LAUSR

by DiSaia et al. in ovarian GCTs, and termed chemotherapeutic retroconversion.3 Somatic-type malignancy occurs in 3–6% of GCTs, almost always in postpubertal patients (aged 15–68).1,2,4 Although most affected patients have teratomatous GCTs,1,2,5 somatic-type malignancy has occasionally been reported in other germ-cell tumors including yolk-sac and spermatocytic tumors.6 The time elapsing between GTC diagnosis and the appearance of STMs tends to vary widely, ranging from simultaneous presentation to a latency period of up to 30 years. The interval for carcinomas (108 months) is longer than for sarcomas (20 months).5 Reported STMs include various types of sarcoma, epithelial malignancies and hematological malignancies.7 Sarcomas are undoubtedly the most common type of malignancy; although rhabdomyosarcomas account for over half the STMs recorded, leiomyosarcomas, angiosarcomas and other STMs have occasionally been reported.8,9 Carcinomas tend to be mostly to be classed as adenocarcinomas NOS6; there are very few reports of neuroendocrine tumors, particularly in testicular lesions. Generally speaking, the prognosis for these tumors is not affected when the STM is located in the testicle; however, development of STM in metastases—as in the present case—is associated with an increased risk of mortality.8 The role of chemotherapy in teratomas with malignant neuroendocrine transformation has not been fully established.7 Complete surgical resection has traditionally been the treatment of choice when malignant transformation occurs at a single site. Metastatic or unresectable tumors will generally require multimodal management including chemotherapy in addition to loco-regional approaches. Although patients tend to respond poorly to cisplatinbased treatments, some tumors may respond to the specific chemotherapy used for the somatic counterpart.10 Summarizing, in this rare case a patient with mixed germ-cell tumor of the testis and metastasis, treated with chemotherapy, seven years later developed an atypical carcinoid tumor, with a somatic-like malignant component, in a metastatic mature cystic teratoma of the lung. Comprehensive pathological examination is essential for the identification of somatic neoplasms within germ cell tumor metastases. References