EMBRYONAL CARCINOMA PRESENTING AS CERVICAL LYMPHADENOPATHY: A CASE REPORT ON THE DIAGNOSTIC DILEMMA OF ORIGIN

The presence of an embryonal carcinoma in a cervical lymph node, in the absence of a palpable testicular mass, presents a diagnostic dilemma regarding whether this represents a rare primary extragonadal germ cell tumor (EGCT) of the neck or a metastasis from an occult spontaneously regressed testicular cancer. We report the case of a 34-year-old male presenting with isolated left cervical lymphadenopathy. Initial physical examination of the testes was unremarkable, potentially supporting a diagnosis of primary cervical origin. However, markedly elevated serum tumor markers (lactate dehydrogenase [LDH] and alpha-fetoprotein [AFP]), alongside a beta-human chorionic gonadotropin (beta-hCG) level within normal limits, prompted a search for a gonadal primary. Scrotal ultrasound revealed a calcified scar in the left testis, and subsequent orchiectomy confirmed a fibrotic nodule with no viable malignancy, consistent with the spontaneous regression of a primary tumor. The patient was treated for Stage IIIC non-seminomatous germ cell tumor (NSGCT) with bleomycin, etoposide, and cisplatin (BEP) chemotherapy and remains disease-free at 3 years. This case illustrates that primary cervical EGCT is a diagnosis of exclusion. The spontaneous regression phenomenon must be rigorously investigated via ultrasound and orchiectomy to avoid misdiagnosis and ensure appropriate multimodal therapy.