This case report presents the management of a very rare tumor. Confronting a rare tumor can be frustrating to both physician and patient. No large retrospective series usually exist that can be used to determine appropriate management. Certainly no phase III trials are available. I have experienced this frustration in trying to determine the best treatment for rare paratesticular tumors and malignant Sertoli/Leydig cell tumors.
If a rare tumor is found to be clinically localized, surgery is likely the best option. However, these cases often raise a number of difficult issues. What about localized lymphatic metastasis? How should a solitary metastasis be managed? What is the appropriate medical management of widespread metastatic disease? These are very difficult questions, which unfortunately cannot be reliably answered on the basis of a review of the literature. The only solution is to make a reasonable guess based on the management of somewhat similar presentations of more common tumors, much as was done in this case. Full informed consent, with discussion of the various management options, is essential.
In summary, I think this patient was managed very well, and I commend the authors for their fine work.
Financial Disclosure: The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.