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Ondrus D, Hornak M. Orchiectomy Alone for Clinical Stage I Nonseminomatous Germ Cell Tumors of the Testis (NSGCTT): A Minimum Follow-Up Period of 5 Years. TUMORI JOURNAL 2018; 80:362-4. [PMID: 7839467 DOI: 10.1177/030089169408000510] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Surveillance after orchiectomy alone has gained great popularity in the management of stage I NSGCTT. Preliminary results were enthusiastic, but critical voices have been raised against general use of this option as routine management. In an effort to identify patients at high risk of relapse, there has been a search for adverse prognostic factors of stage I nonseminomatous germ cell testicular tumors (NSGCTT). The aim of the study was to identify those patients in whom a surveillance policy is less likely to be successful. Methods Eighty patients with stage I NSGCTT were followed for at least 5 years. They were assigned to their respective clinical stage on the basis of physical examination, chest X-ray, CT of the retroperitoneum and post-orchiectomy tumor markers. The criteria for inclusion in clinical stage I were normal results of these examinations. The policy of surveillance consisted of regular follow-up with tumor markers, chest X-ray and CT of the retroperitoneum. Patients who relapsed were treated with cisplatin-containing chemotherapy. In all patients, diagnostic delay, pre-orchiectomy tumor markers, T staging category, size, histopathology and vascular invasion in the primary tumor, and semen analysis were recorded. Results Follow-up revealed that 51 of the 80 patients (63.7%) were free of disease 61-110 months (mean, 83.1) after orchiectomy. Relapse was detected in 29 patients (36.3%) 3-58 months (mean, 13) after orchiectomy. The overall survival rate was 95%. The main risk factors of relapse were: vascular invasion, a major embryonal carcinoma and a minor teratoma component in the primary tumor, and low sperm count before orchiectomy. Conclusions The authors recommend the following risk-adapted treatment procedures: retroperitoneal lymph node dissection in patients with vascular invasion and a major teratoma component, adjuvant chemotherapy in patients with vascular invasion and a major embryonal carcinoma component, and surveillance policy in patients without vascular invasion.
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Affiliation(s)
- D Ondrus
- Department of Urology, Comenius University Medical School, Dérer's Hospital, Bratislava, Slovakia
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Ali TZ, Parwani AV. Benign and Malignant Neoplasms of the Testis and Paratesticular Tissue. Surg Pathol Clin 2009; 2:61-159. [PMID: 26838100 DOI: 10.1016/j.path.2008.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Benign and malignant tumors of the testes and paratesticular tissues present an interesting spectrum of diagnostic entities often encountered in routine surgical pathology practice. Germ cell tumors are the most common tumors of the testes and, despite a rising incidence, have excellent prognosis because of their radiosensitivity and/or effective chemotherapeutic agents. The proper classification of these tumors aids in the choice of appropriate treatment options. This article reviews benign and malignant neoplastic entities of the testes and paratesticular tissues and illustrates the classic pathologic characteristics. The differential diagnosis, along with ancillary studies, clinical significance, and presentation are discussed also.
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Affiliation(s)
- Tehmina Z Ali
- Department of Pathology, University of Maryland Medical Center, NBW47, 22 S. Greene Street, Baltimore, MD 21201, USA.
| | - Anil V Parwani
- Pathology Informatics, Shadyside Hospital, University of Pittsburg Medical Center, 5230 Centre Avenue, Suite WG02.10, Pittsburgh, PA 15232, USA
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Risk-adapted management for patients with clinical stage I non-seminomatous germ cell tumour of the testis. Med Oncol 2008; 26:136-42. [PMID: 18821067 DOI: 10.1007/s12032-008-9095-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 09/11/2008] [Indexed: 10/21/2022]
Abstract
Testis cancer is the most common cancer in young men and its incidence continues to rise. Even if prognosis is considered as good, a group with bad prognosis still remains. We aimed to evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical stage I, non-seminomatous germ cell testicular tumour at high risk of relapse, will spare patients additional chemotherapy or surgery. High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dl, 80% embryonal cell carcinoma or greater, vessel invasion in the primary tumour and tumour stage pT2 or greater. Low-risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting cisplatin, etoposide and bleomycin (BEP). Low-risk patients were observed. Of the 108 patients, we classified 71 as high risk and 37 as low risk of relapse. All of the high-risk patients received two courses of BEP chemotherapy. Low-risk patients were kept on close-up. The median follow-up was 26 months (range 10-60). Of the 71 patients in high-risk group, 3 relapsed with viable cancer and required additional chemotherapy and 1 patient with normal biomarkers and a late-appearing mass underwent retroperitoneal lympadenectomy for mature teratoma. All 4 relapsed patients were in high-risk group and presently they are free of disease. None of the 37 patients at low risk of recurrences developed relapse. We recommend two courses of adjuvant chemotherapy after postorchiectomy for high-risk patients with stage I non-seminomatous germ cell tumour of the testis. Adjuvant chemotherapy for these patients results in a low relapse and morbidity, wich compares favourably with the results of surveillance or RPLND. This well-tolerated approach may spare patients additional surgery or protracted chemotherapy, reduce the cost and eliminate the compliance problems associated with intensive follow up of high-risk patients.
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Amato RJ, Ro JY, Ayala AG, Swanson DA. Risk-adapted treatment for patients with clinical stage I nonseminomatous germ cell tumor of the testis. Urology 2004; 63:144-8; discussion 148-9. [PMID: 14751368 DOI: 10.1016/j.urology.2003.08.045] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate whether two courses of chemotherapy after orchiectomy in patients with clinical Stage I nonseminomatous germ cell testicular tumor at high risk of relapse will spare patients additional chemotherapy or surgery. METHODS High-risk patients had one or more of the following: preorchiectomy alpha-fetoprotein level of 80 ng/dL or greater, 80% embryonal cell carcinoma or greater, or vessel invasion in the primary tumor. Low-risk patients had none of these factors or had 50% teratoma or more without vessel invasion. High-risk patients were offered two 21-day courses of outpatient chemotherapy consisting of carboplatin, etoposide, and bleomycin. Low-risk patients and high-risk patients not receiving chemotherapy were observed. RESULTS Of 99 patients, we classified 76 as high risk and 23 as low risk of relapse. All but eight of the high-risk patients received chemotherapy. No patient who underwent chemotherapy developed relapse, although 1 patient with normal biomarkers and a late-appearing mass underwent retroperitoneal lymphadenectomy for mature teratoma. Two of the 23 low-risk patients had disease relapse; both successfully underwent chemotherapy. The nonhematologic toxicity was mild in patients receiving chemotherapy, and no patient required hospitalization. The median follow-up was 38 months (range 9 to 69). CONCLUSIONS Two courses of postorchiectomy adjuvant chemotherapy were safe and well tolerated and markedly decreased the relapse rate in high-risk patients with clinical Stage I nonseminomatous germ cell testicular tumor without additional surgery or more protracted chemotherapy. This approach may avoid potential problems with compliance and diminish the cost of scrupulous follow-up. Our results support that surveillance for carefully selected patients at a low risk of relapse is appropriate.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/blood
- Bleomycin/administration & dosage
- Carboplatin/administration & dosage
- Carcinoma, Embryonal/drug therapy
- Carcinoma, Embryonal/pathology
- Carcinoma, Embryonal/surgery
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Disease-Free Survival
- Drug Administration Schedule
- Etoposide/administration & dosage
- Germinoma/drug therapy
- Germinoma/pathology
- Germinoma/surgery
- Humans
- Lymph Node Excision
- Male
- Neoplasm Invasiveness
- Neoplasm Proteins/analysis
- Neoplasm Staging
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/surgery
- Orchiectomy
- Prognosis
- Risk Factors
- Seminoma/drug therapy
- Seminoma/pathology
- Seminoma/surgery
- Teratoma/drug therapy
- Teratoma/pathology
- Teratoma/surgery
- Testicular Neoplasms/drug therapy
- Testicular Neoplasms/pathology
- Testicular Neoplasms/surgery
- Treatment Outcome
- alpha-Fetoproteins/analysis
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Affiliation(s)
- Robert J Amato
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas 77030, USA
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5
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Stephenson AJ, Sheinfeld J. The role of retroperitoneal lymph node dissection in the management of testicular cancer. Urol Oncol 2004; 22:225-33; discussion 234-5. [PMID: 15271322 DOI: 10.1016/j.urolonc.2004.04.029] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite continued refinement in terms of technique and the integration of retroperitoneal lymph node dissection (RPLND) in the management of patients with testicular cancer, RPLND remains an essential component in the ultimate cure of these patients. The failure to eradicate all disease in the retroperitoneum exposes patients to the risk of late relapse events with potentially lethal consequences. For patients with low-stage nonseminomatous germ cell tumor (NSGCT), primary RPLND is an important staging tool to define subsequent treatment requirements, simplify the follow-up of patients by obviating the need for routine abdominal imaging, and limit the exposure of patients to the long-term toxicity of chemotherapy. RPLND alone is curative in up to 90% of patients with low-volume retroperitoneal disease. In the post-chemotherapy setting, the inability to reliably exclude the presence of teratoma or viable germ cell cancer in the retroperitoneum mandates that post-chemotherapy RPLND be performed for all NSGCT patients with residual masses. With improvements in surgical technique and perioperative care, RPLND is associated with minimal short- and long-term morbidity in the hands of experienced surgeons at dedicated centers. This article reviews the role of RPLND in the management of patients with NSGCT at all stages and its role in advanced seminoma.
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Affiliation(s)
- Andrew J Stephenson
- Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Rabbani F, Sheinfeld J, Farivar-Mohseni H, Leon A, Rentzepis MJ, Reuter VE, Herr HW, McCaffrey JA, Motzer RJ, Bajorin DF, Bosl GJ. Low-volume nodal metastases detected at retroperitoneal lymphadenectomy for testicular cancer: pattern and prognostic factors for relapse. J Clin Oncol 2001; 19:2020-5. [PMID: 11283135 DOI: 10.1200/jco.2001.19.7.2020] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the incidence, pattern, and predictive factors for relapse in patients with low-volume nodal metastases (stage pN1) at retroperitoneal lymphadenectomy (RPLND) and identify who may benefit from chemotherapy in the adjuvant or primary setting. PATIENTS AND METHODS Fifty-four patients with testicular nonseminomatous germ cell tumor had low-volume retroperitoneal metastases (pathologic stage pN1, 1997 tumor-node-metastasis classification) resected at RPLND, 50 of whom were managed expectantly without adjuvant chemotherapy. The dissection was bilateral in 12 and was a modified template in 38 patients. Retroperitoneal metastases were limited to microscopic nodal involvement in 14 patients. Follow-up ranged from 1 to 106 months (median, 31.4 months). RESULTS Eleven patients (22%) suffered a relapse at a median follow-up of 1.8 months (range, 0.6 to 28 months). The most frequent form of recurrence was marker elevation in nine (18%) patients. Persistent marker elevation after orchiectomy and before retroperitoneal lymphadenectomy was a significant independent predictor of relapse (relative risk, 8.0; 95% confidence interval, 2.3 to 27.8; P =.001). Four of five (80%) patients with elevated markers (alpha-fetoprotein alone in three, alpha-fetoprotein and beta human chorionic gonadotropin in one) suffered a relapse, compared with seven of 45 (15.6%) patients with normal markers. CONCLUSION Clinical stage I and IIA patients with normal markers who have low-volume nodal metastases have a low incidence of relapse and can be managed by observation only if compliance can be assured. In contrast, patients with elevated markers before retroperitoneal lymphadenectomy have a high rate of relapse and should be considered for primary chemotherapy.
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Affiliation(s)
- F Rabbani
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Arnold PM, Morgan CJ, Morantz RA, Eckard DA, Kepes JJ. Metastatic testicular cancer presenting as spinal cord compression: report of two cases. SURGICAL NEUROLOGY 2000; 54:27-33. [PMID: 11024504 DOI: 10.1016/s0090-3019(00)00251-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Testicular cancers are heterogenous neoplasms often found in young adults. They tend to metastasize to the chest, retroperitoneum, or neck, but rarely to the long bones or skeleton. However, they can cause neurologic compromise and should be considered in young male patients who present with symptoms of a spine lesion and no known primary cancer. METHODS Two patients presented with back pain and a rapid progression of lower extremity weakness. Both underwent radiographic workup and emergency surgery. Metastatic workup revealed testicular cancer and widespread metastases. RESULTS Both patients improved neurologically after surgery, but neither regained the ability to ambulate independently. They both underwent chemotherapy. One patient is alive at 1 year follow-up; the other died 9 months after surgery of widespread metastases. CONCLUSIONS Vertebral metastases from testicular tumors, although rare, should be considered in young men presenting with spinal cord compression. Work-up should include magnetic resonance imaging (MRI) of the spine and computed tomography (CT) of the chest, abdomen, and pelvis. Urgent intervention may be required, as these two cases show that loss of neurologic function can be rapid and permanent.
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Affiliation(s)
- P M Arnold
- Section of Neurosurgery, The University of Kansas Medical Center, Kansas City, Kansas 66160, USA
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Suzuki K, Nakazato H, Matsumoto K, Kurokawa K, Suzuki T, Suzuki K, Yamanaka H. Significance of presence of teratomatous elements in the primary tumour of testicular cancer. Int Urol Nephrol 1998; 30:487-91. [PMID: 9821053 DOI: 10.1007/bf02550230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To assess the tumour aggressiveness of teratoma, clinical records of patients with non-seminomatous germ cell testicular cancer were reviewed. Teratomatous elements were found in 57.8% of tumours. The rate of stage I tumours was lower in the teratoma-positive group than in the teratoma-negative group. Lymph node metastasis occurred more frequently than haematogenous metastasis in the teratoma-positive group. Tumour marker response in metastatic stage of teratoma-positive group was very excellent. Even if the radiographic response was not good, most patients were alive without disease after postchemotherapeutic salvage surgery. Furthermore, two patients with pure teratoma, who had tumour recurrence, were successfully treated with the multimodal therapy. Considering the smaller number of stage I patients in the teratoma-positive group than in the teratoma-negative group, the excellent overall response in the teratoma-positive group showed less aggressiveness of the tumour as a whole.
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Affiliation(s)
- K Suzuki
- Department of Urology, School of Medicine, Gunma University, Maebashi, Japan
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Abstract
For clinical stage I seminoma, conventional management consists of adjuvant RT after orchiectomy. Only 5% of patients relapse. The majority can be salvaged by chemotherapy. The overall survival of 98% is excellent. Seminoma is radiosensitive. A lower dose of RT is required than for NSGCT. Standard therapy presently is 30 Gy in 3 weeks, as suggested by the MRC study. RT is generally well tolerated. There have been recent concerns about second malignancies after 10 to 15 years. Surveillance studies have shown that 18% of patients relapse, the majority in para-aortic lymph nodes. About 15% require salvage RT and 5% salvage chemotherapy. Second relapses are seen in patients treated with RT at first relapse, and occur outside of the radiation field. The main advantage of surveillance is that 80% of patients can be spared slightly toxic overtreatment. The main disadvantage is the need for long-term follow-up, which is expensive and stressful to the patient. Good patient compliance, mandatory to an observation policy, is often difficult on a long-term basis. Seminoma is clearly responsive to chemotherapy. Adjuvant carboplatin in clinical stage I has only been evaluated in two studies. Because reliable prognostic factors have not been established, a high-risk group cannot be identified, and chemotherapy must be given to all patients. Whether or not one cycle of chemotherapy is sufficient requires further confirmation, particularly in view of the results with carboplatin as compared with cisplatin in patients with advanced NSGCT. Results of the randomized MRC trial comparing RT with carboplatin are of interest.
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Affiliation(s)
- C N Sternberg
- Department of Medical Oncology, San Raffaele Scientific Institute, Rome, Italy
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10
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Mor Y, Leibovich I, Raviv G, Nass D, Medalia O, Goldwasser B, Nativ O. Testicular seminoma: clinical significance of nuclear deoxyribonucleic acid ploidy pattern as studied by flow cytometry. J Urol 1995; 154:1041-3; discussion 1044. [PMID: 7637050 DOI: 10.1016/s0022-5347(01)66970-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE We evaluated the clinical significance of deoxyribonucleic acid (DNA) ploidy pattern as a predictor of prognosis in patients with testicular seminoma. MATERIALS AND METHODS Flow cytometric nuclear DNA analysis was performed on archival specimens from 65 patients with pure seminoma who underwent radical orchiectomy between 1970 and 1992. RESULTS A total of 42 specimens (65%) exhibited a DNA diploid pattern, while 23 (35%) were DNA aneuploid. Diploidy was manifested in 73% of the stage I tumors versus 31% of stage II cancers (p = 0.004). No correlation was found between ploidy and histological type, size or local extension of the tumor. Tumor progression was observed in 5 patients, exclusively displaying aneuploid histograms (p = 0.0017), and 3 of them subsequently died of the disease. CONCLUSIONS DNA ploidy pattern may provide important prognostic information for patients with testicular seminoma.
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Affiliation(s)
- Y Mor
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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11
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Bassetto M, Parise G, Franceschi T, Pecoraro G, Sidoti O. The serum level of markers during chemotherapy as prognostic indicator in testicular GCT. Urologia 1995. [DOI: 10.1177/039156039506200325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The high specificity and sensitivity of testicular tumour markers AFP and HCG make them particularly useful in the management of these neoplasms. Basai value represents an independent prognostic variable, influencing the choice of therapy. An increase in marker level before chemotherapy may also acquire a powerful prognostic significance. The decay curve pattern is indicative of the radicality of surgery. Also during chemotherapy the behaviour of markers conditions further therapeutiG strategies.
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Affiliation(s)
- M.A. Bassetto
- Divisione Clinicizzata di Oncologia Medica - Osedale Civile Maggiore - Verona
| | - G. Parise
- Laboratorio Analisi Chimico-cliniche e Microgiologiche - Ospedale Civile - Villafranca (Verona)
| | - T. Franceschi
- Divisione Clinicizzata di Oncologia Medica - Osedale Civile Maggiore - Verona
| | - G. Pecoraro
- Servizio Autonomo di Urologia - Ospedale Civile - Villafranca (Verona)
| | - O. Sidoti
- Servizio Autonomo di Urologia - Ospedale Civile - Villafranca (Verona)
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Abstract
BACKGROUND Pure testicular teratoma in adults is a relatively rare malignant tumor with the ability to invade and metastasize. Pure teratoma generally is believed to be less aggressive and less likely to progress, to present in lower stages, and to have better survival rates then other forms of germ cell tumor. Consequently, clinical stage A patients with pure testicular teratoma commonly have been considered to be managed best by surveillance. METHODS A computerized database search identified 41 patients presenting to Indian University with pure teratoma in the orchiectomy specimen. These patients were further subdivided into four groups based on clinical stage, as follows: Group I, 18 patients with clinical Stage A disease; Group II, 4 patients with clinical Stages A-B1 disease based on questionable computed tomography findings; Group III, 3 patients with clinical Stage B1 disease; Group IV, 16 patients with advanced stage (B3-C) disease. The experience with these patients was reviewed. RESULTS The overall risk of lymph node metastasis in retroperitoneal lymph node dissection (RPLND) and the risk of relapse after RPLND for patients with low stage pure testicular teratoma (groups I-III) were 40 and 16%, respectively. In patients with clinical Stage A teratoma, the risk of retroperitoneal metastasis in RPLND was 16.7% and the relapse rate was 11.1%. In addition, nearly 37% of referred patients with pure teratoma presented with advanced disease. CONCLUSIONS These data provide additional confirmation of the metastatic potential of pure testicular teratoma. The proper management of the adult clinical stage A patient with primary pure teratoma of the testis should not necessarily differ from the management of any other histologic type of nonseminomatous testicular tumor. Accordingly, histologic diagnosis of pure teratoma should not mandate surveillance. Instead, patients must be given adequate information regarding management options, as are all other patients presenting with clinical Stage A nonseminoma.
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Affiliation(s)
- I Leibovitch
- Department of Urology, Indiana University School of Medicine, Indianapolis, USA
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de Riese WT, Albers P, Walker EB, Ulbright TM, Crabtree WN, Reister T, Foster RS, Donohue JP. Predictive parameters of biologic behavior of early stage nonseminomatous testicular germ cell tumors. Cancer 1994; 74:1335-41. [PMID: 8055457 DOI: 10.1002/1097-0142(19940815)74:4<1335::aid-cncr2820740425>3.0.co;2-t] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Thirty percent of patients presenting with clinical stage A nonseminomatous testicular germ cell tumors in fact have pathologic stage B disease. This pilot study was performed to determine whether DNA content and cell cycle analysis by flow cytometry and single-cell cytophotometry can improve clinical staging in these patients. METHODS The orchiectomy specimens of 102 patients with clinical stage A disease were analyzed retrospectively using histopathologic classification, flow cytometry, and single-cell cytophotometry. All patients had undergone retroperitoneal lymph node dissection. RESULTS The multivariate analysis in this group of patients resulted in the following model: If the primary tumor consisted of 100% embryonal carcinoma, the patient was classified as high risk for retroperitoneal metastasis. If the patient was found to have less than 100% embryonal carcinoma in the primary tumor, the percent of aneuploid tumor cells in S-phase as identified by flow cytometry was most predictive for pathologic stage. Using this approach, 91% of all patients with pathologic stage B, and 77% of the patients with pathologic stage A were correctly classified; test efficiency was 82%. CONCLUSIONS These results demonstrate an improvement in clinical staging in this group of patients. This paradigm, developed from retrospective analysis, will be tested prospectively in consecutive patients to determine if it is clinically useful.
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Affiliation(s)
- W T de Riese
- Department of Urology, Indiana University Medical Center, Indianapolis 46202
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Lewis DJ, Sesterhenn IA, McCarthy WF, Moul JW. Immunohistochemical expression of P53 tumor suppressor gene protein in adult germ cell testis tumors: clinical correlation in stage I disease. J Urol 1994; 152:418-23. [PMID: 8015085 DOI: 10.1016/s0022-5347(17)32753-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
P53 tumor suppressor gene protein immunostaining was evaluated in the primary tumor of adult testicular germ cell cancer to assess if P53 expression would serve as a clinically useful tumor marker. Representative archival tissues from 152 orchiectomy specimens were studied for P53 immunohistochemistry. Seminoma and nonseminomatous germ cell tumor constituents revealed P53 expression via immunohistochemistry in 90% and 94% of the cases, respectively. For seminoma, there was a trend toward decreased P53 expression with advancing stage. For nonseminomatous germ cell tumor, although all cellular components showed variable P53 expression, P53 expression in embryonal carcinoma constituents increased among stages of disease. A third of pathological stage I cancer patients exhibited 2+ or greater P53-embryonal staining compared with 61% with stage II (p = 0.0670) and 67% with stage III (p = 0.0815) disease, respectively (Kruskal-Wallis, 2-sided test). As a secondary objective, we wanted to determine if P53 immunohistochemistry would be useful to predict occult disease in clinical stage I nonseminomatous germ cell tumor. This group was studied for P53-embryonal immunohistochemistry, the presence of vascular invasion and the quantitative determination of percentage of embryonal carcinoma in the primary tumor in a multivariate fashion to assess if these tests could be clinically useful to predict occult disease. Degree of P53 immunostaining of the embryonal component in the primary tumor was statistically greater for stage II by univariate logistic regression analysis (p = 0.0362). Similarly, the per cent embryonal cancer (p = 0.0002) and vascular invasion (p = 0.0005) were highly significant as predictors of occult stage II disease via the univariate testing. By multivariate logistic regression analysis, the model consisting of per cent embryonal cancer and vascular invasion provided the best prediction of occult disease in the clinical stage I cohort. In addition, this model had the highest sensitivity and specificity of all multivariate models considered. The addition of P53-embryonal staining did not improve predictability nor sensitivity/specificity. The P53 tumor suppressor gene protein is expressed to some degree in most testicular germ cell tumors and degree of staining/expression varies according to stage of disease. From the standpoint of a clinically useful primary tumor risk factor for predicting occult disease, vascular invasion by the tumor and percentage of embryonal carcinoma component in the tumor are more useful than P53 immunohistochemistry.
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Affiliation(s)
- D J Lewis
- Department of Surgery and Clinical Investigation, Walter Reed Army Medical Center, Washington, D. C
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Affiliation(s)
- J Sheinfeld
- Department of Surgery, Memorial-Sloan-Kettering Cancer Center, New York, New York
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de Graaff WE, van Echten-Arends J, Oosterhuis JW, de Jong B, te Meerman GJ, Wiersema-Buist J, Sleijfer DT, Schraffordt Koops H. Cytogenetic abnormalities and clinical stage in testicular nonseminomatous germ cell tumors. CANCER GENETICS AND CYTOGENETICS 1993; 70:12-6. [PMID: 8221606 DOI: 10.1016/0165-4608(93)90124-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
To study the impact of chromosomal abnormalities on the clinical behavior of testicular nonseminomatous germ cell tumors (TNSGCTs), we compared the chromosomal constitution of primary tumors of patients who initially presented and remained without metastases to those with metastatic disease. Furthermore, the chromosomal pattern of primary TNSGCTs was compared to ploidy and the clinicopathologic risk factors histology and small-vessel invasion. The modal chromosome number and the ploidy were in agreement. No correlation was found between the modal chromosome number and histology, presence of vascular invasion, or clinical stage. No correlation was found between structural chromosome abnormalities, like the number of copies of the i(12p) chromosome, and clinical stage. No obvious differences were found in chromosomal constitution of metastatic and non-metastatic tumors. The results of the present study suggest that in TNSGCTs differences in clinical behavior are not associated with gross chromosomal differences.
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Affiliation(s)
- W E de Graaff
- Department of Pathology, University of Groningen, The Netherlands
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18
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de Graaff WE, Sleijfer DT, de Jong B, Dam A, Schraffordt Koops H, Oosterhuis JW. Significance of aneuploid stemlines in testicular nonseminomatous germ cell tumors. Cancer 1993; 72:1300-4. [PMID: 8393372 DOI: 10.1002/1097-0142(19930815)72:4<1300::aid-cncr2820720424>3.0.co;2-o] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hyperpentaploidy in testicular nonseminomatous germ cell tumors (TNSGCT) has been associated with progression of disease of patients who initially had TNSGCT in Stage I. METHODS The authors used flow cytometry to investigate the relationship between ploidy and the clinical behavior in TNSGCT, focusing on hypertetraploid values (DNA index, > 2.00). RESULTS Patients with TNSGCT containing an aneuploid stemline with a hypertetraploid value more often had higher clinical stage of disease and a higher chance of relapse in advanced stages. The presence of multiple aneuploid stemlines in the tumors was found more frequently in patients who had higher clinical stage disease. CONCLUSIONS The results suggest that the presence of highly aneuploid or multiple aneuploid stemlines in TNSGCT are associated with a clinically more malignant behavior.
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Affiliation(s)
- W E de Graaff
- Department of Pathology, State University of Groningen, The Netherlands
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Sternberg CN. ROLE OF PRIMARY CHEMOTHERAPY IN STAGE I AND LOW-VOLUME STAGE II NONSEMINOMATOUS GERM-CELL TESTIS TUMORS. Urol Clin North Am 1993. [DOI: 10.1016/s0094-0143(21)00465-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vogt HB, McHale MS. Testicular cancer. Role of primary care physicians in screening and education. Postgrad Med 1992; 92:93-6, 99-101. [PMID: 1377387 DOI: 10.1080/00325481.1992.11701393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Cure rates for testicular cancer have improved dramatically over the years, but early diagnosis is still essential. Primary care physicians have a responsibility to include testicular examination as part of cancer screening and to educate young male patients about the frequency of testicular cancer in their age-group and on how to perform self-examination. A high index of suspicion and careful bimanual palpation are crucial in evaluation of complaints referable to the scrotum. Prompt urologic consultation must be obtained if a tumor is suspected.
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von Eyben FE, Blaabjerg O, Madsen EL, Petersen PH, Smith-Sivertsen C, Gullberg B. Serum lactate dehydrogenase isoenzyme 1 and tumour volume are indicators of response to treatment and predictors of prognosis in metastatic testicular germ cell tumours. Eur J Cancer 1992; 28:410-5. [PMID: 1375486 DOI: 10.1016/s0959-8049(05)80064-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
44 patients with metastatic testicular germ cell tumours treated with cisplatin-based chemotherapy were evaluated for prognostic implications of clinical characteristics. 22 obtained complete remission by the initial chemotherapy, and 30 are disease-free. S-LDH-1 had an overall predictive value regarding the response of 80%, S-LDH of 64%, S-AFP of 62%, and S-hCG of 62%. In multivariate analysis regarding response, only tumour volume classified according to the Royal Marsden system (P = 0.0036) and S-LDH-1 (P = 0.0069) yielded information. Regarding survival, S-LDH-1 (P = 0.0141) and an estimate of total tumour mass (P = 0.0171) had most impact with additional information from S-hCG only (P = 0.0536). We conclude that S-LDH-1 may be used as a tumour marker in addition to S-hCG and S-AFP in patients with metastatic testicular germ cell tumour.
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Affiliation(s)
- F E von Eyben
- Department of Internal Medicine, Central Hospital, Nykøbing Falster, Denmark
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