Paraneoplastic Limbic Encephalitis Secondary To Mixed Non-Seminomatous Germ Cell Tumours

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S55-S56
Author(s):  
A Ullah ◽  
S Heneidi ◽  
P Biddinger ◽  
N Patel ◽  
C Wehrle ◽  
...  
Keyword(s):  
Germ Cell ◽  
Limbic Encephalitis ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Primary Malignancy ◽  
Rare Presentation ◽  
Paraneoplastic Limbic Encephalitis ◽  
Nonseminomatous Germ Cell Tumor ◽  
Aortic Lymph Node ◽  
Alteration Of Consciousness

Abstract Casestudy: Testicular tumors account for 1–2% of all tumors in men, with 95% of these being germ cell tumors. The main risk factor for the development of testicular cancer is cryptorchidism. Paraneoplastic limbic encephalitis is a rare sequela of testicular tumor associated with anti-Ma2 and KLH11 antibodies. The most effective treatment for paraneoplastic limbic encephalitis is treatment of the primary malignancy. We present a 41-year-old male that presented to the emergency department with two weeks of episodic alteration of consciousness and memory disturbances. Negative neurologic evaluation and imaging led to concern for a paraneoplastic process from a distant malignancy. CT imaging revealed an enlarged, necrotic para-aortic lymph node and subsequent ultrasound demonstrated a right sided testicular mass. Right radical orchiectomy was performed. Microscopically, the mass consisted of mixed respiratory epithelium, gastrointestinal glands and squamous epithelium with keratinization consistent with a post-pubertal testicular teratoma with associated in-situ germ cell neoplasia. Resection of the para-aortic mass revealed large anaplastic cells with epithelioid features, nuclear pleomorphism and frequent mitoses. Immunostaining was positive for Pan-Keratin and OCT4, consistent with poorly differentiated embryonal carcinoma. Resection of the primary and metastatic disease, as well as treatment with corticosteroids resulted in resolution of the encephalitis. This presentation of severe neurological disturbances in the setting of a metastatic mixed nonseminomatous germ cell tumor represents a rare presentation of paraneoplastic limbic encephalitis.

scholarly journals Rare presentation of a seminoma with mixed germ cell tumor in undescended inguinal testis

2019 ◽  
Vol 6 (2) ◽  
pp. 611
Author(s):  
Siddhartha Verma ◽  
Heeralal Jakhar
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Cell Tumor ◽  
Uneventful Recovery ◽  
Predisposing Factor ◽  
Rare Presentation ◽  
Testicular Germ Cell ◽  
Mixed Germ Cell Tumor

Cryptorchidism is the most common predisposing factor in the development of testicular germ cell tumors. Seminoma is the most common malignancy developing in a cryptorchid testis. A rare case of seminoma with mixed germ cell tumor in an undescended testis is reported here. A 35-year-old male patient presented with swelling in left inguinal region science 1.5year. This  was smooth, firm to hard in consistency, restricted mobility and his left scrotum was empty. Serological markers α-FP, β-HCG, LDH were raised.  Sonography and CT scan revealed a testicular tumor in undescended left inguinal testis. High inguinal orchidectomy was done. Patient had an uneventful recovery. The histopathology report of biopsy revealed a seminoma with mixed germ cell tumor. Early diagnosis and management of the undescended testicle are needed to preserve fertility and improve early detection of testicular malignancy. Therapy should begin between six months and two years of age and may consist of hormone or surgical treatment.

scholarly journals Paraneoplastic limbic encephalitis associated with testicular mixed germ cell tumor

2018 ◽  
Vol 2018 ◽  
Author(s):  
Dana Almedallah ◽  
Gada Alsaffar ◽  
Ghadeer Al-Shabeeb ◽  
Aalaa Baarmah ◽  
Eman Nassim
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Limbic Encephalitis ◽  
Cell Tumor ◽  
Paraneoplastic Limbic Encephalitis ◽  
Mixed Germ Cell Tumor

scholarly journals Malignant Transformation of Testicular Teratoma to PNET, Adenocarcinoma, and Osteosarcoma with Complete Remission after Surgery and Combination Chemotherapy in a Young Adult Male

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Angela Shaw ◽  
Miriam Morrell ◽  
Annikka Weissferdt ◽  
Andrea Hayes-Jordan ◽  
Douglas Harrison
Keyword(s):  
Germ Cell ◽  
Malignant Transformation ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Metastatic Lesion ◽  
Immature Teratoma ◽  
Targeted Chemotherapy ◽  
Cell Lineages ◽  
Durable Remission ◽  
Mixed Germ Cell Tumors

Mixed germ cell tumors (GCT) with teratoma components can transform into somatic malignancies which can include histologies outside of traditional germ cell lineages. We describe a case of an 18-year-old man with a metastatic testicular GCT with both mature and immature teratoma components containing malignant transformation into multiple histologies including PNET in the primary testicular tumor and osteosarcoma in a separate pulmonary metastatic lesion. Management with targeted chemotherapy resulted in a durable remission. This is the first reported case that we know of a patient with primary PNET malignant transformation with subsequent metastatic transformation to osteosarcoma.

Incidence of Metastatic Nonseminomatous Germ Cell Tumor Outside the Boundaries of a Modified Postchemotherapy Retroperitoneal Lymph Node Dissection

2007 ◽  
Vol 25 (28) ◽  
pp. 4365-4369 ◽  
Author(s):  
Brett S. Carver ◽  
Bobby Shayegan ◽  
Scott Eggener ◽  
Jason Stasi ◽  
Robert J. Motzer ◽  
...  
Keyword(s):  
Lymph Node ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Testicular Tumor ◽  
Cell Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Retroperitoneal Lymph Node ◽  
Radiographic Evidence ◽  
Nonseminomatous Germ Cell Tumor ◽  
Institutional Review

Introduction Modified template retroperitoneal lymph node dissections (RPLND) have become increasing applied in the postchemotherapy (PC) setting. We evaluated our experience with PC-RPLND to determine the incidence of disease extending outside the boundaries of a modified PC-RPLND. Patients and Methods From 1989 through 2003, a total of 532 men underwent PC-RPLND for metastatic nonseminomatous germ cell tumor (NSGCT). Of these, 269 (51%) had either viable germ cell tumor (GCT) or teratoma present in the RPLND specimen. After Institutional Review Board approval, clinical and pathologic data were obtained from our prospective surgical database. The incidence of retroperitoneal disease outside the boundaries of five modified templates was reported for the presence of viable GCT or teratoma. Results Of the 269 patients with viable GCT or teratoma, 20 to 86 (7% to 32%) patients had evidence of extratemplate retroperitoneal disease, depending on the boundaries of the modified template. There was no difference in the histologic distribution for patients with disease confined to or outside of the modified templates. Despite the absence of preoperative radiographic evidence of disease outside the boundaries of the Testicular Tumor Study Group template, the incidence of extratemplate metastasis for men with residual retroperitoneal masses less than 1, 1 to 2, 2 to 5, and more than 5 cm was two of 24 (8%), seven of 38 (18%), 27 of 92 (29%), and 14 of 55 (25%), respectively. Conclusion Our data suggest a bilateral RPLND is a prudent approach for the management of men with metastatic NSGCT after chemotherapy, given that at least 7% to 32% of men will have teratoma or viable GCT outside the boundaries of a modified template.

Cystic Trophoblastic Tumor in a Primary Central Nervous System Post-Chemotherapy Germ Cell Tumor: The First Case Report

2020 ◽  
Vol 28 (8) ◽  
pp. 925-928
Author(s):  
Ramya Gadde ◽  
Kanika Arora ◽  
Michelle Madden Felicella ◽  
Sohrab Arora ◽  
Liang Cheng ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Cell Tumor ◽  
Smooth Muscle Tissue ◽  
Trophoblastic Tumor ◽  
First Case

Cystic trophoblastic tumor (CTT) is an uncommon trophoblastic proliferation of germ cell tumor origin, mostly reported in post-chemotherapy metastases of testicular germ cell tumors and rarely primary untreated testicular tumors. To date, we are not aware of occurrence in a non-testicular tumor. A 12-year-old boy presented with limb swelling, increased appetite, weight gain, and precocious puberty. Evaluation revealed right frontal lobe mass and elevated α-fetoprotein and β-human chorionic gonadotrophin. After response to neoadjuvant chemotherapy, the tumor was resected. Microscopically, the resection contained predominantly smooth muscle tissue with scattered small foci of glandular teratoma and CTT. Immunohistochemistry (SALL4, glypican 3) revealed no residual yolk sac tumor. Fluorescence in situ hybridization revealed gain of chromosome 12p. The patient has been disease-free for 13 years. This report expands the spectrum of primary central nervous system germ cell tumors with the occurrence of CTT in this site.

Outcome of Patients With Residual Germ Cell or Non-Germ Cell Malignancy After Resection of Primary Mediastinal Nonseminomatous Germ Cell Cancer

2004 ◽  
Vol 22 (7) ◽  
pp. 1195-1200 ◽  
Author(s):  
Bryan P. Schneider ◽  
Kenneth A. Kesler ◽  
Jo Ann Brooks ◽  
Constantin Yiannoutsos ◽  
Lawrence H. Einhorn
Keyword(s):  
Germ Cell ◽  
Residual Disease ◽  
Cell Cancer ◽  
Elevated Serum ◽  
Germ Cell Tumors ◽  
Term Survival ◽  
Poor Risk Patient ◽  
Nonseminomatous Germ Cell Tumor ◽  
Alive With Disease

PurposeTo identify prognostic variables and outcomes in patients with primary mediastinal nonseminomatous germ cell tumor (PMNSGCT) with postchemotherapy resection of persistent cancer.Patients and MethodsForty-seven consecutive patients with residual cancer after resection of PMNSGCT were retrospectively reviewed. Univariate comparisons were performed.ResultsAt diagnosis, 43 patients had elevated serum tumor markers (STMs), and 20 had extramediastinal disease. At resection, 21 patients had elevated STMs. After resection, 26 patients had germ cell tumors (GCT), 12 had malignant transformation of teratoma with elements of non-GCT, and nine had both GCT and non-GCT. Sixteen of 47 patients continuously have no evidence of disease (NED). This includes eight of 26 patients with GCT histology and two of 12 patients with non-GCT histology. Of 27 patients with mediastinal-only disease at presentation, 14 have continuously NED. Of 20 patients with extramediastinal disease at presentation, two have continuously NED. Seven of 21 patients with elevated STMs at time of resection have continuously NED. Sixteen patients received adjuvant chemotherapy, and seven have continuously NED. Overall, 16 of 47 patients have continuously NED, an additional four patients have NED with further therapy (currently NED), two patients are alive with disease, 23 patients died of disease, and two patients died postoperatively.ConclusionThe presence of elevated STMs at resection does not appear to alter outcome if residual disease is completely resected. In this poor-risk patient population, surgical resection of persistent cancer, even in the presence of elevated STMs, can still achieve long-term survival.

scholarly journals Simultaneous intracranial and testicular germ cell tumors: illustrative case

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Lei Han ◽  
Jie Lu ◽  
Luxiong Fang ◽  
Songtao Qi ◽  
Ye Song
Keyword(s):  
Germ Cell ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Cystic Teratoma ◽  
Pineal Region ◽  
Illustrative Case ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
First Case

BACKGROUNDSimultaneous intracranial and testicular germ cell tumors (GCTs) are extremely rare, leading to a lack of adequate experience in their treatment. Therefore, the authors report a case of this kind of GCT.OBSERVATIONSA 5-year-old boy was admitted to the hospital with headache and vomiting. Computed tomography and magnetic resonance imaging suggested the possibility of a GCT in the pineal region. The value of the serum tumor marker alpha-fetoprotein (AFP) was 5,396.1 μg/L, and β-human chorionic gonadotropin levels were within the normal range. Subsequently, the tumor was removed, and the final pathological result was a mixed GCT. Therefore, chemotherapy and radiation were added. However, the authors found a testicular tumor on ultrasound at the same time, and pathology after surgery suggested a mature cystic teratoma. Following treatment, the patient recovered well, and AFP levels dropped to normal values.LESSONSTo the authors’ knowledge, this report is the fourth case of simultaneous intracranial and testicular GCTs and the first case of a simultaneous mixed GCT in the pineal region and mature teratoma of the testis. A combination of surgery, chemotherapy, and radiation therapy for mixed GCTs in the pineal region and surgical excision for testicular reproductive cell tumors are effective in these patients, but long-term monitoring is required.

scholarly journals Mature teratoma with aspergilloma

2019 ◽  
Vol 23 (3) ◽  
pp. 119-122
Author(s):  
Abebe Bezabih ◽  
Asfaw Atnafu
Keyword(s):  
Surgical Treatment ◽  
Germ Cell ◽  
Literature Search ◽  
English Literature ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Rare Presentation ◽  
Mediastinal Teratoma ◽  
Intrathoracic Mass

Mediastinal mature teratomas are benign germ cell tumors which rarely involve the lung, but when they involve the lung they can cavitate. Aspergilloma developing in a mature teratoma is extremely rare, and according to our English literature search, there is only one previously reported case. We report a 21-year-old female who presented with cough and foul-smelling sputum. investigations revealed an intrathoracic mass, which intraoperatively and upon subsequent histological exam was found to be a mature mediastinal teratoma involving the lung and associated with an aspergilloma. Reporting our case will add to the understanding of this rare presentation of mediastinal mature teratomas. Keywords: mature teratoma; aspergilloma; surgical treatment 

scholarly journals Testicular Germ Cell Tumors: Serological and Immunohistochemical Diagnosis

2021 ◽  
Vol 50 (1) ◽  
pp. 58
Author(s):  
Ivan Damjanov
Keyword(s):  
Germ Cell ◽  
Tumor Markers ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Published Data ◽  
Routine Practice ◽  
Testicular Germ Cell Tumors ◽  
Testicular Tumors ◽  
Testicular Germ Cell ◽  
Immunohistochemical Markers

<p>This review deals with serologic and immunohistochemical tumor markers used in clinical laboratories for the diagnosis of testicular germ cell tumors. Time tested serologic markers such as alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase are routinely used in the work-up of patients with testicular tumors. Professional organizations regulating the practice of medicine in most countries worldwide require that the laboratory values for these serologic reactants be included in the pathology reports on testicular tumors as part of the tumor staging process. Immunohistochemical markers of testicular germ have been identified and widely tested during the first two decades of the XXI century. We have selected the most useful immunohistochemical markers from a few of these markers and discussed them in this review.</p><p><strong>Conclusion</strong>. Published data show that testicular tumor markers are widely used in routine practice. The study of tumor markers has improved the pathologic and clinical diagnosis of testicular germ cell tumors and has thus contributed to their treatment.</p>

Long-term follow-up of chemotherapy-induced remissions in patients with disseminated nonseminomatous germ cell tumors

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5029-5029
Author(s):  
Y. Ehrlich ◽  
M. J. Brames ◽  
S. D. Beck ◽  
R. S. Foster ◽  
L. H. Einhorn
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Free Survival ◽  
Nonseminomatous Germ Cell Tumor ◽  
Long Term Follow Up ◽  
Prospective Trials ◽  
Lymph Nodes Dissection ◽  
Lost To Follow Up

5029 Background: There is controversy concerning management of patients (pts) with nonseminomatous germ cell tumor (NSGCT) who obtain a chemotherapy-induced complete radiographic (<1cm node diameter) and serologic remission (CR). It has been our policy not to recommend retroperitoneal lymph nodes dissection (RPLND). Proponents of mandatory RPLND cite a 20% to 30% rate of residual microscopic tumor, mostly teratoma, despite achieving CR. Methods: Retrospective analysis of 141 patients with metastatic NSGCT who obtained CR to cisplatin-based first-line chemotherapy. All were observed without RPLND. Included were 78 consecutive pts treated between Jan 1987 and Sept 1994. Additionally included were 63 pts recruited in 4 prospective trials between Oct 1984 and Apr 2005. Seven pts were lost to follow-up (FU) after <2 year. Results: At a median a FU of 15 years (range 3 months to 23.8 years), 12 pts recurred and 4 are dead of disease (DOD). The estimated 15 year recurrence free and disease specific survival was 90% and 97% respectively. The estimated 15 years recurrence free survival for 109 pts with good risk and 32 pts with intermediate or poor risk was 95% and 73% respectively (p = 0.001). Five pts recurred >2 years (range 3–13 years). All 5 are currently disease free. Six pts recurred in the RP and 2 are DOD. Six pts recurred outside the RP. Two of these 6 are DOD. Conclusions: Pts obtaining CR after primary chemotherapy can be safely observed without RPLND. Relapses are rare and potentially curable with further treatment. No significant financial relationships to disclose.

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