Surgery for lung metastases in a testicular seminoma

Invasive testicular cancer develops from carcinoma in situ (CIS)/testicular intraepithelial neoplasia (TIN), and these histological types are often identified in residual non-malignant testicular tissues. The objective was to highlight the need for an immediate multidisciplinary approach in a case of seminoma with lung metastases in a young patient, to approach optimal therapeutic behaviour. We present the case of a 33-year-old patient, a smoker, who presents with an influenced general condition, bilateral crackling rales, the right testicle slightly enlarged in volume. Emergency chest radiography raises suspicion of lung metastases. Computed tomography (CT) sustains the suspicion of secondary malignancies, which is why the pulmonary formation is approached endobronchial, having as a histopathological result seminoma metastasis. Blood tests, before urological intervention show an alpha-fetoprotein (AFP) = 11.05 mUI/mL, beta human chorionic gonadotropin (hCG) = 20.47 mUI/L, lactate dehydrogenase (LDH) = 754 U/L, subsequently performing right radical orchiectomy (2016), pT1N3M1a-stage IIIB. Repeating the blood tests after the fourth chemotherapy session [bleomycin, etoposide and cisplatin (BEP)] reveals a normalisation of AFP = 0.4 mUI/mL, beta hCG < 0.1 mUI/L, LDH = 276 U/L results, and at positron emission tomography-computed tomography (PET-CT) examination the pulmonary tumour formations were not metabolically active. Subsequently, lung metastases were removed by laser surgery (2020), with significant resorption and preservation of healthy lung parenchyma, and is classified according to the TNM8 staging in stage IV-pT3N0M1a. The particularity of this case was the multiple pulmonary secondary malignancies, which, although imagistically persisted, were not metabolically active, and is interpreted as remainings after oncological treatment. Considering the modifications, the advanced stage and the estimated prognosis, the case can be summarised as a therapeutic success.