Coarctation of the aorta from a mediastinal germ cell tumor: a case report

A 20-yr-old male had compression of the thoracic aorta by a large malignant mediastinal germinoma. The symptoms and signs that simulated coarctation of the aorta included hypertension, markedly decreased femoral pulses, and a systolic murmur that radiated to the back. Following X-ray therapy, the femoral pulses were palpable and the blood pressure became normal. To our knowledge, compression of the aorta by a malignant teratocarcinoma with manifestations mimicking coarctation of the aorta has not been reported.

Treatment of testicular tumors arising in patients with previous inguinal and/or scrotal surgery

Of 20 patients with testicular tumors that occurred after previous inguinal and/or scrotal surgery 6 with seminomas were treated with traditional radiation therapy that included the ipsilateral groin, while 14 with nonseminomatous tumors were treated with retroperitoneal lymph node dissection with or without chemotherapy. No patient suffered inguinal lymph node metastases. Based on the satisfactory results in these patients to date and the lack of subsequent detectable recurrence of tumor we do not advocate additional treatment to the superficial inguinal lymph nodes and scrotum.

Radiation-induced sarcoma following radiotherapy for testicular tumor

We report 4 cases of soft tissue sarcoma following radiation therapy for testicular tumor. The tumors included leiomyosarcoma, fibroxanthosarcoma, reticulum cell sarcoma and spindle cell sarcoma. Each malignancy arose within the irradiated area after a long latent period (mean 12 years) and each was histologically proved. Total radiation doses ranged from 3,500 to 9,000 rad. Three patients died as a result of the second neoplasm. Radiation-induced sarcomas are rare but must be considered in the differential diagnosis of new tumor growth in patients treated previously with radiotherapy. Full evaluation of such new tumor growth, including tissue diagnosis, is necessary before additional therapy is prescribed.

Megavoltage irradiation for pure testicular seminoma: results and patterns of failure

The survival, patterns, and mechanisms of failure in 171 patients with pure testicular seminoma treated with megavoltage irradiation from 1950 to 1976 were analyzed. The survival of the entire group was 93% at five and ten years post-irradiation. Survival at five years was significantly less for Stages III and IV (45%) when compared with Stages I and II (95%, P less than 0.001). Extranodal relapses were more common in early stages, and abdominal recurrences occurred in more advanced stages. Salvage treatment, management of HCG-producing seminomas, and second testicular seminomas are analyzed. The need for aggressive and appropriate radiation technique is emphasized.

[Thymic seminomas (author's transl)]

The authors report on three cases of thymic seminoma treated between 1971 and 1981. These tumours, first described by Friedman in 1981. These tumours, first described by Friedman in 1951, belong to the group of extra-gonadal germinal tumours. They constitute about 2.5% of all thymic masses. The most probable pathogenic theory is abnormal migration of germinal cells from the vitelline sac to the embryonic thymus. Thymic seminomas are usually found in young men and are asymptomatic in 30% of the cases. Macroscopically, they present as solid tumours capable of invading the surrounding structures. Histologically, they resemble gonadal seminomas but are sometimes difficult to identify, which is unfortunate since treatment is dependent upon an accurate histological diagnosis. The authors suggest that the tumour should be biopsied under mediastinal fluoroscopy, so that an accurate histological diagnosis can be made. Treatment consists of surgical excision, which should be restricted and on no account should destroy important structures, completed by mediastinal radiotherapy. The mean survival time is 6.3 years; the 5-year survival rate is 75%.

Primary mediastinal seminoma

Primary mediastinal seminoma is a rare germ cell neoplasm histologically identical to testicular seminoma. Thirteen patients have been treated with definitive megavoltage radiotherapy at the Stanford University Medical Center, Division of Radiation Therapy, between 1961 and 1976. Doses ranged from 2500 rads over five weeks to 6000 rads over seven weeks. Actuarial survival at ten years is 69% with relapse-free survival of 54%. No patient receiving greater than 4700 rads to the primary lesion had local or systemic relapse. Patterns of relapse and recommendations for diagnostic evaluation are discussed. Primary megavoltage irradiation to the mediastinum and neck with a dose of 4500 to 5000 rads over five to six weeks is appropriate treatment.

[Intracranial germinoma; typical CT appearances and radiation therapy (author's transl)]

The typical CT appearances of intracranial germinomas are described in three cases. These consist of an isodense or hyperdense tumour in the mid-line, originating from the pineal body or infundibulum, with marked increase in density on contrast enhancement. Periventricular tumour expansion in relation to the entire supratentorial ventricular system is characteristic. The rapid tumour regression after small doses of radiation is stressed and complete regression of the tumour, as seen on CT, is a sign of its radio-curability.

[Radiation therapy of testicular tumors (author's transl)]

Radiation therapy of seminoma is clearly defined and the results are extremely good. On the other hand radiation therapy of other testicular tumors still is not fully accepted. Excellent results of therapeutical treatment are always challenge for further improvement of therapeutical techniques and reduction of side effects. Best radiation therapy, which is taking into account size of tumor and metastases can produce for 95% of seminoma patients more than 5 years survival. For teratoid carcinoma radiation therapy is used successfully combined with chemotherapy.

Pineal and ectopic pineal tumors: the role of radiation therapy

Seventeen patients wih pineal tumors and one ectopic (suprasellar) germinoma were treated with radiation therapy. Surgery was restricted to decompression in 16 patients, and only two patients had resection of the tumor. Thirteen of 18 patients are alive without evidence for disease with a ten-year survival rate of 88%. The tumor dose ranged from 4000 rads to 6000 rads. No age or dose dependence in survival was noted, but patients with whole brain irradiation or generous volume to include ventricular system had better survival. No case of spinal metastasis was noted. The possibility of increased incidence of meningeal seeding following surgical intervention is considered. From their data, the authors feel that radiation therapy with or without surgical decompression should be the primary treatment for pinealoma. Surgery can be used for diagnosis and/or treatment of patients who show delayed response to radiation. Recommendation is made for the use of whole brain irradiation to 4000 rads followed by a boost to the tumor area to 5000 rads.

Unilateral germinomas involving the basal ganglia and thalamus

Clinical characteristics of six cases of germinoma involving a unilateral basal ganglion and thalamus are summarized. The incidence was estimated as 10% of all intracranial germinomas. The average age at the onset was 10.5 years. The sex incidence showed a male dominance. The clinical course was slowly progressive, and the average duration between onset and diagnosis was 2 years 5 months. Common symptoms and signs were hemiparesis in all cases, fever of unknown origin and eye symptoms in most, mental deterioration and psychiatric signs in three, and convulsions, pubertas praecox, and diabetes insipidus in two. Signs of increased intracranial pressure were found in only two cases in the later state of the disease. Early diagnosis is difficult because of nonspecific symptomatology and slow progression. Carotid angiography and pneumoencephalography showed abnormal findings compatible with basal ganglia and thalamic tumors, but not specific to germinoma. Ipsilateral cortical atrophy and ventricular dilatation might be significant findings. Radioisotope scanning was useful. Computerized tomography scans were the best method of detecting the location and nature of this tumor, and repeat scans showed response to radiation therapy.

[Clinical manifestations and therapy of dysgerminomas (author's transl)]

Due to improved graduated surgery techniques and large-field radiotherapy applied in all cases, the ovarial dysgerminoma has become a disease showing a high rate of recoveries. Under consideration of their own medical records, the authors present the relevant epidemiologic and clinical parameters, establish a diagnosis programme and develop a therapeutic concept which also wants to take into account the individual requirements of patients regarding their age and their prognosis.

Therapeutic use of fractionated total body and subtotal body irradiation

Ninety-one patients were treated using fractionated subtotal body (STBI) or total body irradiation (TBI). These patients had generalized lymphomas, Hodgkin's disease, leukemias, myelomas, seminomas, or oat-cell carcinomas. Subtotal body irradiation is delivered to the entire body, except for the skull and extremities. It was expected that a significantly higher radiation dose could be administered with STBI than with TBI. STBI was given when there was a reasonable likelihood that malignancy did not involve the shielded volumes. A five- to ten-fold increase in tolerance for STBI was demonstrated. Many of these patients have had long-term (up to 17 year--?permanent) remissions. There is little or no treatment-induced symptomatology, and no "sanctuary sites." STBI and TBI are useful therapeutic modalities for many of these malignancies.

A comparison of treatment methods for germinal cell tumors of the testis other than pure seminoma

The results of three approaches to management of the regional lymphatics for Stage I and Stage II nonseminomatous testicular tumors were reviewed. For clinical Stage I disease, the results achieved with orchiectomy and radiation therapy alone are equal to those achieved with orchiectomy and lymphadenectomy. Although the results with preoperative radiotherapy and lymphadenectomy are slightly better, the lymphadenectomy almost always results in aspermia and infertility. The effectiveness of radiotherapy alone is determined by the volume of cancer. Local tumor control with irradiation is good if the tumor burden is relatively small. The local control rates, however, are diminished if the metastases are greater than 2 cm in diameter. The results with preoperative radiotherapy and lymphadenectomy for patients with clinical Stage II disease are superior to those achieved with either primary lymphadenectomy or radiotherapy alone.