Embryonic-type neuroectodermal tumour presenting as a somatic-type malignancy within a post-pubertal type teratoma: a case report

Somatic-type malignancy (SM) may be seen within 2.5–8% of germ cell tumours, within post-pubertal patients. 1 Often, SM can be seen as part of a post-pubertal type teratoma, or as a component of yolk-sac tumours, and are associated with late relapse of a previously treated teratoma. 2 Common SMs include adenocarcinoma, rhabdomyosarcoma, and embryonic-neuroectodermal tumour; with rare nephroblastomas reported. 1-3 Typical cisplatin-based therapy is poorly effective against SMs and given their relative rarity, the most effective treatment modality has not been elucidated. 1-3 Additionally, prognosis is varied. SM limited to the testis is believed to be similar to other germ cell tumours at the same stage, however metastatic disease confers a significantly worse prognosis. 1-2 We present a case of a 40-year-old male who presented with testicular pain and swelling and elevated AFP, BHCG, and LDH. Histopathological examination revealed a mixed germ-cell tumour comprised of a post-pubertal type teratoma (90%), embryonal carcinoma (8%) and yolk-sac component (2%). A SM comprised of an embryonic-neuroectodermal tumour was present within the teratoma. Our case report highlights the need for continued vigilance, awareness, and recognition of SM within a post-pubertal type teratoma, and to further our understanding of the prognostic implications of SMs within testicular germ cell tumours.