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Pathological predictors of metastatic disease in testicular non-seminomatous germ cell tumors: which tumor-node-metastasis staging system? Mod Pathol 2021; 34:834-841. [PMID: 33319858 DOI: 10.1038/s41379-020-00717-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/08/2022]
Abstract
Pathological risk factors for metastatic disease in patients with testicular non-seminomatous germ cell tumors are debated. The tumor-node-metastasis (TNM) classification eighth edition for testicular cancers includes divergent versions, by the International Union Against Cancer (UICC) and by the American Joint Committee for cancer (AJCC). We investigated pathological predictors of metastatic disease at presentation in 219 non-seminomatous germ cell tumors with reference to both classifications. Age, tumor size, percentage of embryonal carcinoma, lymphovascular invasion, invasion of stromal rete testis, hilar soft tissue, epididymis, spermatic cord, and tunica vaginalis, as well as tumor at spermatic cord margin, were assessed and correlated with clinical stage at presentation. Of the 219 NSGCT cases, 151 (69%) were clinical stage I, 68 (31%) were clinical stage II/III. On univariate analysis, tumor size (P = 0.028), percentage of embryonal carcinoma (P = 0.004), lymphovascular invasion (P = 0.001), stromal rete testis invasion (P = 0.001), hilar soft tissue invasion (P = 0.010), epididymis invasion (P = 0.010), direct spermatic cord invasion (P = 0.001), and tumor at spermatic cord margin ((P = 0.009) were associated with higher clinical stage. On multivariate analysis, lymphovascular invasion (P = 0.003), tumor size (P = 0.005), percentage of embryonal carcinoma (P = 0.005), stromal rete testis invasion (P = 0.008) remained significant. A tumor size of 6 cm and an embryonal carcinoma percentage of 70% were the significant cut-off values. We conclude that in addition to lymphovascular invasion, stromal rete testis invasion, tumor size, and embryonal carcinoma percentage are strong predictors of metastatic disease at presentation and their inclusion should be considered in any future TNM revision. Further, our results support the changes in the AJCC TNM eighth edition as invasion of the epididymis and hilar soft tissue were both univariately significant.
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Farooq A, Jorda M, Whittington E, Kryvenko ON, Braunhut BL, Pavan N, Procházková K, Zhang L, Rai S, Miller T, Liu J, Szabo A, Iczkowski KA. Rete Testis Invasion Is Consistent With Pathologic Stage T1 in Germ Cell Tumors. Am J Clin Pathol 2019; 151:479-485. [PMID: 30576407 DOI: 10.1093/ajcp/aqy168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Rete testis invasion by germ cell tumors is frequently concomitant with lymphovascular or spermatic cord invasion (LVI/SCI); independent implications for staging are uncertain. METHODS In total, 171 seminomas and 178 nonseminomatous germ cell tumors (NSGCTs; 46 had 1%-60% seminoma component) came from five institutions. Metastatic status at presentation, as a proxy for severity, was available for all; relapse data were unavailable for 152. Rete direct invasion (ReteD) and rete pagetoid spread (ReteP) were assessed. RESULTS ReteP and ReteD were more frequent in seminoma than NSGCT. In seminoma, tumor size bifurcated at 3 cm or more or less than 3 cm predicted metastatic status. Tumors with ReteP or ReteD did not differ in size from those without invasions but were less than with LVI/SCI; metastatic status or relapse did not show differences. In NSGCT, ReteP/ReteD did not correlate with size, metastatic status, or relapse. CONCLUSIONS Findings support retaining American Joint Committee for Cancer pathologic T1 stage designation for rete testis invasion and pT1a/pT1b substaging of seminoma.
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Affiliation(s)
| | - Merce Jorda
- University of Miami Miller School of Medicine/Jackson Health System, Miami, FL
| | | | | | - Beth L Braunhut
- University of Miami Miller School of Medicine/Jackson Health System, Miami, FL
| | - Nicola Pavan
- University of Miami Miller School of Medicine/Jackson Health System, Miami, FL
| | | | - Lian Zhang
- University of Colorado Anschutz Medical Campus, Aurora
| | - Samarpit Rai
- University of Miami Miller School of Medicine/Jackson Health System, Miami, FL
| | | | - Joy Liu
- Medical College of Wisconsin, Milwaukee
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Abstract
This article reviews the most frequently encountered tumor of the testis; pure and mixed malignant testicular germ cell tumors (TGCT), with emphasis on adult (postpubertal) TGCTs and their differential diagnoses. We additionally review TGCT in the postchemotherapy setting, and findings to be integrated into the surgical pathology report, including staging of testicular tumors and other problematic issues. The clinical features, gross pathologic findings, key histologic features, common differential diagnoses, the use of immunohistochemistry, and molecular alterations in TGCTs are discussed.
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Martinelli CMDS, Lengert AVH, Cárcano FM, Silva ECA, Brait M, Lopes LF, Vidal DO. MGMT and CALCA promoter methylation are associated with poor prognosis in testicular germ cell tumor patients. Oncotarget 2016; 8:50608-50617. [PMID: 28881587 PMCID: PMC5584175 DOI: 10.18632/oncotarget.11167] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/26/2016] [Indexed: 02/05/2023] Open
Abstract
Testicular germ cell tumors (TGCT) represent the second main cause of cancer-related death in young men. Despite high cure rates, refractory disease results in poor prognosis. Epigenetic reprogramming occurs during the development of seminomas and non-seminomas. Understanding the molecular and genetic basis of these tumors would represent an important advance in the search for new TGCT molecular markers. Hence the frequency of methylation of a gene panel (VGF, MGMT, ADAMTS1, CALCA, HOXA9, CDKN2B, CDO1 and NANOG) was evaluated in 72 primary TGCT by quantitative methylation specific PCR. A high frequency of MGMT (90.9%, 20/22; p=0.019) and CALCA (90.5%, 19/21; p<0.026) methylation was associated with non-seminomatous tumors while CALCA methylation was also associated with refractory disease (47.4%, 09/19; p=0.005). Moreover, promoter methylation of both genes predicts poor clinical outcome for TGCT patients (5-year EFS: 50.5% vs 77.1%; p=0.032 for MGMT and 51.3% vs 77.0%; p=0.029 for CALCA). The findings of this study indicate that methylation of MGMT and CALCA are frequent and could be used as new molecular markers of prognosis in TGCT.
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Affiliation(s)
- Camila Maria da Silva Martinelli
- Pediatric Oncology Laboratory, Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil.,Brazilian Childhood Germ Cell Tumor Study Group, Brazilian Pediatric Oncology Society, São Paulo, SP, Brazil
| | - André van Helvoort Lengert
- Pediatric Oncology Laboratory, Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil.,Brazilian Childhood Germ Cell Tumor Study Group, Brazilian Pediatric Oncology Society, São Paulo, SP, Brazil
| | - Flavio Mavignier Cárcano
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil.,Barretos School of Health Sciences, Dr. Paulo Prata/FACISB, Barretos, SP, Brazil.,Brazilian Childhood Germ Cell Tumor Study Group, Brazilian Pediatric Oncology Society, São Paulo, SP, Brazil
| | - Eduardo Caetano Albino Silva
- Department of Pathology, Barretos Cancer Hospital, Barretos, SP, Brazil.,Brazilian Childhood Germ Cell Tumor Study Group, Brazilian Pediatric Oncology Society, São Paulo, SP, Brazil
| | - Mariana Brait
- Department of Otolaryngology and Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Luiz Fernando Lopes
- Barretos School of Health Sciences, Dr. Paulo Prata/FACISB, Barretos, SP, Brazil.,Barretos Children's Cancer Hospital, Barretos, SP, Brazil.,Brazilian Childhood Germ Cell Tumor Study Group, Brazilian Pediatric Oncology Society, São Paulo, SP, Brazil
| | - Daniel Onofre Vidal
- Pediatric Oncology Laboratory, Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, SP, Brazil.,Barretos Children's Cancer Hospital, Barretos, SP, Brazil.,Brazilian Childhood Germ Cell Tumor Study Group, Brazilian Pediatric Oncology Society, São Paulo, SP, Brazil
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Peng XG, Dong Y, Zhang TT, Wang K, Ma YJ. Immune Reconstitution of CD4+T Cells after Allogeneic Hematopoietic Stem Cell Transplantation and its Correlation with Invasive Fungal Infection in Patients with Hematological Malignancies. Asian Pac J Cancer Prev 2015; 16:3137-40. [DOI: 10.7314/apjcp.2015.16.8.3137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Ozturk A, Unalan D, Guleser GN. Knowledge, attitude and practices of technicians working at hospitals towards testicular cancer and self-examination of testicles in Turkey. Asian Pac J Cancer Prev 2015; 15:10095-9. [PMID: 25556432 DOI: 10.7314/apjcp.2014.15.23.10095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study was conducted to determine knowledge level of technicians working in hospitals about testicular cancer (TC) and self-examination of testicles (TSE) and to determine levels of consciousness and implementation status about TSE. MATERIALS AND METHODS This cross-sectional study was conducted with technicians working in hospitals (n=243) between 2nd January-31st May 2012 at private and governmental hospitals in urban Kayseri. Healthy control subjects (n=235) who were similar to technicians in terms of age, education level and income status were also included to the study. Chi-square test was used in comparison of categorical variables. RESULTS Technicians were significantly more aware of TC than controls, but the latter were found to have significantly more information about TSE. There was no significant difference between the two groups in terms of knowing how to do TSE and 80% of both groups were unaware this exam. Of technicians, 19.8% and of controls, 25.5% did TSE, the difference being statistically insignificant. First reason for not doing TSE was "not-knowing" among technicians (48.1%) while it was "ignorance" among controls (66.8%). Of technicians doing TSE, 37.5% did as it came to their mind while 51.7% of controls performed TSE several times in the previous year. Technicians were significantly more afraid of getting TC than controls (p=0.037). CONCLUSIONS It was determined in the present study that rates of TSE were similar between technicians and controls. However compliance with the recommended frequency and right method was low. Consequently, public health educationshould be planned and applied in order to increase the knowledge of TC and TSE.
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Affiliation(s)
- Ahmet Ozturk
- Department of Biostatistics, Faculty of Medicine, Erciyes University, Kayseri, Turkey E-mail :
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Zhao JY, Ma XL, Li YY, Zhang BL, Li MM, Ma XL, Liu L. Diagnostic Accuracy of 18F-FDG-PET in Patients with Testicular Cancer: a Meta-analysis. Asian Pac J Cancer Prev 2014; 15:3525-31. [DOI: 10.7314/apjcp.2014.15.8.3525] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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