The malignant potential of postchemotherapy residual mature teratoma for disseminated nonseminomatous testicular tumors

Scrotal recurrence of germ cell tumour in a non-violated scrotum

Testicular cancer is the most common cancer diagnosis in males aged 15-30 years. For over a century, radical inguinal orchiectomy has been the standard of care for initial treatment of testicular cancer. This approach is preferred over trans-scrotal interventions, in an effort to avoid tumour seeding, spermatic cord invasion, and disturbance to lymphatic drainage. Scrotal violation is defined as any trans-scrotal intervention that may impact spread of disease in testicular cancer, including scrotal orchiectomy, fine-needle aspiration, and testicular biopsy. Studies have shown statistically significant differences in local recurrence rates between patients who undergo the standard inguinal surgical approach and cases with scrotal violation. Over 95% of testicular cancers are curative, often with surgery alone. Recurrence of disease is divided into two categories: local and distant sites. Local recurrence of testicular cancer involves the scrotal and inguinal regions, including superficial inguinal lymph nodes. More commonly, local recurrence is seen in cases of testicular cancer with scrotal violation. We describe a case of local recurrence of testicular cancer in a non-violated scrotum, a finding that has not been previously reported in the literature.

Testis risk and prognostic factors. The pathologist's perspective

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.

Cytogenetic analysis of a mature teratoma and a yolk sac tumor component of a late relapse of a disseminated testicular nonseminoma

We report on the cytogenetics of a primary testicular nonseminoma, a residual mature teratoma after remission-induction chemotherapy, and a late relapse after 9 years of follow-up, in one patient. The late relapse was composed of a mature teratoma and a yolk sac tumor component. Cytogenetic comparison of the different tumors shows that progression of primary testicular nonseminoma to residual mature teratoma and to a late-relapse lesion is accompanied by net loss of chromosomes. In addition, our findings may suggest that transformation to viable cancer in a late-relapse lesion is accompanied by further chromosomal losses.

Cytogenetics of primary testicular nonseminoma, residual mature teratoma, and growing teratoma lesion in individual patients

Residual mature teratoma (RMT) is often left behind when metastases of primary nonseminomatous germ cell tumors (NSs) are treated with chemotherapy. RMT is composed of fully differentiated somatic tissue. A growing teratoma (GTE) lesion may occur after (incomplete) resection of RMT. To shed light on tumor progression or the mechanism(s) of therapy related differentiation we investigated the chromosomal pattern of the primary NSs and RMTs in twelve patients, of the primary NS, RMT, and GTE lesion in one patient, and of the RMT and GTE lesion in two patients. Although several chromosomal differences are observed between the RMT and NSs and between the GTE and RMTs in the same patient, we obtained no evidence that specific chromosomal alteration(s) play a role in metastasis or differentiation.

A case of growing teratoma syndrome

Residual masses are a common finding after chemotherapy for metastases from nonseminomatous germ cell tumours of the testes. The prognosis of these patients with resected teratoma following successful cisplatin-based combination chemotherapy generally has been assumed to be good. Herein we reported an unusual teratoma case named "growing teratoma syndrome' by Logothetis et al. This patient was treated with multiple operations.

Outcome analysis after post-chemotherapy surgery in patients with non-seminomatous germ cell tumours

BACKGROUND

The goal of the study was to analyse long-term outcome after post-chemotherapy surgery in male patients with non-seminomatous germ cell tumours (NSGCT).

PATIENTS AND METHODS

We reviewed the charts of 111 patients with metastatic NSGCT treated at a single institution from 1979 to 1993 who underwent post-chemotherapy resection of residual masses after normalisation of tumour markers. The prognostic relevance of the extent of tumour residuals, the comprehensiveness of surgery and the histology at resection was analysed.

RESULTS

Thirteen patients (12%) harboured viable cancer, and 46 patients (41%) mature teratoma at post-chemotherapy surgery. Only seven (54%) of the 13 patients with viable cancer remained continuously disease-free. Incomplete surgery predicted an impaired outcome (62% vs. 86% survival), although only one recurrence was observed at a site of an incompletely resected mass. Moreover, a progression-free interval < or = 3 months after post-chemotherapy surgery was correlated with worse subsequent survival (p = 0.0001).

CONCLUSIONS

Post-chemotherapy surgery remains an essential part of the treatment for metastatic NSGCT. Resection of viable cancer and mature teratoma is of therapeutic benefit. Viable cancer at surgery defines the need for further chemotherapy.