Since the computerized tomography scanning depicted necrotic conglomerulate lymph nodes at inferior cervical region posterior to internal jugular vein and close to common carotid artery and apical pleura (Figure I), a selective neck dissection (level III-IV-V) was performed for the residual disease.įigure 1: The necrotic and conglomerulate lymph nodes posterior to internal jugular vein and common carotid artery and superior to apical pleura on the CT scan of the neck. Although fine needle aspiration did not demonstrate a positive result, uro-oncology tumor council accepted this supraclavicular mass as a metastasis of embryonal testicular carcinoma, and they recommended surgical treatment for this mass. Nine months after the lymph node dissection, he had noticed a mass on the left side of his neck while there was no evidence of infradiaphragmatic disease. Therefore, he had undergone retroperitoneal lymph node dissection in which histologic examination had demonstrated mature teratoma. Although all tumor markers had become negative after chemotheraphy, thoracoabdominal computerized tomography scanning has showed no regression of pre-existing retroperitoneal lymph nodes. As the histologic examination of the testicle had demonstrated embryonal carcinoma, he had had four courses of chemotherapy consisting cisplatin, etoposite and bleomycine. According to his medical history, he had undergone orchiectomy one year ago. Sixteen year-old male presented with a 3-week history of a painless supraclavicular mass on the left side. The aim of this report is to present a case of nonseminomatous testicular carcinoma with supraclavicular metastasis, and to discuss the treatment of choice for residual neck disease in an adolesant. Since it is an oncologically safe procedure and effective for eliminating the possibility of residual neoplastic or teratomatous elements, neck dissection is accepted as a reliable treatment modality in such cases. At this point, the head and neck surgeon plays role in the diagnosis and surgical treatment of residual neck disease. If residual or metastatic disease is noticed elsewhere after the therapy, it should be treated by definitive surgery in order to improve the survival and to reduce the risk of recurrence. Testicular carcinoma often responds the combination of orchiectomy and chemotherapy. Neck metastasis in the patients with testis cancer is an infrequent but, well established phenomenon and the incidence of neck metastasis in testicular carcinoma has been reported to be 4-5 %. Although the disease usually presents as a testicular mass or enlargement, abdominal, thoracal or cervical masses indicating metastatic disease may be noted during the follow-up. Testicular carcinoma (seminomatous and nonseminomatous tumors) is the most common malignancy in men between 20-30 years of age. Supraclavicular lymph node metastasis from infradiaphragmatic malignancies generally indicates widespread disease that lost the chance of surgical treatment for cure, but testicular carcinoma represents an exception to this generalization.
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