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Lobo J, Rodrigues Â, Henrique R, Christiansen A, Beyer J, Moch H, Bode PK. Morphological spectrum and molecular features of somatic malignant transformation in germ cell tumours. Histopathology 2022; 81:84-98. [PMID: 35438203 DOI: 10.1111/his.14667] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/20/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS Somatic malignant transformation (SMT) arising in germ cell tumours (GCTs) is an infrequent, but clinically relevant event. There is only limited knowledge on the morphological spectrum of SMT, and therapeutic management of these patients is poorly defined. In this work we revisit two consecutive case series (n=756) of GCTs. Clinicopathological data of SMT arising in GCT were determined, with focus on the histopathological spectrum, and molecular aspects were obtained by Fluorescence in situ Hybridization (FISH) and Next Generation Sequencing (NGS). METHODS AND RESULTS 30 male patients (28 primary testicular, 2 primary extragonadal) were included. These patients represent 4% of GCT patients diagnosed in two institutes (University Hospital Zurich and IPO Porto). The most common SMT were adenocarcinoma (n=8), embryonic-type neuroectodermal tumours (ENETs, n=8) and rhabdomyosarcoma (n=6), but a wide range of challenging morphologies were depicted, including low-grade neuroglial tumour, adenosquamous carcinoma, neuroblastoma and neuroendocrine carcinoma. SMT was found in 15 primary tumour samples and in 27 metastatic samples of these 30 patients, the latter showing poorer overall-survival. Adenocarcinoma occurred only in metastasis post-chemotherapy and in one primary retroperitoneal GCT with SMT, but not in GCT of the testis. 12p gains were identified by FISH in all cases. NGS results were available in 6 patients. Clinical trials and/or targeted treatments based on the molecular profile of SMT were recommended in 4 patients. CONCLUSIONS SMT arising in GCTs represents a diagnostic challenge and should be confirmed by a specialized uropathologist. NGS based treatment recommendations may improve outcome of these patients.
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Affiliation(s)
- João Lobo
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-, UP, ), Rua Jorge Viterbo Ferreira 228, 4050-513, Porto, Portugal
| | - Ângelo Rodrigues
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-, UP, ), Rua Jorge Viterbo Ferreira 228, 4050-513, Porto, Portugal
| | - Rui Henrique
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-, UP, ), Rua Jorge Viterbo Ferreira 228, 4050-513, Porto, Portugal
| | - Ailsa Christiansen
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH, 8091, Zurich, Switzerland
| | - Jörg Beyer
- Universitätsklinik für Medizinische Onkologie, Inselspital, Universitätsklinik der Universität Bern, Bern University, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH, 8091, Zurich, Switzerland.,Faculty of Medicine, University of Zurich, Rämistrasse 71, 8006, Zurich, Switzerland
| | - Peter Karl Bode
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Schmelzbergstrasse 12, CH, 8091, Zurich, Switzerland
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2
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Pham RL, Ray A, Margraf LR. Mixed Nonseminomatous Germ Cell Tumor with Rhabdomyosarcomatous Malignant Transformation in a Pediatric Patient. Indian J Med Paediatr Oncol 2021. [DOI: 10.4103/ijmpo.ijmpo_207_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractTesticular germ cell tumors (GCTs) are the most common malignancy in males aged 15–34. The transformation of GCTs into secondary somatic-type malignancies is rare, and the lack of clear treatment guidelines presents a clinical challenge for treating physicians, especially when chemosensitivities do not overlap. We present the case of a 15-year-old-male with a mixed nonseminomatous malignant GCT with an embryonal rhabdomyosarcoma component, which made up 60% of the primary tumor. He was successfully treated with surgical resection and chemotherapy. We highlight our experience in diagnosing and treating this tumor, and through literature review, suggest treatment guidelines for treating a pediatric patient with similar tumor presentation.
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Affiliation(s)
- Robin L Pham
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Anish Ray
- Cook Children's Medical Center, Fort Worth, TX, USA
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3
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Vanderstappen C, Denies E, Perdaens C, Vandendriessche H. Adult testiculair rhabdomyosarcoma, a rare tumour arising in a teratoma with somatic type malignancy: A case report. Urol Case Rep 2020; 33:101385. [PMID: 33102083 PMCID: PMC7574148 DOI: 10.1016/j.eucr.2020.101385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022] Open
Abstract
We describe a case of a 40 year old male who presented with a painless testicular mass, suspected for a testicular tumor. On microscopic examination, diagnosis of a testicular rhabdomyosarcoma was made, which is rare in an adult population.
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Affiliation(s)
| | - E Denies
- Department of Urology, AZ Jan Portaels, Vilvoorde, Belgium
| | - C Perdaens
- Department of Pathology, AZ Jan Portaels, Vilvoorde, Belgium
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4
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Testicular rhabdomyosarcoma after chemotherapy for metastatic germ cell tumors. Int Cancer Conf J 2019; 8:175-180. [PMID: 31559118 DOI: 10.1007/s13691-019-00378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022] Open
Abstract
A 36-year-old male was referred to our hospital with left scrotal swelling. Computed tomography revealed a massive tumor in his left scrotum. The tumor extended along the gonadal vein extraperitoneally forming a massive tumor. Pathological examination showed a mixed-type germ cell tumor. Despite several chemotherapeutic treatments, the tumor continued to grow, and the patient died 28 months later after his first presentation at our institution. Autopsy revealed that the tumor comprised rhabdomyosarcoma and mature teratoma. We could not find useful tumor markers to facilitate the diagnosis of rhabdomyosarcoma. However, we recommend rebiopsy or palliative operation as options for re-diagnosis in case of resistant germ cell tumor. Here, we present a case of testicular tumor that exhibited different pathological examination results before and after treatment.
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5
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Washino S, Konishi T, Saito K, Ohshima M, Nakamura Y, Miyagawa T. Two cases of somatic-type malignancy as a very late relapse of testicular cancer successfully managed by surgical resection. J Surg Case Rep 2017; 2017:rjx233. [PMID: 29218213 PMCID: PMC5710656 DOI: 10.1093/jscr/rjx233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/03/2017] [Accepted: 11/23/2017] [Indexed: 11/14/2022] Open
Abstract
A late-relapse germ cell tumor might contain malignant non-germ cell tumors, known as 'somatic-type malignancy (SM)'. The development of a secondary SM is rare, and this phenomenon remains poorly understood. Case 1 developed lung metastasis 13 years after chemotherapy followed by retroperitoneal lymph node dissection for stage IIA non-seminoma. The tumor increased in size after chemotherapy. The patient underwent a pneumonectomy. Pathology revealed an adenocarcinoma with immature teratoma. The patient has experienced no relapse for 9 years. Case 2 developed a pelvic tumor after 10 years of surveillance for stage I seminoma. The tumor increased in size after chemotherapy. The patient underwent pelvic tumor resection with cystectomy. Pathology revealed a mature teratoma with SMs consisting of sarcoma and adenocarcinoma. The patient has experienced no relapse for 6 months. Surgical resection played a major role in the treatment of very late-relapse germ cell tumors with SM.
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Affiliation(s)
- Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Tsuzumi Konishi
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Kimitoshi Saito
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Masashi Ohshima
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Yuhki Nakamura
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan
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6
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Tarnowski M, Tkacz M, Zgutka K, Bujak J, Kopytko P, Pawlik A. Picropodophyllin (PPP) is a potent rhabdomyosarcoma growth inhibitor both in vitro and in vivo. BMC Cancer 2017; 17:532. [PMID: 28793874 PMCID: PMC5550998 DOI: 10.1186/s12885-017-3495-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/23/2017] [Indexed: 12/02/2022] Open
Abstract
Background Insulin-like growth factors and insulin are important factors promoting cancer growth and metastasis. The molecules act through IGF1 (IGF1R) and insulin (InsR) receptors. Rhambodmyosarcomas (RMS) overproduce IGF2 – a potent ligand for IGF1R and, at the same time, highly express IGF1 receptor. The purpose of the study was to evaluate possible application of picropodophyllin (PPP) – a potent IGF1R inhibitor. Methods In our study we used a number of in vitro assays showing influence of IGF1R blockage on RMS cell lines (both ARMS and ERMS) proliferation, migration, adhesion, cell cycling and signal transduction pathways. Additionally, we tested possible concomitant application of PPP with commonly used chemotherapeutics (vincristine, actinomycin-D and cisplatin). Moreover, we performed an in vivo study where PPP was injected intraperitoneally into RMS tumor bearing SCID mice. Results We observed that PPP strongly inhibits RMS proliferation, chemotaxis and adhesion. What is more, application of the IGF1R inhibitor attenuates MAPK phosphorylation and cause cell cycle arrest in G2/M phase. PPP increases sensitivity of RMS cell lines to chemotherapy, specifically to vincristine and cisplatin. In our in vivo studies we noted that mice treated with PPP grew smaller tumors and displayed significantly decreased seeding into bone marrow. Conclusions The cyclolignan PPP effectively inhibits RMS tumor proliferation and metastasis in vitro and in an animal model. Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3495-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maciej Tarnowski
- Department of Physiology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland.
| | - Marta Tkacz
- Department of Physiology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Katarzyna Zgutka
- Department of Physiology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Joanna Bujak
- Department of Physiology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Patrycja Kopytko
- Department of Physiology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
| | - Andrzej Pawlik
- Department of Physiology, Pomeranian Medical University, al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland
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7
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Cabral FC, Krajewski KM, Rosenthal MH, Hirsch MS, Howard SA. Teratoma with malignant transformation: report of three cases and review of the literature. Clin Imaging 2014; 38:589-93. [PMID: 24908364 DOI: 10.1016/j.clinimag.2014.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/20/2014] [Accepted: 04/18/2014] [Indexed: 11/27/2022]
Abstract
Teratoma with malignant transformation is an uncommon, very aggressive germ cell tumor that has undergone transformation of a somatic teratomatous component to a histologic type identical to a somatic malignancy. We review the clinical presentation, imaging appearances, and prognosis of this entity and highlight its aggressive behavior by reporting on three patients with metastatic testicular nonseminomatous germ cell tumor with histologically proved malignant transformation.
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Affiliation(s)
- Fernanda C Cabral
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
| | - Katherine M Krajewski
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michael H Rosenthal
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michelle S Hirsch
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stephanie A Howard
- Department of Imaging, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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8
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Zeh N, Wild PJ, Bode PK, Kristiansen G, Moch H, Sulser T, Hermanns T. Retroperitoneal teratoma with somatic malignant transformation: a papillary renal cell carcinoma in a testicular germ cell tumour metastasis following platinum-based chemotherapy. BMC Urol 2013; 13:9. [PMID: 23402579 PMCID: PMC3577457 DOI: 10.1186/1471-2490-13-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 02/08/2013] [Indexed: 11/19/2022] Open
Abstract
Background Malignant transformation describes the phenomenon in which a somatic component of a germ cell teratoma undergoes malignant differentiation. A variety of different types of sarcoma and carcinoma, all non-germ cell, have been described as a result of malignant transformation. Case presentation A 33-year-old man presented with a left testicular mass and elevated tumour markers. Staging investigations revealed retroperitoneal lymphadenopathy with obstruction of the left ureter and distant metastases. Histopathology from the left radical orchiectomy showed a mixed germ cell tumour (Stage III, poor prognosis). The ureter was stented and four cycles of cisplatin, etoposide and bleomycin chemotherapy administered. After initial remission, the patient recurred four years later with a large retroperitoneal mass involving the renal vessels and the left ureter. Left retroperitoneal lymph node dissection with en-bloc resection of the left kidney was performed. Histopathology revealed a germ cell tumour metastasis consisting mainly of mature teratoma. Additionally, within the teratoma a papillary renal cell carcinoma was found. The diagnosis was supported by immunohistochemistry showing positivity for AMACR, CD10 and focal expression of RCC and CK7. There was no radiological or histo-pathological evidence of a primary renal cell cancer. Conclusions To the best of our knowledge, malignant transformation into a papillary renal cell carcinoma has not been reported in a testicular germ cell tumour metastasis following platinum-based chemotherapy. This histological diagnosis might have implications for potential future therapies. In the case of disease recurrence, renal cell cancer as origin of the recurrent tumour has to be excluded because renal cell carcinoma metastases would not respond well to the classical germ cell tumour chemotherapy regimens.
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Affiliation(s)
- Nina Zeh
- Department of Urology, University Hospital Zürich, Zürich, Switzerland
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9
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Teratoma with malignant transformation: a case report with pathological, cytogenetic, and immunohistochemistry analysis. Sarcoma 2011; 2011:450743. [PMID: 21776193 PMCID: PMC3138084 DOI: 10.1155/2011/450743] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 04/20/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Teratoma with malignant transformation (TMT) is rare and most commonly encountered in adult patient with germ cell tumor (GCT). Method. We report a rare case of testicular teratoma with metastatic TMT/embryonal rhabdomyosarcoma (ERMS). A 44-year-old man underwent right orchiectomy which revealed a malignant teratoma, he subsequently had right pneumonectomy with two pulmonary masses containing a high-grade embryonal rhabdomyosarcoma. The patient developed liver metastasis three months after initial diagnosis. He was treated with a chemotherapy regimen with vincristine, dactinomycin, and cyclophosphamide (VAC) alternating with vincristine and irinotecan (VI) with complete resolution of his liver lesion. The tumors were examined with a battery of cytogenetic, immunohistochemical, and molecular assays. Results. The malignant cells were immunohistochemically positive for desmin, myogenin, and MyoD1. Molecular cytogenetics of embryonal rhabdomyosarcoma tissue revealed the presence of i(12p). The tumor expressed high level of TOPO2A, TOPO1, MRP1, MGMT, BCRP, ERCC1, RRM1, and TS. Conclusion. The activity of topoisomerase inhibitors and the potential usefulness of topoisomerase expression as biomarkers should be further tested in aprospective study.
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10
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Voss MH, Feldman DR, Bosl GJ, Motzer RJ. A review of second-line chemotherapy and prognostic models for disseminated germ cell tumors. Hematol Oncol Clin North Am 2011; 25:557-76, viii -ix. [PMID: 21570609 DOI: 10.1016/j.hoc.2011.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite an excellent prognosis even for patients with disseminated disease, about 20% to 30% of men with advanced germ cell tumors are refractory to first-line chemotherapy or experience disease recurrence after an initial remission with such treatment. Many of these are cured with conventional dose cisplatin/ifosfamide-based regimen or high-dose chemotherapy with stem cell rescue. Controversy exists regarding the optimal choice between these 2 second-line approaches, and available data for each is reviewed here. Clinical factors can help prognosticate patients, and recently an international effort developed a prognostic model for the second-line setting that can be universally applied in future studies.
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Affiliation(s)
- Martin H Voss
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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11
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Peinemann F, Kröger N, Bartel C, Grouven U, Pittler M, Erttmann R, Kulig M. High-dose chemotherapy followed by autologous stem cell transplantation for metastatic rhabdomyosarcoma--a systematic review. PLoS One 2011; 6:e17127. [PMID: 21373200 PMCID: PMC3044147 DOI: 10.1371/journal.pone.0017127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 01/21/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients with metastatic rhabdomyosarcoma (RMS) have a poor prognosis. The aim of this systematic review is to investigate whether high-dose chemotherapy (HDCT) followed by autologous hematopoietic stem cell transplantation (HSCT) in patients with metastatic RMS has additional benefit or harm compared to standard chemotherapy. METHODS Systematic literature searches were performed in MEDLINE, EMBASE, and The Cochrane Library. All databases were searched from inception to February 2010. PubMed was searched in June 2010 for a last update. In addition to randomized and non-randomized controlled trials, case series and case reports were included to complement results from scant data. The primary outcome was overall survival. A meta-analysis was performed using the hazard ratio as primary effect measure, which was estimated from Cox proportional hazard models or from summary statistics of Kaplan Meier product-limit estimations. RESULTS A total of 40 studies with 287 transplant patients with metastatic RMS (age range 0 to 32 years) were included in the assessment. We identified 3 non-randomized controlled trials. The 3-year overall survival ranged from 22% to 53% in the transplant groups vs. 18% to 55% in the control groups. Meta-analysis on overall survival in controlled trials showed no difference between treatments. Result of meta-analysis of pooled individual survival data of case series and case reports, and results from uncontrolled studies with aggregate data were in the range of those from controlled data. The risk of bias was high in all studies due to methodological flaws. CONCLUSIONS HDCT followed by autologous HSCT in patients with RMS remains an experimental treatment. At present, it does not appear justifiable to use this treatment except in appropriately designed controlled trials.
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Affiliation(s)
- Frank Peinemann
- Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
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12
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Peinemann F, Smith LA, Kromp M, Bartel C, Kröger N, Kulig M. Autologous hematopoietic stem cell transplantation following high-dose chemotherapy for non-rhabdomyosarcoma soft tissue sarcomas. Cochrane Database Syst Rev 2011:CD008216. [PMID: 21328307 DOI: 10.1002/14651858.cd008216.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Soft tissue sarcomas (STS) are a highly heterogeneous group of rare malignant solid tumors. Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) comprise all STS except rhabdomyosarcoma. In patients with advanced local or metastatic disease, autologous hematopoietic stem cell transplantation (HSCT) applied after high-dose chemotherapy (HDCT) is a planned rescue therapy for HDCT-related severe hematologic toxicity. OBJECTIVES To assess the effectiveness and safety of HDCT followed by autologous HSCT for all stages of soft tissue sarcomas in children and adults. SEARCH STRATEGY We searched the electronic databases CENTRAL (The Cochrane Library 2010, Issue 2), MEDLINE and EMBASE (February 2010). Online trial registers, congress abstracts and reference lists of reviews were searched and expert panels and authors were contacted. SELECTION CRITERIA Terms representing STS and autologous HSCT were required in the title, abstract or keywords. In studies with aggregated data, participants with NRSTS and autologous HSCT had to constitute at least 80% of the data. Comparative non-randomized studies were included because randomized controlled trials (RCTs) were not expected. Case series and case reports were considered for an additional descriptive analysis. DATA COLLECTION AND ANALYSIS Study data were recorded by two review authors independently. For studies with no comparator group, we synthesised results for studies reporting aggregate data and conducted a pooled analysis of individual participant data using the Kaplan-Meyer method. The primary outcomes were overall survival (OS) and treatment-related mortality (TRM). MAIN RESULTS We included 54 studies, from 467 full texts articles screened (11.5%), reporting on 177 participants that received HSCT and 69 participants that received standard care. Only one study reported comparative data. In the one comparative study, OS at two years after HSCT was estimated as statistically significantly higher (62.3%) compared with participants that received standard care (23.2%). In a single-arm study, the OS two years after HSCT was reported as 20%. In a pooled analysis of the individual data of 54 participants, OS at two years was estimated as 49% (95% CI 34% to 64%). Data on TRM, secondary neoplasia and severe toxicity grade 3 to 4 after transplantation were sparse. All 54 studies had a high risk of bias. AUTHORS' CONCLUSIONS Due to a lack of comparative studies, it is unclear whether participants with NRSTS have improved survival from autologous HSCT following HDCT. Owing to this current gap in knowledge, at present HDCT and autologous HSCT for NRSTS should only be used within controlled trials.
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Affiliation(s)
- Frank Peinemann
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care (IQWiG), Dillenburger Str. 27, Cologne, Germany, 51105
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13
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Stamatiou K, Papadopoulos P, Perlepes G, Galariotis N, Olympitis M, Moschouris H, Vasilakaki T. Mixed germ cell tumor of the testicle with ravdomuosarcomatous component: a case report. CASES JOURNAL 2009; 2:9299. [PMID: 20062623 PMCID: PMC2803963 DOI: 10.1186/1757-1626-2-9299] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Accepted: 12/10/2009] [Indexed: 11/19/2022]
Abstract
Introduction Testicular tumors can be classified as seminomatous and non-seminomatous germ-cell tumor (NSGCT) types. Mixed germ cell tumors contain more than one germ cell component and are much more common than any of the pure histologic forms representing 32%-60% of all germ cell tumors. The composition of these tumors varies. Here we present a rare case of a mixed germ cell tumor composed of seminoma, Yolk sack tumor and teratoma containing a sarcoma component of somatic type malignancy. Case presentation A 32-year-old Caucasian male presented with history of right-sided scrotal swelling since 6 months. Backache was present since 2 months and a history of right epididimitis was also present since 8 months. Alpha-Fetoprotein, beta-HCG and LDH values were found abmormal. USG of the scrotum revealed a large right testis swelling characterized by scarce cystic elements and calcifications. CT scan of the abdomen showed nodular metastasis involving the interaortocaval, precaval, and right para-aortic lymph nodes. The block of enlarged lymph nodes infiltrated the psoas muscle. The patient underwent right-sided high orchidectomy and was given chemotherapy of the BEP regimen. After the 2nd cycle the patient discontinued the chemotherapy and when he came for follow-up after a gap of 3 months, despite the normalisation in tumor markers values, the retroperitoneal mass was relapsed. CT scan of the chest showed multiple lung metastases. Conclusion More than 50% of germ-cell tumors include more than 2 basic germ-cell tumor types, with the exception of spermatocytic seminoma. About 90% of the patients with nonseminomatous tumors can achieve complete cure with aggressive chemotherapy and most of them can be cured. Although prognosis of testicular tumors depends largely on clinical stage, histological type and adhesion to the treatment influence the prognosis as well.
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14
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KORSKI KONSTANTY, BREBOROWICZ DANUTA, FILAS VIOLETTA, BREBOROWICZ JAN, GRYGALEWICZ BEATA, PIENKOWSKA-GRELA BARBARA. A case of primary testicular germ cell tumor with rhabdomyosarcoma metastases as an example of applying the FISH method to diagnostic pathology. APMIS 2007; 115:1296-301. [DOI: 10.1111/j.1600-0643.2007.00582.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Sumerauer D, Vicha A, Zuntova A, Stejskalova E, Krskova L, Kabickova E, Kodet R, Eckschlager T. Teratoma in an adolescent with malignant transformation into embryonal rhabdomyosarcoma: case report. J Pediatr Hematol Oncol 2006; 28:688-92. [PMID: 17023832 DOI: 10.1097/01.mph.0000212992.72059.eb] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The somatic type tumors are occasionally found in nonseminomatous germ cell tumors in men. These malignancies are presumed to arise from malignant transformation (MT) of teratoma or by differentiation of totipotential germ cell. OBSERVATION A case of MT of germ cell tumor in 17-year-old male into embryonal rhabdomyosarcoma is described. The histopathologic diagnosis was that of embryonal rhabdomyosarcoma in which no germ cell elements were found. The germ cell origin of transformed histology is supported by cytogenetic analysis (isochromosome 12p), and elevated alpha(1)-fetoprotein. Despite intensive therapy the patient died. CONCLUSIONS MT of teratoma is rare entity with poor prognosis.
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MESH Headings
- Adolescent
- Cell Transformation, Neoplastic/genetics
- Chromosome Aberrations
- Chromosomes, Human, Pair 12/genetics
- Cytogenetic Analysis
- Fatal Outcome
- Humans
- Immunohistochemistry
- Lung Neoplasms/diagnosis
- Lung Neoplasms/secondary
- Lymphatic Metastasis
- Male
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/genetics
- Mediastinal Neoplasms/therapy
- Neoplasm, Residual
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/therapy
- Rhabdomyosarcoma, Embryonal/diagnosis
- Rhabdomyosarcoma, Embryonal/genetics
- Rhabdomyosarcoma, Embryonal/therapy
- Teratoma/diagnosis
- Teratoma/genetics
- Teratoma/therapy
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Affiliation(s)
- David Sumerauer
- Department of Pediatric Hematology and Oncology, Charles University, Second Medical School, University Hospital Motol, Prague, Czech Republic.
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Cotta CV, Konoplev S, Medeiros LJ, Bueso-Ramos CE. Metastatic tumors in bone marrow: histopathology and advances in the biology of the tumor cells and bone marrow environment. Ann Diagn Pathol 2006; 10:169-92. [PMID: 16730315 DOI: 10.1016/j.anndiagpath.2006.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The nonhematopoietic tumors most often diagnosed in the bone marrow are metastatic. Currently, accurate diagnosis of tumor metastasis requires integration of the clinical findings; morphological features; and results of immunohistochemical stains, cytogenetics, and molecular studies. This review focuses on a practical approach to the diagnosis of metastatic tumors in the bone marrow according to current standards of practice and discusses recent advances in understanding of tumor metastasis and the interaction between tumors and the bone marrow environment.
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Affiliation(s)
- Claudiu V Cotta
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA
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17
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Fountas KN, Donner RS, Nikolakakos LG, Feltes CH, Karampelas I, Robinson JS. Adult paravertebral pleomorphic rhabdomyosarcoma infiltrating diffusely the whole spinal axis. J Neurosurg Spine 2005; 2:344-8. [PMID: 15796361 DOI: 10.3171/spi.2005.2.3.0344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ The authors report a unique case of diffuse spinal metastatic disease due to a pleomorphic rhabdomyosarcoma (RMS) in an adult. In additon to its overall rarity, peculiar characteristics of the particular tumor included its site of origin, demonstrated radiologically as the lumbar paravertebral musculature (psoas muscle) and the transcanalicular spread into the vertebral canal, resulting in thecal compression at multiple levels. The salient clinicopathological characteristics of RMS, as they related particularly to the spine, are subsequently discussed and a short review of the major therapeutic modalities for these tumors is offered.
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Affiliation(s)
- Kostas N Fountas
- Department of Neurosurgery, The Medical Center of Central Georgia, Mercer University School of Medicine, Macon, Georgia, USA.
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Donadio AC, Motzer RJ, Bajorin DF, Kantoff PW, Sheinfeld J, Houldsworth J, Chaganti RSK, Bosl GJ. Chemotherapy for Teratoma With Malignant Transformation. J Clin Oncol 2003; 21:4285-91. [PMID: 14645417 DOI: 10.1200/jco.2003.01.019] [Citation(s) in RCA: 183] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Teratoma with malignant transformation (MT) is a well-described entity that refers to the MT of a somatic teratomatous component in a germ cell tumor (GCT) to a histology that is identical to a somatic malignancy (eg, rhabdomyosarcoma [RMS]). Surgical resection has been the mainstay of therapy for localized transformed disease because these tumors are thought to be resistant to standard treatment. We report that chemotherapy has a role in selected patients with MT, determined by cell type. Patients and Methods: Chemotherapy was administered to 12 patients with MT of GCT limited to a single cell type (two patients with primitive neuroectodermal tumors, five with undifferentiated RMS, one with anaplastic small-cell tumor, two with adenocarcinoma, and two with leukemia); 10 patients had measurable disease. GCT origin was confirmed by molecular cytogenetics in five patients. Each patient received chemotherapy regimens based on the specific malignant cell observed in the transformed histology. Results: Seven patients with measurable disease achieved a partial response, with the duration of response ranging between 1 month and 7 years. Three of those patients are alive. Three patients did not respond to treatment, and all of those patients died as a result of their disease. Conclusion: Chemotherapy for MT limited to a single cell type may result in major responses and long-term survival in selected patients. Local therapy after chemotherapy is an important component of treatment to achieve maximum response.
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Affiliation(s)
- Alessia C Donadio
- Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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