On the necessity for postchemotherapy surgery for residual abdominal masses in metastatic nonseminomatous germ cell tumors (NSGCT) of testis

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5088-5088
Author(s):  
S. J. Harland ◽  
R. Welch ◽  
R. Huddart ◽  
S. Stenning ◽  
P. Pollock ◽  
...  
Keyword(s):  
Abdominal Mass ◽  
Germ Cell Tumors ◽  
Good Prognosis ◽  
Retroperitoneal Lymph Node Dissection ◽  
Chemotherapy Response ◽  
Abdominal Masses ◽  
Residual Masses ◽  
One Year ◽  
The Uk ◽  
The Masses

5088 Background: Residual abdominal masses after chemotherapy for metastatic NSGCT of testis may contain viable tumor-derived tissue which can be a nidus for relapse of disease, particularly when the tissue is frankly malignant. This justifies routine retroperitoneal lymph node dissection (RPLND) for large masses where malignant tissue is found at an appreciable rate. Yet RPLND is often carried out for smaller, or even absent, residual masses and differentiated teratoma (TD) is commonly found. There is little data on the consequence of leaving these smaller masses in situ, which is the practice in some units in the UK. Methods: 51 patients were identified from the MRC patients entered into the TE20 trial of 3 vs 4 cycles of BEP for good prognosis metastatic NSGCT who fell into the following category: metastatic NSGCT, residual abdominal mass only, unresected post-chemotherapy, response evaluation: CR or PR marker -ve. Collaborators were asked to report on mass size, relapse status, whether an operation was ever performed and the latest CT appearance. Results: 51/51 responses were received. Follow-up from the end of chemotherapy was >3years in all but two cases and the median was 5 years. When later surgery was carried out, for persistence or enlargement of the masses, the specimens contained TD with or without necrosis. One patient suffered a relapse one year after the surgery which took place 4.5 years after chemotherapy. Of the 41 patients who did not undergo surgery, 37 were considered on subsequent CTs to have normal appearances without further treatment. Conclusions: For patients with small residual masses in good prognosis metastatic disease no short or medium term benefit from routine surgery would have been seen. Its role in this situation is therefore questionable. For larger (>14mm) masses the need for routine surgery merits further study. [Table: see text] No significant financial relationships to disclose.

Management of clinical stage (CS) I and II patients with non-seminomatous germ cell tumors of the testis (NSGCTT) avoiding upfront retroperitoneal lymph node dissection (RPLND)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5090-5090
Author(s):  
A. Flechon ◽  
F. El Karak ◽  
C. Salas ◽  
M. Rivoire ◽  
J. Droz
Keyword(s):  
Medical Management ◽  
Residual Disease ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Retroperitoneal Lymph Node Dissection ◽  
Retroperitoneal Lymph Node ◽  
Residual Masses ◽  
Time To Relapse ◽  
Car Accident

5090 Background: CS I, Is, IIa and IIb may be treated by either upfront RPLND or upfront medical management followed by RPLND in selected cases. We retrospectively analyzed the later approach. Methods: From 1993 to 2003, 225 NSGCTT patients CS I and Is, IIa, IIb were treated at our center. In total, 148 patients with CS I were managed by surveillance followed by CT and surgical exeresis of residual disease in case of relapse and 77 with CS Is, IIa and IIb underwent upfront chemotherapy and RPLND in case of residual masses. Median follow-up was 52 months for all patients (0.16–165 months). Results: In CS I: 47/148 (32%) patients relapsed: 22/42 (52%) patients with microvascular involvement versus 25/106 without (24%). The median time to relapse was 5 months (0.16–79 months). All relapsing patients received CT except one for whom we have no information. Twenty-two patients (46%) had RPLND. Two patients died, one probably of haemorrhage one month after RPLND and one in a car accident. In CS II: 4 (5%) patients had CS Is, 40 (52%) CS IIa and 33 (43%) CS IIb. Respectively 71 (92%), 5 (6.5%) and 1 (1,5%) patients had good, intermediate or poor prognosis according to the IGCCCG. All patients received cisplatin-based chemotherapy. Forty-one (53%) patients had RPLND after CT and one refused surgery for residual disease. Histological review showed a teratoma in 22 cases (54%), necrosis in 16 (39%) and residual active disease in 3 (7%). Six patients (8%) relapsed: 1 of them had a growing teratoma. One patient died of disease and all others are alive with no evidence of disease. In total, after medical management of CS I and II, avoiding primary RPLND, only 124 (55%) and 63 (28%) patients had eventually CT and RPLND respectively. Ninety-nine percent patients were cured. Conclusions: Upfront medical treatment of CS I and CS II NSGCTT is a good option which allows to avoid unnecessary CT and RPLND indications. [Table: see text] No significant financial relationships to disclose.

Evaluation of the oncologic benefit of adjunctive surgery at time of postchemotherapy retroperitoneal lymph node dissection (PC-RPLND).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 388-388 ◽  
Author(s):  
Tim Nestler ◽  
Pia Paffenholz ◽  
David Pfister ◽  
Andreas Hiester ◽  
Alessandro Nini ◽  
...  
Keyword(s):  
Germ Cell ◽  
Frozen Section ◽  
Intraoperative Complications ◽  
Germ Cell Tumors ◽  
Rank Test ◽  
Retroperitoneal Lymph Node Dissection ◽  
Safe Procedure ◽  
Multiple Organs ◽  
Residual Masses ◽  
Metastatic Involvement

388 Background: PC-RPLND for advanced nonseminomatous germ cell tumors aims to resect all remaining metastatic tissue. The resection of adjacent visceral or vascular organs is commonly performed to achieving complete resection of the residual masses. However, the frequency of metastatic involvement of those organs with teratoma or vital cancer is currently unknown. Methods: We reviewed a cohort of 1181 patients who underwent PC-RPLND between 2008 and 2018 as a 2-center study and identified 235 (20%) cases of adjunctive surgery during PC-RPLND. We analysed the pathohistological presence of germ cell tumor elements in the resected organs: viable tumor (V), teratoma (T) or necrosis / fibrosis (N). Surgery associated complications were reported according to the Clavien-Dindo classification. Outcomes of subgroups were compared by using log-rank test. Results: V, T, N was present in 51 (21%), 91 (39%) and 93 (40%) of all patients with adjunct resected organs. In 235 patients, 316 adjunct organs were resected with 64 (27%) of these patients receiving a resection of multiple organs. The kidney was the most often resected organ (n = 74; V: 27% T: 39% N: 34%), followed by V. Cava (n = 66; V: 24% T: 36%, N: 40%) and partial liver resections (n = 48; V: 15%, T: 31%, N: 54%). Intraoperative complications occurred in 21% of patients (VT 32% vs N 17%, p = 0.021). Postoperative complications occurred in 35% of which 22% were Clavien Grad III-V showing no significant differences between VTN p = 0.093. 27% of all patients suffered from a relapse during a median follow-up of 22 months [0-180]. Patients with T or V in the resected specimens had a significantly reduced 5-year RFS compared to patients with only N (39%, 81%, p < 0.001). Conclusions: This study shows for the first time that 40% of all resections of adjunct organs are oncologically unnecessary due to the presence of N only in the pathological specimens. In case of doubt we propose an organ safe procedure with multiple intraoperative frozen section to avoiding oncologically unnecessary adjunctive surgeries especially nephrectomies and vascular resections. Additionally, a more accurate presurgical workup is required to spare patients with N from PC-RPLND.

scholarly journals Neuroblastoma Occurring in a 38-year Old Nigerian Man: A Rare Finding

Rare Tumors ◽  
2009 ◽  
Vol 1 (1) ◽  
pp. 20-21 ◽  
Author(s):  
Martin A. Nzegwu ◽  
Aloy Aghaji
Keyword(s):  
Standard Treatment ◽  
Treatment Guidelines ◽  
Histological Grade ◽  
Abdominal Mass ◽  
Tumor Resection ◽  
Neuron Specific Enolase ◽  
Mycn Amplification ◽  
Standard Treatment Guidelines ◽  
One Year ◽  
The Masses

Neuroblastoma (NB) is a common malignancy in children, but rarely occurs in adults. Accepted unfavorable prognostic factors include age over one year, low histological grade and advanced stage, MYCN amplification, chromosomal aberrations, elevations of neuron specific enolase and lactate dehydrogenase, and increased catecholamine metabolites in urine or serum. In adults, abdomen/retroperitoneum are the primary sites and in children the adrenal gland. We report a 38-year old civil servant who presented at our urology clinic on the 21st of December 2007 with a six month history of right flank dull pain which was worse on walking and relieved by rest, hypertension and a large right retroperitoneal mass. Tumor resection revealed a grade III NB. Chemotherapy using a combination of vincristine, adriamycin and cyclophosphamide was started. Follow-up showed regression of the mass initially with a relapse after patient absconded for three months. He resurfaced with new masses and he had a repeat chemotherapy with disappearance of the masses and is currently undergoing further treatment. To our knowledge this is the only report of NB in an adult registered so far in Nigeria and perhaps the whole of Africa. Currently, there are no standard treatment guidelines for patients with NB in adulthood. This study emphasizes the need for a standard treatment regime for adult onset neuroblastoma and its recognition as a possible differential in intra-abdominal mass in adults.

scholarly journals Study on clinical profile and management of abdominal tumours in children

2019 ◽  
Vol 6 (2) ◽  
pp. 447
Author(s):  
Varsha S. Kane ◽  
Babu P. Ubale
Keyword(s):  
Abdominal Mass ◽  
The Other ◽  
Clinical Profile ◽  
Urinary System ◽  
Challenging Problem ◽  
Intravenous Pyelography ◽  
Abdominal Masses ◽  
The Masses ◽  
Abdominal Tumours ◽  
Routine Investigations

Background: The discovery of an abdominal mass in a child usually presents a challenging problem in the diagnosis and treatment to the paediatrician, surgeon and urologist. Because of the heterogenicity of the lesion knowledge of differential of a mass in abdomen is essential for the logical evaluation of a child.Methods: The present study comprises of 25 children who presented with an intra-abdominal mass were included. The medical causes of the abdominal masses i.e. hepatosplenomegaly and leukemias were excluded. All patients admitted were routine investigated and whichever necessary. After the diagnosis, surgery was done wherever indicated and post-operatively the diagnosis was confirmed after the histopathological report.Results: All the cases presented with mass in abdomen while the other presentations were pain in abdomen (36%), fever (20%) and haematuria and vomiting (16% each). It was found that 64% of the masses were urological in origin while 36% of the masses were non-urological in origin. 21 (84%) patients underwent surgery, 10 (40%) patients took chemotherapy, 9 (36%) patients took radiotherapy.Conclusions: Routine investigations were only helpful in diagnosing the infection in infecting cases. Most reliable specific investigation was intravenous pyelography. It was found that majority of the abdominal masses in children were arising from urinary system. Correlation between pre-operative and post-operative diagnosis was found almost consistent.

scholarly journals A Rare Case Report of ‘Fetus in Fetu’ in a One Year Eight Month Old Child

2020 ◽  
Vol 9 (3) ◽  
pp. 1-3
Author(s):  
Manas Mukul Mandal ◽  
Rohit Shaw ◽  
Narendranath Mukhopadhyay ◽  
Sumon Kumar Saha
Keyword(s):  
Germ Cell Tumors ◽  
The Body ◽  
Palpable Mass ◽  
Fetus In Fetu ◽  
Organ Systems ◽  
Abdominal Masses ◽  
Rare Case Report ◽  
Vertebral Bodies ◽  
One Year ◽  
Malignant Germ Cell Tumors

Fetus in fetu is a very unusual pathology in which a deformed underdeveloped fetus is found inside the body of another child. It is an uncommon abnormality and thought to be a result of abnormal embryogenesis in the case of diamniotic monochorionic pregnancy. Most commonly presents as a palpable mass in the abdomen. Imaging modalities can reveal the presence of bony elements within the mass cavity like vertebral bodies, long bones, and even underdeveloped organ systems. It should be differentiated from mature or well-organized teratoma & other causes of infantile abdominal masses like Nephroblastoma, Neuroblastoma, Hydronephrosis & malignant germ cell tumors in undescended testis. Surgery is the mainstay of treatment. To date around two hundred cases have been reported worldwide.

Compliance with follow-up (f.-up) program and outcome of patients (pts) with stage I nonseminomatous germ cell tumors (NSGCT).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15025-e15025
Author(s):  
Mikhail Fedyanin ◽  
Alexey Tryakin ◽  
Elena Denisova ◽  
Anatoly Bulanov ◽  
Tatiana Zakharova ◽  
...  
Keyword(s):  
Germ Cell Tumors ◽  
Residual Tumor ◽  
Good Prognosis ◽  
Stage I ◽  
Retroperitoneal Lymph Node Dissection ◽  
Surgical Removal ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Group 5 ◽  
The Impact

e15025 Background: There are limited data about f.-up quality of pts with stage I NSGCT after orchiectomy (OE) management and their survival. A retrospective analysis was performed to find the impact of compliance with schedule of f.-up on outcome of relapsed pts with stage I NSGCT. Methods: We analyzed data of 261 pts with stage I GCT treated in our department from 1994 to 2010. NSGCT was revealed in 128 (49%) pts. Therapeutic options following OE comprised retroperitoneal lymph node dissection (RPLND) – in 4/128 (3%), adjuvant cisplatin-based chemotherapy (CT) - in 75/128 (58%) and surveillance - in 49/128 (39%). The following procedures were performed in our center during the f.-up: ultrasound of the abdomen and pelvis, serum AFP, HCG and LDH – bimonthly in the 1st year, quarterly in the 2nd year, biannually in the 3rd-4th years and then annually; X-Ray of the chest – thrice-yearly in the 1st year, biannually on the 2nd year and then annually. Median f.-up time was 75 (range 16 - 176) months. Results: No pts had relapse after RPLND, 4/75 (5,3%) pts had relapses after CT, 16/49 (32%) pts – in surveillance group. 17/20 (85%) relapses were revealed in the first 2 years of f.-up. During relapses, 17/20 (85%) pts had good, 2/20 (10%) - intermediate and 1 patient - poor IGCCCG prognosis. The mean number of visits in the 1st year after OE was 3, on the 2nd year -1,4, in the 3rd- 4th years - 1 per year. All relapsed pts received induction CT (EP or BEP regimen). 11/20 (55%) pts were compliant to visits, 9/20 (45%) pts were not. The 5-years overall survival was 90% and 68% (p=0,3); the median size of metastases in RPLN was 2,2 and 5,5 cm (p=0,001), respectively. All pts in intermediate and poor prognosis were in the noncompliant group, whereas all pts, who were compliant were in good prognosis (3/9 (33%) vs 0/11 (0%), p=0,07). Moreover, surgical removal of residual tumor after induction CT was more often performed in the noncompliant group (5/11 (33%) vs 5/9 (71%), р=0.6). Conclusions: Poor compliance with f.-up program in stage I NSGCT results to non significant worse long-term outcome. Also pts, who were compliant had significantly smaller size of metastases in retroperitoneal lymph nodes at relapse and had good IGCCCG prognosis in all case.

Serum miRNA to predict post-chemotherapy viable disease in testicular non-seminomatous germ cell tumor patients.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 546-546
Author(s):  
Ricardo Romao Nazario Leao ◽  
Ton Van Agthoven ◽  
Arnaldo Figueiredo ◽  
Kamel Fadaak ◽  
Pedro Castelo-Branco ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Area Under The Curve ◽  
Retroperitoneal Lymph Node Dissection ◽  
Serum Mirna ◽  
Serum Microrna ◽  
Therapeutic Value ◽  
Residual Masses ◽  
Chemotherapy Patients ◽  
Nonseminomatous Germ Cell Tumors

546 Background: Retroperitoneal lymph node dissection (RPLND) is recommended for residual masses > 1cm post-chemotherapy (pc) for nonseminomatous germ cell tumors (NSGCT). There is no reliable predictor for pcRPLND histology and up to 50% will harbour necrosis/fibrosis only, thus rendering a potentially morbid surgery to be of limited therapeutic value. Objective: To evaluate the ability of defined serum microRNA (miRNA) using the ampTSmiR test to predict residual viable NSGCT after chemotherapy. Methods: Serum miRNA levels (miR-371a-3p, miR-373-3p and miR-367-3p) were measured in 82 patients (cohort A = 39, cohort B = 43) treated with orchiectomy, chemotherapy and pcRPLND to predict viable GCT post-chemotherapy. Outcomes, measurements and statistical analysis: miRNA levels were compared to clinical characteristics, serum tumor markers and correlated with presence of viable GCT (vs. teratoma; vs. necrosis/fibrosis). miRNA-discriminative capacity was determined by receiver operating characteristic (ROC) analysis. Results: Serum miRNA were associated with stage at the time of chemotherapy and declined significantly post-chemotherapy. Patients with fibrosis/necrosis and teratoma had a significant decline in all three miRNA levels after chemotherapy, while those with viable disease had very little change. Patients with necrosis/fibrosis demonstrated similar miRNA levels as patients with residual teratoma. miR-371a-3p demonstrated the highest discriminative capacity [area under the curve (AUC) 0.874, CI 95% 0.774 - 0.974 p < 0.0001] for viable disease post chemotherapy. If considering a more relaxed cut-point of 3cm before consideration of pcRPLND, miR-371a-3p correctly stratified all patients with residual retroperitoneal lesions ≤ 3 cm ( p= 0.02; 100% sensitivity). Conclusions: Our study is the first to explore a miRNA-based serum test to determine histology in post-chemotherapy residual masses and we demonstrated the value of miR-371a-3p to predict presence of viable GCT. Prospective studies are required to confirm its clinical utility.

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