitourin Cancer. 2015 Oct;13(5):428-34.
Mortensen MS, Bandak M, Kier MG, et al. Surveillance versus adjuvant radiotherapy for patients with high-risk stage I seminoma. Cancer. 2017 Apr 1;123(7):1212-8.
Gilligan T, Lin DW, Aggarwal R, et al. Testicular Cancer, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019 Dec;17(12):1529-1554.
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