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Cao ZL, Lian BJ, Chen WY, Fang XD, Jin HY, Zhang K, Qi XP. Diagnosis and treatment of primary seminoma of the prostate: A case report and review of literature. World J Clin Cases 2023; 11:2267-2275. [PMID: 37122514 PMCID: PMC10131029 DOI: 10.12998/wjcc.v11.i10.2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Primary seminoma of the prostate (PSP) is a rare type of extragonadal germ cell tumour that is easily misdiagnosed, owing to the lack of specific clinical features. It is therefore necessary for clinicians to work toward improving the accuracy of PSP diagnosis.
CASE SUMMARY A 59-year-old male patient presenting with acute urinary retention was admitted to a local hospital. A misdiagnosis of benign prostatic hyperplasia led to an improper prostatectomy. Histopathology revealed PSP invading the bladder neck and bilateral seminal vesicles. Further radiotherapy treatment for the local lesion was performed, and the patient had a disease-free survival period of 96 mo. This case was analysed along with 13 other cases of PSP identified from the literature. Only four of the cases (28.6%) were initially confirmed by prostate biopsy. In these cases, imaging examinations showed an enlarged prostate (range 6-11 cm) involving the bladder neck (13/14). Of the 14 total cases, 11 (78.6%) presented typical pure seminoma cell features, staining strongly positive for placental alkaline phosphatase, CD117, and OCT4. The median age at diagnosis was 51 (range 27-59) years, and patients had a median progression-free survival time of 48 (range 6-156) mo after treatment by cisplatin-based chemotherapy combined with surgery or radiotherapy. The remaining three were cases of mixed embryonal tumours with focal seminoma, which had clinical features similar to those of pure PSP, in addition that they also had elevated serum alpha-fetoprotein, beta-human chorionic gonadotropin, and lactose dehydrogenase.
CONCLUSION PSP should be considered in patients younger than 60 years with an enlarged prostate invading the bladder neck. Further prostate biopsies may aid in proper PSP diagnosis. Cisplatin-based chemotherapy is still the main primary therapy for PSP.
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Affiliation(s)
- Zhi-Lie Cao
- Department of Urology, The 903rd PLA Hospital, Hangzhou Medical College, Hangzhou 310004, Zhejiang Province, China
| | - Bi-Jun Lian
- Department of Urology, The 903rd PLA Hospital, Hangzhou Medical College, Hangzhou 310004, Zhejiang Province, China
| | - Wei-Ying Chen
- Department of Urology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318050, Zhejiang Province, China
| | - Xu-Dong Fang
- Department of Urology, The 903rd PLA Hospital, Hangzhou Medical College, Hangzhou 310004, Zhejiang Province, China
| | - Hang-Yang Jin
- Department of Urology, The 903rd PLA Hospital, Hangzhou Medical College, Hangzhou 310004, Zhejiang Province, China
| | - Ke Zhang
- Center for Radiation Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou 310002, Zhejiang Province, China
| | - Xiao-Ping Qi
- Department of Urology, The 903rd PLA Hospital, Hangzhou Medical College, Hangzhou 310004, Zhejiang Province, China
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Rojas AP, Vo DV, Mwangi L, Rehman S, Peiris AN. Oncologic manifestations of Klinefelter syndrome. Hormones (Athens) 2020; 19:497-504. [PMID: 33000452 DOI: 10.1007/s42000-020-00241-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
Klinefelter syndrome (47,XXY) has a prevalence of approximately 1 in 500 males. It is a condition characterized by an extra X chromosome and is an underdiagnosed clinical entity. Inactivation of genes enables their escape from regulatory mechanisms, which can result in such classic physical manifestations as hypogonadism, gynecomastia, infertility, and various hormonal and physical abnormalities. While the endocrine manifestations of 47,XXY are well-known, the oncologic manifestations have received less attention. An association between cancer and 47,XXY has not as yet been clearly defined, with variability noted in the prevalence of different malignancies in 47,XXY patients. The mechanisms underlying these altered oncologic risks are still under debate. Some of the proposed explanations include hormone imbalance, developmental malfunctions, and failed DNA repair mechanisms. However, the recognition of the oncological associations linked to 47,XXY could be helpful. Screening measures in certain malignancies may enable an earlier diagnosis of 47,XXY and the implementation of more customized care in 47,XXY and the mosaic variants.. The data for this review was compiled from relevant PubMed articles published within the last three decades and organized based on cancer type.
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Affiliation(s)
- Alexsandra P Rojas
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
- , Lubbock, TX, USA.
| | - Diana V Vo
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Lance Mwangi
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Shabnam Rehman
- Oncology Division of Internal medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Alan N Peiris
- Clinical Research Institute and Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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3
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Feroz SH, Sistare MW, Jabbour JI, Masri M, Dominguez C. Unusual Chemotherapeutic Resistant Testicular Embryonal Germ Cell Tumor with Widespread Metastasis in a Case of Klinefelter Syndrome: A Case Report. Cureus 2020; 12:e7637. [PMID: 32399369 PMCID: PMC7213769 DOI: 10.7759/cureus.7637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cryptorchidism is an undeniable risk factor for testicular germ cell tumors (TGCTs) and is also commonly associated with Klinefelter syndrome (KS) patients. Embryonal cell carcinoma usually shows strong expression of CD30 and OCT3/4, with patchy staining of PLAP1. Most patients with nonseminomatous GCTs (NSGCTs) can achieve total remission with proactive chemotherapy, and most can be cured. We present an extremely rare case of a testicular embryonal germ cell tumor that is atypical in its gene expression and response to chemotherapy treatment. A 71-year-old male patient presented in July 2019 with abdominal pain of unknown duration, weight loss for one year, and recent history of altered bowel habits. His past medical history is significant for KS and congenital unilateral cryptorchidism. Physical examination yielded mild abdominal distention and bilateral inguinal lymphadenopathy. Imaging revealed a posterior mediastinal mass and large retroperitoneal masses. The above features, in addition to the history of KS and unilateral cryptorchidism, were highly suggestive of a testicular retroperitoneal germ cell tumor. Serologic studies revealed elevated lactate dehydrogenase (LDH) while other tumor markers were normal. Excisional biopsy of inguinal lymph nodes revealed poorly differentiated embryonal cell carcinoma with strong expression of SALL4, a rare expression of OCT 3/4, and the absence of expression of CD30 and placental alkaline phosphatase (PLAP). The patient was given four cycles of bleomycin, etoposide and platinum (BEP) chemotherapy, as is the standard chemotherapy regimen for these tumors, without any significant change in the size of the masses or lymph nodes. Unfortunately, there are no specific guidelines when it comes to the management of KS patients with testicular GCTs (embryonal cell carcinoma) with aberrant histological markers and normal serum tumor markers. These findings in combination with chemotherapeutic resistance indicate a need for more specific treatment modalities and follow-up for unusual testicular embryonal GCTs in KS patients.
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Affiliation(s)
| | | | | | - Mohammad Masri
- Surgical Oncology, Larkin Community Hospital, Miami, USA.,General Surgery, University of Miami, Miami, USA
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4
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Accardo G, Vallone G, Esposito D, Barbato F, Renzullo A, Conzo G, Docimo G, Esposito K, Pasquali D. Testicular parenchymal abnormalities in Klinefelter syndrome: a question of cancer? Examination of 40 consecutive patients. Asian J Androl 2015; 17:154-8. [PMID: 25130577 PMCID: PMC4291860 DOI: 10.4103/1008-682x.128514] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 11/23/2013] [Accepted: 01/12/2014] [Indexed: 11/30/2022] Open
Abstract
Klinefelter syndrome (KS) is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology generally; nevertheless it seems to be low. We evaluated the need for imaging and serum tumor markers for testicular cancer screening in KS. Participants were 40 consecutive KS patients, enrolled from December 2009 to January 2013. Lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin subunit (β-HCG) serum levels assays and testicular ultrasound (US) with color Doppler, were carried out at study entry, after 6 months and every year for 3 years. Abdominal magnetic resonance (MR) was performed in KS when testicular US showed micro-calcifications, testicular nodules and cysts. Nearly 62% of the KS had regular testicular echotexture, 37.5% showed an irregular echotexture and 17.5% had micro-calcifications and cysts. Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules <1 cm, but none had nodules >1 cm. MR ruled out the diagnosis of cancer in all KS with testicular micro calcifications, nodules and cysts. No significant variations in LDH, AFP, and β-HCG levels and in US pattern have been detected during follow-up. We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found. We did not find testicular cancer in KS, and testicular US, tumor markers and MR were, in selected cases, useful tools for correctly discriminating benign from malignant lesions.
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Affiliation(s)
- Giacomo Accardo
- Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Naples, Italy
| | - Gianfranco Vallone
- Department of Biomorphological and Functional Sciences, Second University of Naples, Naples, Italy
| | - Daniela Esposito
- Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Naples, Italy
| | - Filomena Barbato
- Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Naples, Italy
| | - Andrea Renzullo
- Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Naples, Italy
| | - Giovanni Conzo
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Giovanni Docimo
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Katherine Esposito
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy
| | - Daniela Pasquali
- Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Naples, Italy
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Abstract
We report a case of a mediastinal seminoma occurring 19 months after the resolution of a pineal germinoma. A 15-year-old boy with headaches and visual changes was diagnosed with a pineal germinoma by biopsy and mildly elevated beta-human chorionic gonadatropin (beta-HCG) in serum and cerebral spinal fluid. Radiation therapy leads to the resolution of his pineal germinoma and normalization of the beta-HCG. A mediastinal seminoma (germinoma) was diagnosed nearly 2 years later because of rising serum beta-HCG. There was no evidence of recurrent central nervous system disease. The patient underwent systemic chemotherapy with the complete resolution of the mediastinal seminoma.
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6
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Barrett SV, Vasey PA, White JD. Management of Intra-abdominal Seminoma Associated with Cognitive Impairment and Undiagnosed Congenital Heart Disease. Clin Oncol (R Coll Radiol) 2008; 20:90-1. [PMID: 17825541 DOI: 10.1016/j.clon.2007.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 08/06/2007] [Indexed: 10/22/2022]
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7
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Phillips N, Jequier AM. Early testicular cancer: a problem in an infertility clinic. Reprod Biomed Online 2007; 15:520-5. [DOI: 10.1016/s1472-6483(10)60383-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Brandes BM, Mesrobian HGO. Evaluation and management of genital anomalies in two patients with Klinefelter syndrome and review of literature. Urology 2005; 65:976-9. [PMID: 15882735 DOI: 10.1016/j.urology.2004.12.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 11/30/2004] [Accepted: 12/20/2004] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To present the evaluation and management of cryptorchidism and varicocele in patients with Klinefelter syndrome and review the literature. Recent advances in reproductive medicine have resulted in fertility in patients with Klinefelter syndrome. However, cryptorchidism and varicocele can affect the fertility potential on their own. METHODS We present 2 cases and review the literature with an emphasis on the fertility potential. RESULTS Germ cells were present in the testicular biopsy of an infant with cryptorchidism but not in the adolescent with a varicocele. The latter biopsy showed tubular sclerosis. CONCLUSIONS The fertility potential of patients with Klinefelter syndrome and cryptorchidism may be preserved or enhanced by an early orchiopexy. However, the potential benefit of ligation of internal spermatic veins in patients with Klinefelter syndrome and a varicocele warrants further study. Cryopreservation should be considered early in adolescence or adulthood as germ cells become depleted at an accelerated rate after puberty.
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Affiliation(s)
- Blanca M Brandes
- Department of Urology, Medical College of Wisconsin and Children's Hospital of Wisconsin, Milwaukee, Wisconsin 53226, USA
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9
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Inai H, Kawai K, Morishita Y, Nagata M, Noguchi M, Akaza H. Retroperitoneal extragonadal germ cell tumor in a patient with Klinefelter's syndrome. Int J Urol 2005; 12:765-7. [PMID: 16174054 DOI: 10.1111/j.1442-2042.2005.01151.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 22-year-old man was diagnosed with retroperitoneal seminoma associated with Klinefelter's syndrome. The tumor was 14 x 12 cm in size and surrounded the superior mesenteric artery. He received induction chemotherapy with bleomycin, etoposide and cisplatin (BEP) followed by salvage chemotherapy with paclitaxel, ifosfamide and cisplatin (TIP). The tumor considerably decreased in size and remains as a poorly defined plaque. At the time of writing, he is being followed closely and is free from progression.
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Affiliation(s)
- Hiromu Inai
- Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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10
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Tsutsumi Y, Tanaka J, Minami H, Musashi M, Fukushima A, Ehira N, Kanamori H, Yamato H, Sasaki J, Funaki C, Hasegawa S, Obara S, Ogura N, Asaka M, Imamura M, Masauzi N. Acute biphenotypic leukemia and an acquired X chromosome. ACTA ACUST UNITED AC 2005; 157:94-5. [PMID: 15676158 DOI: 10.1016/j.cancergencyto.2004.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lutke Holzik MF, Sijmons RH, Sleijfer DT, Sonneveld DJA, Hoekstra-Weebers JEHM, van Echten-Arends J, Hoekstra HJ. Syndromic aspects of testicular carcinoma. Cancer 2003; 97:984-92. [PMID: 12569597 DOI: 10.1002/cncr.11155] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In patients with hereditary or constitutional chromosomal anomalies, testicular carcinoma can develop sporadically or on the basis of an underlying hereditary genetic defect. Greater knowledge of these genetic defects would provide more insight into the molecular pathways that lead to testicular carcinoma. To the authors' knowledge, little attention has been paid to date to the comorbid occurrence of testicular carcinoma in patients with hereditary disorders or constitutional chromosomal anomalies. METHODS The authors performed a review of the literature. RESULTS Twenty-five different hereditary disorders or constitutional chromosomal anomalies have been reported in patients who developed seminomatous or nonseminomatous testicular carcinoma. CONCLUSIONS Although most of these malignancies were too rare to enable the detection of statistically significant correlations between the chromosomal/hereditary disorder and the testicular tumor, it was striking that many of the patients had also other urogenital abnormalities. Susceptibility to urogenital abnormalities seems to disrupt normal urogenital differentiation and suggests a correlation with testicular dysgenesis and, thus, also with testicular carcinoma. Other evidence of causal involvement has been found in the field of tumor cytogenetics. Some of the genes responsible for hereditary disorders have been mapped to regions that are of interest in the development of sporadic testicular carcinoma. Molecular studies on candidate genes will be required to provide definite answers. Completion of the human gene map and the availability of advanced gene arrays and bioinformatics are expected to greatly facilitate further exploration of the role of hereditary genetic defects in testicular carcinoma.
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Affiliation(s)
- Martijn F Lutke Holzik
- Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands
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