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Ghrewati M, Mahmoud A, Beliani T, Kumar M. Rhabdomyosarcoma in Adults: De Novo or Conversion From Non-seminomas? Cureus 2024; 16:e55449. [PMID: 38571873 PMCID: PMC10988532 DOI: 10.7759/cureus.55449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
Rhabdomyosarcoma (RMS) is a highly sporadic, very aggressive, and fatal soft tissue tumor in adults. Although more common and treatable in the pediatric population, the occurrence of pleomorphic RMS in adults has a low incidence. Hence, it is not easy to treat. Surgery is the primary definitive treatment, along with radiation therapy, while adjuvant chemotherapy has recently gained popularity. We present an infrequent case of RMS in a patient with a recent history of mixed non-seminomatous germ-cell tumor testicular cancer. Therefore, it was challenging to treat the RMS as a new malignancy or as a recurrence of non-seminomatous testicular cancer. Our patient passed away, unfortunately, but we hope this case can help the minimal data in this regard in order to save more lives in the future.
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Affiliation(s)
- Moutaz Ghrewati
- Oncology, St. Joseph's University Medical Center, Paterson, USA
| | - Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Tala Beliani
- Oncology, Kansas City University, Kansas City, USA
| | - Mehandar Kumar
- Oncology, St. Joseph's University Medical Center, Paterson, USA
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Guo CC, Czerniak B. Reprint of: somatic-type malignancies in testicular germ cell tumors. Hum Pathol 2023; 133:102-114. [PMID: 36890027 DOI: 10.1016/j.humpath.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 03/08/2023]
Abstract
The development of somatic-type malignancy (SM) in testicular germ cell tumor represents a major challenge in the diagnosis and treatment of testicular cancer. Most SMs are derived from teratoma, and the remainder is associated with yolk sac tumor. They occur more frequently in metastases than in primary testicular tumors. SMs demonstrate a variety of histologic types, including sarcoma, carcinoma, embryonic-type neuroectodermal tumor, nephroblastoma-like tumor, and hematologic malignancy. Sarcoma, particularly rhabdomyosarcoma, accounts for the majority of SMs in the primary testicular tumors, whereas carcinoma, particularly adenocarcinoma, is the most common SM in metastases. Although SMs derived from testicular germ cell tumors mimic their histologic counterparts in other organs with overlapping immunohistochemical profiles, isochromosome 12p is present in most SMs, which can be useful in the differential diagnosis. The presence of SM in the primary testicular tumor may not worsen the outcome, but the development of SM in metastasis is associated with a poor prognosis. Furthermore, somatic-type carcinoma is likely associated with a worse prognosis than somatic-type sarcoma. Although SMs respond poorly to the cisplatin-based chemotherapy, timely surgical resection is an effective treatment for most patients.
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Affiliation(s)
- Charles C Guo
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77401, USA.
| | - Bogdan Czerniak
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77401, USA
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Guo CC, Czerniak B. Somatic-Type Malignancies in Testicular Germ Cell Tumors. Hum Pathol 2022; 127:123-135. [PMID: 35803413 DOI: 10.1016/j.humpath.2022.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/04/2022]
Abstract
The development of somatic-type malignancy (SM) in testicular germ cell tumor represents a major challenge in the diagnosis and treatment of testicular cancer. Most SMs are derived from teratoma, and the remainder is associated with yolk sac tumor. They occur more frequently in metastases than in primary testicular tumors. SMs demonstrate a variety of histologic types, including sarcoma, carcinoma, embryonic-type neuroectodermal tumor, nephroblastoma-like tumor, and hematologic malignancy. Sarcoma, particularly rhabdomyosarcoma, accounts for the majority of SMs in the primary testicular tumors, whereas carcinoma, particularly adenocarcinoma, is the most common SM in metastases. Although SMs derived from testicular germ cell tumors mimic their histologic counterparts in other organs with overlapping immunohistochemical profiles, isochromosome 12p is present in most SMs, which can be useful in the differential diagnosis. The presence of SM in the primary testicular tumor may not worsen the outcome, but the development of SM in metastasis is associated with a poor prognosis. Furthermore, somatic-type carcinoma is likely associated with a worse prognosis than somatic-type sarcoma. Although SMs respond poorly to the cisplatin-based chemotherapy, timely surgical resection is an effective treatment for most patients.
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Bonet X, Oderda M, Campobasso D, Hoepffner JL. A pelvic mass 21 years after a Wilms tumour: late recurrence or new tumour? Urologia 2021:3915603211026103. [PMID: 34171983 DOI: 10.1177/03915603211026103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Late Wilms tumour (WT) recurrences are rare events with poorly understood pathogenesis. They could be induced by previous chemo- and radiotherapy regimens, which can also prompt a rhabdomyomatous differentiation. Prostatic embryonal rhabdomyosarcoma (PER) is an extremely rare disease in adults, with an aggressive behaviour and abysmal prognosis. Radio-induced PER have been described. CASE DESCRIPTION We report the case of a 29 years old man, with a history of WT, diagnosed with a symptomatic prostatic mass. Blastemic elements were shown at the transrectal biopsy, suggesting the possibility of a late WT recurrence. After laparoscopic resection, an unexpected pathologic diagnosis was reached: PER. CONCLUSION We retrace and analyse the diagnostic and therapeutic path of the case that represents a mixture of two different conditions which might be unrelated or intertwined in a causal relationship. Among the differential diagnosis of a prostatic mass, the possibility of a prostatic sarcoma should not be overlooked, in presence of blastemic elements, even in a patient with a WT history.
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Affiliation(s)
- Xavier Bonet
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Department of Urology, Hospital de Bellvitge, Barcelona, Spain
| | - Marco Oderda
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Department of Urology, University of Turin, Turin, Italy
| | - Davide Campobasso
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Urology Unit, Civil Hospital of Guastalla, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy
| | - Jean-Luc Hoepffner
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Department of Urology, Hospital de Bellvitge, Barcelona, Spain.,Department of Urology, University of Turin, Turin, Italy.,Urology Unit, Civil Hospital of Guastalla, Azienda USL-IRCCS di Reggio Emilia, Guastalla, Italy.,Institut Bergonié, Bordeaux, France
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Neuroglial Differentiation and Neoplasms in Testicular Germ Cell Tumors Lack Immunohistochemical Evidence of Alterations Characteristic of Their CNS Counterparts. Am J Surg Pathol 2019; 43:422-431. [DOI: 10.1097/pas.0000000000001206] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Ulbright TM. Pitfalls in the interpretation of specimens from patients with testicular tumours, with an emphasis on variant morphologies. Pathology 2017; 50:88-99. [PMID: 29129333 DOI: 10.1016/j.pathol.2017.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/20/2017] [Indexed: 12/15/2022]
Abstract
Accurate diagnosis of primary and metastatic tumours is essential in testicular cancer. While many cases are straightforward, some pose difficulties, especially when variant morphologies occur. Seminoma with 'atypical' features, including increased nuclear pleomorphism and crowding and greater cytoplasmic density with loss of membrane definition, mimics embryonal carcinoma, although ancillary features (fibrous septa, lymphocytes) and immunohistochemistry are of great help. Other deceptive seminoma features include prominent to exclusive intertubular growth, microcystic/tubular patterns, and signet-ring tumour cells. Conversely, embryonal carcinomas may have 'seminoma-like' foci, as may Sertoli cell tumours with diffuse growth and pale cytoplasm. Solid pattern yolk sac tumour mimics seminoma and, conversely, microcytic seminoma resembles yolk sac tumour. Other architectural patterns, ancillary yolk sac tumour features (intercellular basement membrane deposits, hyaline cytoplasmic globules) and immunohistochemistry aid in distinction from seminoma. Embryonal carcinomas may show, in addition to 'seminoma-like' foci, pseudoendodermal sinus-like structures, sieve-like patterns, endometrioid-like morphology and prominent zones of stratified columnar tumour cells. These may cause confusion with yolk sac tumour and teratoma, although careful attention to cytological features usually suffices for accurate diagnosis. Recent work has defined 'new' primary trophoblastic tumours, i.e., cystic trophoblastic tumour and epithelioid trophoblastic tumour. The newly termed 'spermatocytic tumour' occasionally consists mostly of a monotonous proliferation of intermediate-sized tumour cells with prominent nucleoli, thereby simulating either seminoma or embryonal carcinoma. Prostatic adenocarcinoma remains the most common tumour to metastasise to the testis and can cause confusion with rete carcinomas and primary germ cell tumours. Post-chemotherapy resections pose their own challenges. Effete tumour cells in areas of necrosis and prominent fibroxanthomatous reactions should not be interpreted as persistent, viable germ cell tumour. 'Fibrosis' often has atypical widely scattered spindle tumour cells in a densely collagenous background but does not merit additional treatment apart from excision. The marked cytological atypia that may occur in metastatic teratoma may be disconcerting but, again, the proper treatment is complete surgical excision rather than more chemotherapy. Glandular and sarcomatoid yolk sac tumours, which are almost exclusively seen after chemotherapy, resemble adenocarcinomas and sarcomas, respectively. Unlike de novo malignancies, they are mostly seen in sites expected for metastases.
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Affiliation(s)
- Thomas M Ulbright
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indiana University Health Pathology Laboratory, Indianapolis, IN, United States.
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Perspectives on testicular germ cell neoplasms. Hum Pathol 2017; 59:10-25. [DOI: 10.1016/j.humpath.2016.08.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/16/2022]
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Berney DM, Lu YJ, Shamash J, Idrees M. Postchemotherapy changes in testicular germ cell tumours: biology and morphology. Histopathology 2016; 70:26-39. [DOI: 10.1111/his.13078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel M Berney
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Yong-Jie Lu
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Jonathan Shamash
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Muhammad Idrees
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine and Indiana Pathology Institute; Indianapolis IN USA
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Testing testes: problems and recent advances in the diagnosis of testicular tumours and implications for treatment. Clin Oncol (R Coll Radiol) 2011; 24:30-8. [PMID: 21925852 DOI: 10.1016/j.clon.2011.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/14/2011] [Accepted: 07/05/2011] [Indexed: 11/22/2022]
Abstract
The low incidence of testicular tumours and the fact that they show an extremely high diversity means that they may be poorly understood. Knowledge of the range of tumours and the differences in treatment available is essential for appropriate management. The advent of cisplatin chemotherapy and the exquisite sensitivity of seminoma to radiotherapy have resulted in excellent cure rates. Nevertheless, research has continued unabated, particularly to understand the molecular basis of germ cell tumours and why certain tumours are recalcitrant to treatment. This overview is an attempt to demystify areas of confusion and highlight areas of current interest in testicular pathology and oncology.
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Abstract
PURPOSE OF REVIEW To discuss several important developments in testicular germ cell tumors in the past year. RECENT FINDINGS Genomic studies are examining gene expression as possible markers for disease relapse and chemotherapy resistance. Optimal treatment strategies for early-stage nonseminomatous tumors continue to evolve and patient compliance with posttreatment surveillance schedules remains problematic. Advanced and platinum-refractory disease states continue to be challenging entities in terms of optimizing therapy and outcome. SUMMARY Significant challenges remain for treatment of certain categories of testicular germ cell tumors. Treatment and surveillance paradigms continue to be defined and refined as research in these areas continues.
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Affiliation(s)
- Heather D Mannuel
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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