Too late relapse of testicular cancer after 27 years; a case report

Germ cell tumors (GCTs) are the most common solid tumors in young men, with a peak incidence at 25-35 years. Approximately 50% of the testicular GCTs are pure seminomas and 50% are non-seminomas. Late relapse of testicular cancer (LRTC) is a rare disease with the incidence rate of 2.6% and is defined as >2 years interval between initial treatment and recurrence.
We report here a patient with nonseminomatous GCT who experienced relapse 27 years after his first diagnosis. He came with gross hematuria and huge abdominal mass. There was a giant retroperitoneal mass with invasion to the left kidney and other organs in computerized tomography. A biopsy was conducted and pathology revealed recurrence of malignant mixed nonseminoma GCT. The tumor was unresetable. Therefore patient was treated with four cycles of chemotherapy. PET scan was conducted after chemotherapy showed residue of tumor thus retroperitoneal lymph node dissection (RPLND) was done.
We concluded that with increasing lifespan of cancer patients, follow up of these patients for very late relapse must be conducted lifelong.