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Velez D, Zhao P, Mayer T, Singer E. Intra-abdominal seminoma found incidentally during trauma workup in a man with bilateral cryptorchidism. Urol Ann 2015; 7:534-6. [PMID: 26692683 PMCID: PMC4660714 DOI: 10.4103/0974-7796.162220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Bilateral cryptorchidism is a rare occurrence and seminoma is the most common germ cell tumor found in undescended testes when they occur. We present the case of a patient with bilateral cryptorchidism who presented to our trauma center after a motor vehicle collision and was found incidentally to have a 17-cm intra-abdominal mass. The mass was subsequently biopsied and proven to be seminoma. The patient completed three cycles of bleomycin/etoposide/cisplatin chemotherapy and successfully underwent a postchemo retroperitoneal lymph node dissection with no viable residual tumor or positive lymph nodes found in the surgical specimen. He also had an orchiopexy of the contralateral testicle. The patient recovered fully and has been found to be recurrence-free four months postoperatively. We highlight the importance of cisplatin-based chemotherapy and extensive tumor resection as the mainstay of initial cancer control.
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Affiliation(s)
- Danielle Velez
- Department of Surgery, Division of Urology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Philip Zhao
- Department of Surgery, Division of Urology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Tina Mayer
- Section of Medical Oncology, Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Eric Singer
- Section of Urologic Oncology, Rutgers-Cancer Institute of New Jersey, New Brunswick, NJ, USA
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Osunkoya AO, Grignon DJ. Practical issues and pitfalls in staging tumors of the genitourinary tract. Semin Diagn Pathol 2012; 29:154-66. [DOI: 10.1053/j.semdp.2011.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Heinzelbecker J, Katzmarzik M, Weiss C, Trojan L, Michel MS, Haecker A. Changes of stage, predictive factors and adjuvant treatment modalities in seminomatous testicular cancer from 1987 to 2007 and their impact on the status of metastasis, recurrence-free and overall survival: a single-center analysis. Urol Int 2011; 87:282-7. [PMID: 21876335 DOI: 10.1159/000329768] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 05/30/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To observe the changing presentation of seminomatous testicular cancer (STC), placing particular emphasis on predictive factors with a view to evaluating their impact on the status of metastasis, recurrence-free survival (RFS) and overall survival (OAS). MATERIALS AND METHODS 180 patients with STC were evaluated retrospectively. Four study periods were generated and compared for changes. The data were analyzed for predictive factors for metastasis. Mean follow-up was 83 months (range 10-246, patients alive = 146). RESULTS The number of STC patients increased constantly throughout 2007. From 1992 onwards, significantly more patients were diagnosed as being in CS1 (p = 0.001). The odds ratio (OR) of metastasis was significantly higher for pT3 than pT2 STC (OR 12.4 vs. 1.7; p = 0.003); pT1 tumors showed a lower risk factor. The 10- and 15-year RFS were 91 and 85%, respectively. Patients in clinical stages higher than CS1 (CS>1) had significantly reduced RFS (p < 0.001). The 5- and 10-year OAS were 97 and 96%, respectively. Patients in CS>1 had significantly reduced OAS rates (p = 0.013). CONCLUSIONS The number of STC cases is increasing, particularly in the case of patients in CS1. This emphasizes the need for surveillance regimens and makes the evaluation of predictive factors for metastasis, recurrence and survival essential.
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Affiliation(s)
- Julia Heinzelbecker
- Department of Urology, Mannheim Medical Center, Mannheim, Germany. julia.heinzelbecker @ umm.de
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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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Valdevenito JP, Gallegos I, Fernández C, Acevedo C, Palma R. Correlation Between Primary Tumor Pathologic Features and Presence of Clinical Metastasis at Diagnosis of Testicular Seminoma. Urology 2007; 70:777-80. [DOI: 10.1016/j.urology.2007.05.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2006] [Revised: 03/27/2007] [Accepted: 05/22/2007] [Indexed: 11/26/2022]
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Koh DM, Hughes M, Husband JE. Cross-sectional imaging of nodal metastases in the abdomen and pelvis. ACTA ACUST UNITED AC 2007; 31:632-43. [PMID: 16897278 DOI: 10.1007/s00261-006-9022-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Accurate nodal staging is important for the management of patients with abdominal and pelvic malignancies. Local and nodal staging using cross-sectional imaging can influence treatment planning. The measurement of nodal size is still the most widely used criteria for discriminating between benign and malignant nodes. However, knowledge of the pathways of nodal spread, the treatment history, and careful analysis of nodal characteristics can improve nodal assessment. An appreciation of normal structures that may simulate nodal disease is also important. The potential for further improving nodal staging accuracy by positron emission tomography and magnetic resonance lymphography is discussed.
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Affiliation(s)
- D M Koh
- Academic Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton SM2 5PT, UK.
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Browne TJ, Richie JP, Gilligan TD, Rubin MA. Intertubular growth in pure seminomas: associations with poor prognostic parameters. Hum Pathol 2005; 36:640-5. [PMID: 16021570 DOI: 10.1016/j.humpath.2005.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Clinical stage I seminomas are effectively treated with surgery raising concerns as to when to give adjuvant radiation therapy given the risk of secondary malignancies. A recent randomized trial found tumor size and rete testis invasion to be the strongest predictors of relapse in clinical stage I seminomas. These 2 parameters may be surrogate measures of tumor volume. Intertubular seminoma (ITS) of the testis describes the presence of neoplastic germ cells within the interstitium of the testis. These cells are detected away from the main macroscopic mass. Because ITS can infiltrate in a 3-dimensional fashion, it may also represent a measure of tumor volume not usually noted in standard pathology reporting. The goal of this study was to determine the incidence of ITS in pure seminomas and its association with other prognostic parameters. One hundred twenty consecutive pure seminomas surgically removed between 1998 and 2003 were evaluated. ITS was defined as the presence of an interstitial or intertubular growth pattern of tumor cells, which was noncontiguous with the main tumor and present at least 3 high-power fields away from the tumor mass. The average tumor size was 3.4 cm. Of the entire cohort of patients, which included pathological stages T1 through T3, 11% had invasion through the tunica albuginea, 51% had rete testis invasion, 51% had lymphovascular invasion, 93% had associated intratubular germ-cell neoplasia, and 36% had ITS. ITS was significantly associated with rete testis invasion ( P = .001). Logistic regression analysis looking at ITS, tumor size, patient age, and lymphovascular invasion revealed that only ITS was associated with rete testis invasion (RR, 4.1, P < .0001). ITS is present in a significant proportion of pure seminomas and has a significant association with rete testis invasion. The presence of ITS may therefore be an important prognostic factor, not only because it alters the calculated size of the tumor but also because it has an association with rete testis invasion.
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Affiliation(s)
- Tara-Jane Browne
- Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115, USA
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Warde P, Specht L, Horwich A, Oliver T, Panzarella T, Gospodarowicz M, von der Maase H. Prognostic factors for relapse in stage I seminoma managed by surveillance: a pooled analysis. J Clin Oncol 2002; 20:4448-52. [PMID: 12431967 DOI: 10.1200/jco.2002.01.038] [Citation(s) in RCA: 451] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Several management options are available to patients with stage I seminoma, including adjuvant radiotherapy, surveillance, and adjuvant chemotherapy. We performed a pooled analysis of patients from the four largest surveillance studies to better delineate prognostic factors associated with disease progression. PATIENTS AND METHODS Individual patient data were obtained from each center (Princess Margaret Hospital, Danish Testicular Cancer Study Group, Royal Marsden Hospital, and Royal London Hospital) for 638 patients. Tumor characteristics (size, histologic subtype, invasion of rete testis, and tumor invasion into small vessels [SVI]) as well as age at diagnosis were analyzed for prognostic importance for relapse. RESULTS With a median follow-up of 7.0 years (range, 0.02 to 17.5 years), 121 relapses were observed for an actuarial 5-year relapse-free rate (RFR) of 82.3%. On univariate analysis, tumor size (RFR: <or= 4 cm, 87%; > 4 cm, 76%; P =.003), rete testis invasion (RFR: 86% [absent] v 77% [present], P =.003), and the presence of SVI (RFR: 86% [absent] v 77% [present], P =.038) were predictive of relapse. On multivariate analysis, tumor size (<or= 4 cm v > 4 cm, hazard ratio 2.0; 95% confidence interval [CI], 1.3 to 3.2) and invasion of the rete testis (hazard ratio 1.7; 95% CI, 1.1 to 2.6) remained as important predictors for relapse. CONCLUSION We have identified size of primary tumor and rete testis invasion as important prognostic factors for relapse in patients with stage I seminoma managed with surveillance. This information will allow patients and clinicians to choose management based on a more accurate assessment of an individual patient's risk of relapse. In addition, it will allow clinicians to tailor follow-up protocols based on risk of occult disease.
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Affiliation(s)
- Padraig Warde
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada.
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Parkinson MC, Harland SJ, Harnden P, Sandison A. The role of the histopathologist in the management of testicular germ cell tumour in adults. Histopathology 2001; 38:183-94. [PMID: 11260297 DOI: 10.1046/j.1365-2559.2001.01071.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the last 20--30 years the availability of effective chemotherapy and more accurate clinical staging has greatly improved the prognosis for patients with testicular germ cell tumours. Initially, such treatment appeared to diminish the role of histopathology to the distinction between seminoma and nonseminomatous germ cell tumour (NSGCT) in the primary specimen. However, histopathology has evolved as a prognostic tool indicating the risk of relapse in various defined clinical contexts thereby facilitating therapeutic decisions. The clinical emphasis has been on quality of life and reduction of therapy both in terms of the number of patients treated and the number of chemotherapy courses given to each patient. The treatment of adult testicular germ cell tumours may differ between countries but protocols are established. Therefore it is appropriate to discuss the role of histopathology during this era of relative therapeutic stability.
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Affiliation(s)
- M C Parkinson
- UCL Hospitals Trust and Institute of Urology, UCL London, UK
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Sápi Z, Szapanidisz J, Tóth B, Bodrogi I. DNA Ploidy Pattern in Pure Seminomas. Pathol Oncol Res 2001; 1:71-74. [PMID: 11173571 DOI: 10.1007/bf02893587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nuclear extract and image cytometry was used to determine the DNA ploidy pattern of 31 pure seminomas. At least 5-year but usually 10-year follow-up was available to compare the clinical outcome to the DNA ploidy pattern. In 24 cases (77.4%) the DNA indexes (DI) showed tetraploid (1,8 < DI < 2,2) pattern confirming the recent cytogenetic and flow cytometric DNA studies of others. However, in 7 cases (22,6%) the tumors were aneuploid. Out of these aneuploid cases 2 had two subpopulations and 2 had less than 1,8 DI. These latter cases (providing the loss of chromosomal DNA) had elevated AFP levels in serum that raises the question of nonseminomatous transformation without any morphological evidence. Usually, the aneuploid cases had worse prognoses but there was no significant difference. Because of the small number of aneuploid cases wider clinicopathologic studies are required to confirm our results.
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Affiliation(s)
- Zoltán Sápi
- St. John's Hospital, Department of Pathology, Budapest, Hungary
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Abstract
OBJECTIVES To assess the characteristics of patients with recurrent disease by a retrospective analysis. METHODS Between 1982 and 1998, 488 patients were treated in Nijmegen for testicular cancer. All patients underwent orchiectomy and adjuvant treatment when indicated. Patients were routinely followed up. RESULTS In 36 patients (7.4%), disease recurrence was found during follow-up; 12 had contralateral disease and 24 systemic recurrence. Contralateral testicular cancer occurred a median of 63.8 months (range 43.2 to 165.2) after orchiectomy and systemic recurrence at a median of 6.1 months (range 1.5 to 94.4). Contralateral testicular cancer was more frequent in patients with pure seminoma (odds ratio 4.3, 95% confidence interval 1.4 to 13.1); 8 of 9 patients with contralateral cancer received adjuvant radiotherapy. The best predictor of systemic recurrence after nonseminoma germ cell tumor was the presence of teratoma and embryonal cell components in the primary tumor. In the entire population, 19 patients (3.9%) died of the disease. None of the patients with contralateral testicular recurrence or systemic recurrence after Stage I seminoma died of the disease. One of 10 patients died of recurrent Stage I nonseminoma germ cell tumor. The chance of dying of recurrence after metastatic nonseminoma germ cell tumor was 36%. CONCLUSIONS Recurrence after an initially complete response is rare in testicular cancer. Contralateral testicular cancer is associated with the presence of seminoma components in the primary tumor and occurs almost 10 times later than systemic recurrence. The prognosis after contralateral testicular cancer and after recurrence in Stage I seminoma is good.
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Affiliation(s)
- H G van der Poel
- Department of Urology, University Hospital, Nijmegen, The Netherlands
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Abstract
Pathologic analysis is invaluable in defining the levels of risk for the development of a testicular tumor or for metastasis in a patient with an established testicular cancer. The identification of IGCNU in testicular biopsies defines a group of patients at high risk for subsequent invasive germ cell tumor unless they are treated by orchiectomy or radiotherapy. This method for defining the risk for the development of a testicular tumor is not effective in prepubertal patients, except for those with intersex syndromes. Pathologic analysis of testicular germ cell tumors in patients with clinical stage I disease may allow their stratification into high- and low-risk groups for occult metastases. This would provide a rational basis for recommending intervention or surveillance, respectively. The precise classification of postchemotherapy lesions permits an assessment of the patient's risk for subsequent recurrence and progressive tumor.
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Affiliation(s)
- T M Ulbright
- Department of Pathology, Indiana University School of Medicine, Indianapolis, USA
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Ulbright TM. Protocol for the examination of specimens from patients with malignant germ cell and sex cord-stromal tumors of the testis, exclusive of paratesticular malignancies: a basis for checklists. Cancer Committee, College of American Pathologists. Arch Pathol Lab Med 1999; 123:14-9. [PMID: 9923830 DOI: 10.5858/1999-123-0014-pfteos] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- T M Ulbright
- Department of Pathology, Indiana University School of Medicine, Indianapolis, USA
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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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Marks A, Ballinger JR, Reilly RM, Law J, Baumal R. A novel anti-seminoma monoclonal antibody (M2A) labelled with technetium-99m: potential application for radioimmunoscintigraphy. BRITISH JOURNAL OF UROLOGY 1995; 75:225-9. [PMID: 7850331 DOI: 10.1111/j.1464-410x.1995.tb07316.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To study the potential usefulness of monoclonal antibody (mAb) M2A specific for seminoma to image tumour nodules in a preclinical nude mouse model. MATERIALS AND METHODS MAb M2A was labelled with technetium-99m (99mTc) following reduction and was administered intraperitoneally to nude mice bearing subcutaneous HEY cell xenografts against which the antibody was originally raised. Biodistribution and gamma scintigraphy studies were performed 24 h after administration of 99mTc-M2A. RESULTS Biodistribution studies showed specific targeting of 99mTc-M2A to HEY tumours in comparison with control mAb 99mTc-6E8 and 99mTc-2G3 which do not bind to HEY cells. Subcutaneous HEY cell tumours (0.5-1.0 g) were successfully imaged using gamma-scintigraphy following administration of 99mTc-M2A. CONCLUSION The results of this study indicate the potential usefulness of 99mTc-M2A as a clinical reagent for imaging seminoma metastases.
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Affiliation(s)
- A Marks
- Banting and Best Department of Medical Research, University of Toronto, Ontario, Canada
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Affiliation(s)
- G K Zagars
- Department of Clinical Radiotherapy, University of Texas, M.D. Anderson Cancer Center, Houston 77030
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Marks LB, Anscher MS, Shipley WU. The Role of Radiation Therapy in the Treatment of Testicular Germ Cell Tumors. Hematol Oncol Clin North Am 1991. [DOI: 10.1016/s0889-8588(18)30376-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Abu-Jawdeh GM, Oyasu R. Testicular Germ Cell Tumors. Pathol Int 1991. [DOI: 10.1111/j.1440-1827.1991.tb02503.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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