Validity of predictions of residual retroperitoneal mass histology in nonseminomatous testicular cancer.

1998 ◽  
Vol 16 (1) ◽  
pp. 269-274 ◽  
Author(s):  
E W Steyerberg ◽  
A Gerl ◽  
S D Fossá ◽  
D T Sleijfer ◽  
R de Wit ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Tumor Markers ◽  
Goodness Of Fit ◽  
Mature Teratoma ◽  
Testicular Germ Cell Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Testicular Germ Cell ◽  
Goodness Of Fit Tests ◽  
Predicted Probability ◽  
Adequate Reliability

PURPOSE To validate predictions of the histology (necrosis, mature teratoma, or cancer) of residual retroperitoneal masses in patients treated with chemotherapy for metastatic nonseminomatous testicular germ cell tumor. PATIENTS AND METHODS We studied 172 testicular cancer patients who underwent resection while tumor markers were normal. Predictive characteristics for the residual histology were registered, including the presence of teratoma elements in the primary tumor, the prechemotherapy level of tumor markers (alpha-fetaprotein [AFP], human chorionic gonadotropin [HCG], lactate dehydrogenase [LDH]), the size of the residual mass, and the percentage of shrinkage in mass diameter. We calculated the predicted probability of necrosis and the ratio of cancer and mature teratoma with previously published logistic regression formulas. RESULTS The distribution of the residual histology was necrosis in 77 (45%), mature teratoma in 72 (42%), and cancer in 23 (13%). Necrosis could be well distinguished from other tissue, with an area under the receiver operating characteristic (ROC) curve of 82%. No tumor was found in 15 patients with a predicted probability of necrosis over 90%. The predicted probabilities corresponded reliably with the observed probabilities (goodness-of-fit tests, P > .20), although a somewhat higher probability of necrosis was observed in patients treated with chemotherapy containing etoposide. Conversely, cancer could not reliably be predicted or adequately discriminated from mature teratoma. CONCLUSION The predicted probabilities of necrosis have adequate reliability and discriminative power. These predictions may validly support the decision-making process regarding the need and extent of retroperitoneal lymph node dissection.

Is postchemotherapy retroperitoneal surgery necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses?

1992 ◽  
Vol 10 (4) ◽  
pp. 569-573 ◽  
Author(s):  
S D Fosså ◽  
H Qvist ◽  
A E Stenwig ◽  
H H Lien ◽  
S Ous ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Tumor Markers ◽  
Primary Tumor ◽  
Residual Disease ◽  
Mature Teratoma ◽  
Residual Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Retroperitoneal Mass ◽  
Residual Masses ◽  
Minimal Residual

PURPOSE At least one third of the patients with metastatic testicular cancer are rendered tumor-free by cisplatin-based chemotherapy. One may question, therefore, the routine use of postchemotherapy retroperitoneal lymph node dissection (RLND), especially if the residual masses are less than 20 mm in diameter. To define the role of such surgery, we analyzed the postchemotherapy histology in testicular cancer patients with minimal residual disease. PATIENTS AND METHODS Seventy-eight patients with advanced nonseminomatous testicular cancer underwent RLND after three to four cycles of cisplatin- or carboplatin-based chemotherapy. In all patients, the largest diameter of the residual retroperitoneal mass was less than 20 mm. RESULTS Complete fibrosis/necrosis was found in 51 patients, mature teratoma in 22, and vital malignant germ cell tumor in five. In two of the latter five patients, alphafetoprotein (AFP) had increased immediately before RLND. In the 76 patients with normal pre-RLND tumor markers, the presence of undifferentiated malignant teratoma (MTU) in the primary tumor and normal prechemotherapy tumor markers were independent parameters predicting complete fibrosis/necrosis, which was demonstrated in all 15 patients with these two pretreatment parameters. CONCLUSIONS Postchemotherapy RLND can be omitted in patients with MTU in the primary tumor who have normal AFP/human chorionic gonadotropin (AFP/HCG) before chemotherapy and whose residual retroperitoneal mass is less than 20 mm in diameter. If the pre-RLND tumor markers are normal, RLND should be performed in all other patients with small residual masses, even in the presence of a normal computed tomography (CT) and particularly if regular follow-up of the patients is not guaranteed.

scholarly journals Oligometastatic Growing Teratoma Syndrome: A Case for an Aggressive Surgical Approach

2015 ◽  
Vol 9 (3) ◽  
pp. 163-165 ◽  
Author(s):  
William S. Gange ◽  
Robert H. Blackwell ◽  
John Biemer ◽  
Güliz A. Barkan ◽  
Maria M. Picken ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Clinical Stage ◽  
Mature Teratoma ◽  
Disease Free Survival ◽  
Testicular Germ Cell Tumor ◽  
Testicular Germ Cell ◽  
Growing Teratoma Syndrome ◽  
Aggressive Surgical Approach ◽  
Metastatic Sites

Growing teratoma syndrome is an infrequent presentation of testicular cancer. We present a case of growing teratoma syndrome in a patient who initially presented with clinical stage I nonseminomatous testicular germ cell tumor, who subsequently developed large volume oligometastases to the retroperitoneum, thorax, and thigh. Despite two regimens of chemotherapy, his disease progressed. Complete surgical extirpation of all gross tumors confirmed mature teratoma. An aggressive surgical approach, including postchemotherapy resection of all known metastatic sites, can provide long-term disease-free survival.

Evidence for Altered Hypothalamic-Hypophyseal-Gonadal Axis in Untreated Patients with Testicular Germ-Cell Tumor

1989 ◽  
Vol 75 (5) ◽  
pp. 505-509
Author(s):  
Sergio Crispino ◽  
Gabriele Tancini ◽  
Sandro Barni ◽  
Paolo Lissoni
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Venous Blood ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumor ◽  
Cell Tumor ◽  
Testicular Germ Cell Tumors ◽  
Testicular Germ Cell ◽  
Significant Difference

To investigate the function of the hypothalamic-hypophyseal-gonadal axis in testicular germ cell tumors, we evaluated gonadotropin responses to gonadotropin-releasing hormone (GnRH) in 12 untreated patients with testicular cancer (5 seminomas and 7 non-seminomas). GnRH was given i.v. at a dose of 100 μg as a bolus, and venous blood samples were collected at 0, 20, 60, and 120 min. As controls, 14 healthy males were studied. Basal levels of testosterone, estradiol and prolactin were also detected in each patient. Hormonal serum concentrations were measured by the radioimmunoassay. Mean basal testosterone, estradiol and prolactin levels were not significantly different from those of controls. Patients had a lower FSH and LH peak after GnRH than controls, without, however, any significant difference. As regards histology, nonseminoma patients lacked an FSH response to GnRH and had statistically lower mean peak levels than controls. Moreover, non-seminoma patients had statistically lower mean peak values of LH after GnRH than controls. These data show that patients with testicular germ cell tumor, and more particularly those with non-seminomas, have an altered function of the hypothalamic-hypophyseal-gonadal axis, which is already present prior to therapy. Further studies, particularly in stage I patients treated only with orchiectomy, should be performed to confirm and better define the Physiopathologic significance of the altered hypothalamic-hypophyseal-gonadal axis in testicular cancer and to clarify the alteration of fertility, which is frequently present before treatment.

scholarly journals Rare inactivating PDE11A variants associated with testicular germ cell tumors

2015 ◽  
Vol 22 (6) ◽  
pp. 909-917 ◽  
Author(s):  
Anand Pathak ◽  
Douglas R Stewart ◽  
Fabio R Faucz ◽  
Paraskevi Xekouki ◽  
Sara Bass ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumor ◽  
Testicular Tissue ◽  
Transcript Variant ◽  
Coding Region ◽  
Testicular Germ Cell ◽  
Rare Mutations ◽  
Gene Study

Germline inactivating mutations of isoform 4 of phosphodiesterase (PDE) 11A (coded by the PDE11A gene) have been associated with familial adrenocortical tumors and familial testicular cancer. Testicular tissue is unique in expressing all four isoforms of PDE11A. In a prior candidate gene study of 94 familial testicular germ cell tumor (TGCT) subjects, we identified a significant association between the presence of functionally abnormal variants in PDE11A and familial TGCT risk. To validate this novel observation, we sequenced the PDE11A coding region in 259 additional TGCT patients (both familial and sporadic) and 363 controls. We identified 55 PDE11A variants: 20 missense, four splice-site, two nonsense, seven synonymous, and 22 intronic. Ten missense variants were novel; nine occurred in transcript variant 4 and one in transcript variant 3. Five rare mutations (p.F258Y, p.G291R, p.V820M, p.R545X, and p.K568R) were present only in cases and were significantly more common in cases vs controls (P=0.0037). The latter two novel variants were functionally characterized and shown to be functionally inactivating, resulting in reduced PDE activity and increased cAMP levels. In further analysis of this cohort, we focused on white participants only to minimize confounding due to population stratification. This study builds upon our prior reports implicating PDE11A variants in familial TGCT, provides the first independent validation of those findings, extends that work to sporadic testicular cancer, demonstrates that these variants are uncommonly but reproducibly associated with TGCT, and refines our understanding regarding which specific inactivating PDE11A variants are most likely to be associated with TGCT risk.

scholarly journals Burned-Out Testicular Cancer: Really a Different History

2017 ◽  
Vol 10 (3) ◽  
pp. 846-850 ◽  
Author(s):  
Claudia Mosillo ◽  
Simone Scagnoli ◽  
Giulia Pomati ◽  
Salvatore Caponnetto ◽  
Maria Laura Mancini ◽  
...  
Keyword(s):  
Testicular Cancer ◽  
Germ Cell ◽  
Histopathological Examination ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Testicular Tumor ◽  
Testicular Germ Cell ◽  
Abdominal Lymph Node ◽  
Cell Components ◽  
Histological Regression

Two or more histological types characterize more than 60% of testicular germ cell tumors (GCTs). Burned-out testicular tumor refers to partial or complete histological regression of the primary testicular lesions. The most frequent GCT type involved in this kind of histological regression is choriocarcinoma, followed by embryonal carcinoma. To our knowledge, there are no cases of the burned-out phenomenon in teratoma. We report a case of a 19-year-old man presenting to our institute with a right testicular lesion, evidence of mediastinal and abdominal lymph node metastasis, and high levels of GCT serum biomarkers. After orchiectomy, the histopathological examination showed a mixed GCT: mature teratoma, immature teratoma, and histological features of testicular cancer regression (burned-out phenomenon). The patient underwent first-line chemotherapy (BEP regimen) which resulted in a complete instrumental and biochemical response after 4 cycles. Teratoma is considered a less aggressive type of GCT. In this particular case, metastatic disease seems to result from non-germ cell components which underwent early spontaneous regression.

scholarly journals Benign Neck Metastasis of a Testicular Germ Cell Tumor

2015 ◽  
Vol 100 (1) ◽  
pp. 164-168 ◽  
Author(s):  
Haim Gavriel ◽  
Stephen Kleid
Keyword(s):  
Germ Cell ◽  
Neck Dissection ◽  
Mature Teratoma ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumor ◽  
Neck Mass ◽  
Testicular Germ Cell ◽  
Chyle Leak ◽  
Neck Metastasis ◽  
Lower Neck

Abstract Germ cell tumors (GCTs) are relatively rare neoplasms considered to be curable malignancies since the introduction of cisplatin. The presence of neck metastasis has been reported, with fewer reports of metastatic mature teratoma. In this study, 3 cases of “benign neck” metastasis in patients with GCT between 1998 and 2010 were reviewed retrospectively. In all 3 cases the presenting clinical sign was a left lower neck mass, leading to the diagnosis of the primary site in the testis. All had surgical salvage following chemotherapy, with benign lesions or mature teratoma in histopathology of the neck mass. Chemotherapy was followed by salvage lower-half neck dissection showing benign features in the neck specimen, even though malignancy was proven histologically in other areas. Only 1 patient had a postoperative chyle leak, which resolved spontaneously after several days. Neck dissection is recommended in those patients because malignancy cannot be excluded.

scholarly journals The Past and Future of Biomarkers in Testicular Germ Cell Tumors

2020 ◽  
Vol 1 (1) ◽  
pp. 77-84
Author(s):  
Aditya Bagrodia ◽  
Siamak Daneshmand ◽  
Liang Cheng ◽  
James Amatruda ◽  
Matthew Murray ◽  
...  
Keyword(s):  
Germ Cell ◽  
Tumor Markers ◽  
Critical Role ◽  
Elevated Serum ◽  
Germ Cell Tumors ◽  
Testicular Germ Cell Tumor ◽  
Next Generation ◽  
Testicular Germ Cell ◽  
Circulating Micrornas ◽  
Serum Tumor Markers

Testicular germ cell tumor (GCT) is the most common malignancy in 18- to 40-year-old men. Unlike most other cancers, GCT is frequently curable even when metastatic. These tumors can be classified histologically into seminoma and non-seminoma, which determines treatment. Therefore, successful treatment requires accurate diagnosis, classification, and monitoring. Serum tumor markers, including lactate dehydrogenase, α-fetoprotein, and β-human chorionic gonadotropin, aid in the classification and staging of GCTs. These markers therefore play a critical role in the decision-making process when managing GCT patients. However, there exist many scenarios in which these markers fail to perform adequately. This is particularly true in the case of seminoma, where only 10% to 15% will have elevated serum tumor markers. Non-specific elevation of these markers is also a common occurrence, complicating the interpretation of borderline positive results, particularly in follow-up. To bridge this gap in performance, next generation biomarkers are being investigated. In this review, we consider the role of conventional serum tumor markers in GCT management and discuss recent advances in the next generation of biomarkers, with a focus on circulating microRNAs. We discuss the value that circulating microRNAs could bring as an addition to currently used markers, as well as potential weaknesses, in GCT management.

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