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Cheng X, Yu H, Li J, Han X, Meng E, Zhou H, Wang D, Niu B, Zhang X. Dramatic response to local radiotherapy in a refractory metastatic mediastinal yolk sac tumor patient harboring a germline BRCA2 frameshift mutation: a case report. Cancer Biol Ther 2022; 23:393-400. [PMID: 35576916 PMCID: PMC9116401 DOI: 10.1080/15384047.2022.2072635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mediastinal yolk sac tumors (YSTs) are highly aggressive germ cell tumors with an extremely poor prognosis. Radiotherapy plays an important role in the treatment of mediastinal YSTs. To maximize benefit from radiotherapy in patients with mediastinal YSTs, exploring functionally relevant biomarkers is essential. Previous studies have demonstrated that mutations in DNA-damage repair (DDR) genes, including BRCA1/2, potentially enhance sensitivity to radiotherapy in solid tumors. However, DDR-gene mutations, as possible predictive biomarkers for radiotherapy in primary mediastinal YSTs, have not yet been reported. Herein, we report a 29-year-old male patient with a refractory metastatic primary YST involving a germline frameshift mutation in the BRCA2 gene (NM_000059.3: exon11: c.4563_4564delAT: L1522fs). During treatment alternation, the patient was found to respond poorly to chemotherapy with or without an immune checkpoint inhibitor but well to radiotherapy. Finally, the patient achieved approximately 17 months of overall survival. To the best of our knowledge, this case report is the first to describe a remarkable response to local radiotherapy in a patient with a refractory metastatic mediastinal YST involving a DDR-gene mutation (germline BRCA2 frameshift variation). This case report provides insightful clues for precision radiotherapy in clinical practice.
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Affiliation(s)
- Xi Cheng
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Haiming Yu
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Jinying Li
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Xiaona Han
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
| | - Erhong Meng
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China
| | - Houqing Zhou
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China.,Department of Medicine, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China
| | - Dongliang Wang
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China.,Department of Medicine, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China
| | - Beifang Niu
- Department of Scientific Research Project, ChosenMed Technology (Beijing) Co., Ltd, Beijing, China.,Computer Network Information Center, Chinese Academy of Sciences, Beijing, China.,School of Computer Science and Technology, University of the Chinese Academy of Sciences, Beijing, China
| | - Xiaotao Zhang
- Department of Radiation Oncology, The Affiliated Qingdao Central Hospital of Qingdao University, Qingdao, China
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Dieckmann KP, Isbarn H, Grobelny F, Dumlupinar C, Utschig J, Wülfing C, Pichlmeier U, Belge G. Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates-A Comprehensive Statistical Analysis. Cancers (Basel) 2022; 14:5447. [PMID: 36358866 PMCID: PMC9653836 DOI: 10.3390/cancers14215447] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.
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Affiliation(s)
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Francesca Grobelny
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Cansu Dumlupinar
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry und Epidemiology, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Gazanfer Belge
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
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Nair LM, Krishna KMJ, Kumar A, Mathews S, Joseph J, James FV. Prognostic factors and outcomes of nonseminomatous germ cell tumours of testis-experience from a tertiary cancer centre in India. Ecancermedicalscience 2020; 14:1145. [PMID: 33343704 PMCID: PMC7738268 DOI: 10.3332/ecancer.2020.1145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Indexed: 12/15/2022] Open
Abstract
Germ cell tumour of the testis is the most common cancer in young men in the western world. India has the lowest incidence globally, and hence Indian data are sparse. We report the outcomes of patients with nonseminomatous germ cell tumours of testis treated at a tertiary cancer centre in South India over a period of 10 years. Patients with a histopathological diagnosis of nonseminomatous germ cell tumours of the testis from 1 January 2006 to 31 December 2016 were included in the study. Patient demographics, tumour characteristics and treatment details were retrieved from case records. Kaplan–Meier method was used to estimate progression-free survival (PFS) and overall survival (OS). Cox regression model was used to analyse the prognostic factors. One hundred and nineteen patients with nonseminomatous germ cell tumours of the testis were included in the study. The median follow-up was 81 months. The estimated 4-year OS and progression-free survival were 87.1% and 84.5%, respectively. The four-year OS for good, intermediate and poor-risk groups was 93.6%, 87.5% and 52.6%, respectively. The PFS at 4 years was 91.4%, 87.8% and 47.4% for good, intermediate and poor-risk groups, respectively. The presence of nonpulmonary visceral metastasis and biochemical response after chemotherapy were significant predictors for OS and PFS in multivariate cox proportional hazards regression. The survival figures are comparable to the rest of the world except in the poor prognostic risk group. The inferior survival noticed in this group of patients may be due to the lack of good salvage procedures. High-dose chemotherapy with stem-cell support may be considered more often for this group of patients.
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Affiliation(s)
| | | | - Aswin Kumar
- Genitourinary Clinic, RCC, Thiruvananthapuram 695011, India
| | - Susan Mathews
- Genitourinary Clinic, RCC, Thiruvananthapuram 695011, India
| | - John Joseph
- Genitourinary Clinic, RCC, Thiruvananthapuram 695011, India
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Deng L, He X, Xie K, Xie L, Deng Y. Dual Therapy Coating on Micro/Nanoscale Porous Polyetheretherketone to Eradicate Biofilms and Accelerate Bone Tissue Repair. Macromol Biosci 2018; 19:e1800376. [PMID: 30549406 DOI: 10.1002/mabi.201800376] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/29/2018] [Indexed: 12/15/2022]
Abstract
Defective osteogenesis and latent infections continue to be two major issues in the therapy of bone tissue regeneration. In this study, a unique hierarchically micro/nanoscale-architecture is first proposed and produced on polyetheretherketone (PEEK). Besides, a "simvastatin-PLLA film-tobramycin microspheres" delivery system is subsequently fabricated to endow the PEEK implant with osteogenic and antibacterial capabilities. In vitro antibacterial evaluations confirm that the decorated PEEK scaffolds possess excellent resistance against planktonic/adherent bacteria. In vitro cell attachment/proliferation, lactate dehydrogenase (LDH) content, alkaline phosphatase (ALP) activity, calcium mineral deposition experiments, and real-time PCR analysis all exhibit that the superior proliferation rate and osteo-differentiation potential of MC3T3-E1 pre-osteoblasts are presented on the PEEK samples with dual functional decoration. In the mouse calvarial defect model, the micro-CT and histological results demonstrate that our scaffolds display a remarkable bone forming capability. Generally, the PEEK scaffolds co-endowed with simvastatin and tobramycin microspheres possess great potential in clinics.
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Affiliation(s)
- Lijun Deng
- School of Chemical Engineering, Sichuan University, Chengdu, 610065, China
| | - Xianhua He
- School of Chemical Engineering, Sichuan University, Chengdu, 610065, China
| | - Kenan Xie
- School of Chemical Engineering, Sichuan University, Chengdu, 610065, China
| | - Lu Xie
- State Key Laboratory of Oral Diseases West China College of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Yi Deng
- School of Chemical Engineering, Sichuan University, Chengdu, 610065, China.,Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, SAR, China
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Dieckmann KP, Richter-Simonsen H, Kulejewski M, Ikogho R, Zecha H, Anheuser P, Pichlmeier U, Isbarn H. Testicular Germ-Cell Tumours: A Descriptive Analysis of Clinical Characteristics at First Presentation. Urol Int 2018; 100:409-419. [PMID: 29649815 DOI: 10.1159/000488284] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/08/2018] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Clinical characteristics of testicular germ cell tumours (GCTs) apparently change over time, and some vary geographically. The aim of this study is to document the clinical profile of contemporary GCT patients. PATIENTS AND METHODS Four hundred twenty-two Caucasian GCT-patients treated in one German centre during 2000-2017, were analysed in terms of patient-age, laterality, histology, tumour-size, clinical stages (CS), pathological (pT)-stages and serum biomarker expression. The results were analysed descriptively and compared with the literature. RESULTS Median age was 36 years and 60.2% had seminoma. Βeta-human chorionic gonadotropin was expressed in 37.9% and alpha Fetoprotein in 25.6%. CS1 presenting stage was 66.6% of all GCT patients, 79.1% in seminoma, and 47.6% in nonseminoma. Tumour size was significantly associated with pT-stages and CS. Patients >50 years had significantly more seminoma (77.6%) than younger ones (57.9%). Comparison with literature data revealed a shifting towards higher age, lower CS, higher proportion of seminoma and striking differences of characteristics among geographic regions. CONCLUSIONS A typical contemporary clinical profile of testicular GCTs is presented in this study. Median age, relative incidence of seminoma and proportion of CS1 appear to be increasing over time. Striking differences among ethnic groups regarding the characteristics of GCT require further investigation.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany.,Asklepios Klinik Altona, Hodentumorzentrum Hamburg, Hamburg, Germany
| | | | | | - Raphael Ikogho
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany
| | - Henrik Zecha
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany
| | - Petra Anheuser
- Albertinen Krankenhaus Hamburg, Klinik für Urologie, Hamburg, Germany
| | - Uwe Pichlmeier
- Universitätsklinikum Hamburg Eppendorf, Zentrum für Experimentelle Medizin, Institut für Medizinische Biometrie und, Hamburg, Germany
| | - Hendrik Isbarn
- Universitätsklinikum Hamburg Eppendorf, Martini-Klinik, Hamburg, Germany
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A Rare Case of Primary Anterior Mediastinal Yolk Sac Tumor in an Elderly Adult Male. Case Rep Oncol Med 2016; 2016:8961486. [PMID: 27144043 PMCID: PMC4837257 DOI: 10.1155/2016/8961486] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022] Open
Abstract
Mediastinal germ cell tumors are extragonadal germ cell tumors (EGGCTs) commonly seen in children and young adults. They are more common in men. Clinically they are classified as teratomas, seminomas, and nonseminomatous germ cell tumors. Primary mediastinal yolk sac neoplasm is an extremely rare tumor. We present here a very rare case of primary yolk sac tumor of the anterior mediastinum in a 73-year-old male. Mediastinal germ cell tumors have a worse prognosis than gonadal germ cell tumors. Chemotherapy followed by adjuvant surgery improves overall response in EGGCTs. However, comorbidities can render treatment with chemotherapy and surgery challenging in elderly patients.
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Tong S, Chen M, Zu X, Li Y, He W, Lei Y, Liu W, Qi L. Trans- and extraperitoneal retroperitoneal lymph node dissection (RPLND) in the treatment for nonseminomatous germ cell testicular tumors (NSGCT): a single Chinese center's retrospective analysis. Int Urol Nephrol 2013; 46:363-9. [PMID: 23996573 DOI: 10.1007/s11255-013-0547-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the role of two different approaches to perform laparoscopic RPLND: transperitoneal laparoscopic retroperitoneal lymph node dissection (TL-RPLND) and extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RPLND). MATERIALS AND METHODS Between February 2003 and April 2013, 39 patients with nonseminomatous germ cell testicular tumors were treated by RPLND in our center. Twenty-one patients had TL-RPLND, and 18 patients had EL-RPLND. We performed a comprehensive retrospective study comparing TL-RPLND and EL-RPLND. Certain parameters, including operative time, estimated blood loss, perioperative complications, resected lymph nodes, postoperative intestinal function recovery time, ejaculation, and postoperative tumor markers, were abstracted and compared. RESULTS In the EL-RPLND and TL-RPLND groups, the operation times were 178 ± 31 and 207 ± 25 min; the amounts of estimated blood loss were 87 ± 26 and 111 ± 21 ml; the postoperative intestinal function recovery times were 1.2 ± 0.7 and 2.4 ± 0.6 days; the postoperative hospital stays were 5.8 ± 1.1 and 5.5 ± 1.4 days; and the numbers of resected lymph nodes were 16.2 ± 1.5 and 15.8 ± 1.6, respectively. No conversion from laparoscopic to open surgery occurred. No patient in either group received an intraoperative blood transfusion. Overall, two patients developed postoperative fever, and one developed abdominal distension. After a median follow-up of 45 months, no regional relapse or metastases occurred, but 4 patients at clinical stage II were treated successfully by three cycles of platinum-based postoperative chemotherapy. Currently, all patients show no evidence of disease. CONCLUSION Our results demonstrate that EL-RPLND was superior to the transperitoneal approach in terms of the operation time, estimated blood loss, and postoperative intestinal function recovery time, whereas no differences were observed in the number of lymph nodes resected. EL-RPLND was demonstrated to be safe and feasible, with satisfactory clinical outcomes when performed by experienced laparoscopic surgeons. Larger cohorts of patients with longer term follow-up are needed for further studies to determine the role of different approaches to L-RPLND.
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Affiliation(s)
- Shiyu Tong
- Department of Urology, Xiangya Hospital, Central South University, Changsha City, Hunan Province, China
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Malecki M, Tombokan X, Anderson M, Malecki R, Beauchaine M. TRA-1-60 +, SSEA-4 +, POU5F1 +, SOX2 +, NANOG + Clones of Pluripotent Stem Cells in the Embryonal Carcinomas of the Testes. ACTA ACUST UNITED AC 2013; 3. [PMID: 23772337 DOI: 10.4172/2157-7633.1000134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Cancer of the testes is currently the most frequent neoplasm and a leading cause of morbidity in men 15-35 years of age. Its incidence is increasing. Embryonal carcinoma is its most malignant form, which either may be resistant or may develop resistance to therapies, which results in relapses. Cancer stem cells are hypothesized to be drivers of these phenomena. SPECIFIC AIM The specific aim of this work was identification and isolation of spectra of single, living cancer stem cells, which were acquired directly from the patients' biopsies, followed by testing of their pluripotency. PATIENTS METHODS Biopsies were obtained from the patients with the clinical and histological diagnoses of the primary, pure embryonal carcinomas of the testes. The magnetic and fluorescent antibodies were genetically engineered. The SSEA-4 and TRA-1-60 cell surface display was analyzed by multiphoton fluorescence spectroscopy (MPFS), flow cytometry (FCM), immunoblotting (IB), nuclear magnetic resonance spectroscopy (NMRS), energy dispersive x-ray spectroscopy (EDXS), and total reflection x-ray spectroscopy (TRXFS). The single, living cells were isolated by magnetic or fluorescent sorting followed by their clonal expansion. The OCT4A, SOX2, and NANOG genes' transcripts were analyzed by qRTPCR and the products by IB and MPFS. RESULTS The clones of cells, with the strong surface display of TRA-1-60 and SSEA-4, were identified and isolated directly from the biopsies acquired from the patients diagnosed with the pure embryonal carcinomas of the testes. These cells demonstrated high levels of transcription and translation of the pluripotency genes: OCT4A, SOX2, and NANOG. They formed embryoid bodies, which differentiated into ectoderm, mesoderm, and endoderm. CONCLUSION In the pure embryonal carcinomas of the testes, acquired directly from the patients, we identified, isolated with high viability and selectivity, and profiled the clones of the pluripotent stem cells. These results may help in explaining therapy-resistance and relapses of these neoplasms, as well as, in designing targeted, personalized therapy.
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Affiliation(s)
- Marek Malecki
- Phoenix Biomolecular Engineering Foundation, San Francisco, CA, USA ; University of Wisconsin, Madison, WI, USA
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