Announcement Module
No announcement yet.

Segmental infarct or burned out seminoma?

Page Title Module
Move Remove Collapse
Conversation Detail Module
  • Filter
  • Time
  • Show
Clear All
new posts

  • Segmental infarct or burned out seminoma?

    Hey, all! First time poster and I have an unusually presenting case. On October 6 of last year, I was transferred from my doctors office to the emergency room for acute and intermittent testicular pain. They found no evidence of a torsion which they initially thought it was but said it could have detorsed itself. Upon ultrasonography, they noticed a lesion that was consistent with malignancy. I had a follow up ultrasound on the 21st which showed a slight decrease in size with a more pronounced cystic component. In November I had a CT with contrast of my abdomen and pelvis which was pretty much clear. It didn't even make mention of my retroperitoneal lymph nodes. In December, I had a follow up testicular ultrasound and it showed a pretty remarkable decrease in size of the original lesion. Fast forward to a few Fridays ago and I had yet another ultrasound which yielded almost complete resolution of the original ultrasonographic findings. There is a tiny bit of hypoechoic stranding but that is it. All along, my tumor markers have been normal. The doctors are very much leaning towards segmental infarction which certainly makes sense to me, especially with the acute pain. Now, the urologist says that if it has metastasized to my retroperitoneal lymph nodes, that there would be tumor markers present. My concern is that of a burned out testicular tumor that metastasized. He said that would be impossible because the type of tumors that burn out produce markers. I was not so sure that this is true so I consulted Dr. Einhorn who confirmed that a pure seminoma can, indeed, burn out. I am definitely inclined to believe that this is infarct, simply because of the presentation of symptoms and the resolution of the lesion. It is just that slight underlying fear that it might not be. You know? I have a follow up abdominal/pelvic CT I can have performed at my leisure along with tumor markers and another ultrasound. I plan on utilizing these, but this will be my 5th CT in six months (had to have 3 others due to an acute issue that has since resolved elsewhere in my body). Should I request a chest X-ray, also? Also, if this is a seminoma that has burned out and my CT is clear, should I have other CTs down the road? Could the seminoma burn out only to reappear years from now? Thanks for any advice given and thank you for providing a great community and resource for those fighting, those who have fought, and those who may never even have TC. Your support is much appreciated.

  • #2
    Hello, I think it is good that you largely accept the doctors diagnosis/prognosis, but it is good to have some skepticism. I had a pure seminoma (pathology at local and at IU) I presented with multiple retro lypmph node masses, their was a suspicious "focal region" in testes. I did not present with elevated markers (accept slightly elevated LDH at diagnosis).

    IO - had no viable pathology with suspicioun of tumor burnout
    follow-up bioposy of big juicy 8 cm lymph tumor showed 100% Seminoma
    So, yes, seminoma, and non-marker positivite seminoma can burn out.

    I am not expert but would suspect that burnout occurs from tumor finding better blood supply where it would re-establish itself (confirm with Dr. as this could help establish a bit of surveillance window to rule out any cancer risk).


    • #3
      My LDH on the day of the initial incident was elevated by about 15 points. I think they believe that this could have been due to tissue damage from the torsion or infarct.


      • #4
        RWA, if I may... what prompted you to seek medical attention? Did they give you any idea of a time span between burn out and metastasis?


        • #5
          my largest lymph tumor was approx. 8cm and thus started to make contact with a spinal nerve and cause me sudden EXTREME pain. I though I was passing a kidney stone based on quick internet read for flank pain, then after CT at emergency I learned of my tennis ball size tumor and his golf ball size friends. Because of the presentation I was not so concerned on asking questions about time from testicular burnout to large lymph mets, I do know that Seminoma can be a slower grower than non-seminoma. I never really noticed a lump or swelling of the affected testes, but after presentation I recalled the sensation of "heaviness" in that testical the only time I really thought about that was when I was cutting some trees and moving heavy logs on my property and wondered if I torqued or jacked something up from over exertion this was around early april time frame my TC diagnosis was mid july of same year, talk with a Dr., I am just sharing what I recall.


          • #6
            First off: Lack of tumor markers really tells us nothing unless they were elevated earlier. Only the presence of tumor markers is really useful.It is indeed possible to have TC without marker elevation. I don't think there is any type of TC that *always* produces markers, but I could be wrong.

            That said, you've had a clear CT & U/S and your symptoms have resolved, go ahead & do the follow up CT & U/S for peace of mind, but if they are clear, accept that your problem wasn't TC & go live your life. Just remember to do a once a month exam .

            Jan, 1975: Right I/O, followed by RPLND
            Dec, 2009: Left I/O, followed by 3xBEP


            • #7
              Lethal Dose, it may help your peace of mind to know that the US of my testicle did show radiological abnormality, it just did not provide the pathology needed to move into treatment. But, even if I did not have the lymph tumors, my US was viewed as not normal.


              • #8
                Thanks, guys. My US still isn't "normal". It's still showing some stranding where the abnormality was which COULD be (but isn't likely to be) a burned out tumor. I'm certainly feeling positive and will absolutely continue with the follow up CT and US. If clear, I will follow the doc's advice, enjoy life, and do monthly exams. Your support and prayers are appreciated and know that mine are with this community regardless of my personal outcome. Talk soon.


                • #9
                  Just following up... had abdominal CT which was 100% clear. This marks the 10th month since the initial incident of pain. Going to talk to Doc next week, but this seems like excellent news. Do you guys think this still could be a burned out primary that is harboring cancerous cells or is the consensus here that it would have already reared its ugly head? Either way, going to keep on keeping on and enjoy life regardless of outcome.