Mesenteric lymphadenopathy in patients with germ cell tumor.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 347-347
Author(s):  
Hooman Djaladat ◽  
Craig R. Nichols ◽  
Siamak Daneshmand
Keyword(s):  
Lymph Node ◽  
Lymph Nodes ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Mesenteric Lymph Node ◽  
Frozen Section ◽  
Cell Tumor ◽  
High Dose ◽  
Cell Transplant ◽  
Mesenteric Lymph

347 Background: Mesenteric lymphadenopathy may be secondary to inflammatory, infectious or tumoral pathologies. The most common malignancies causing mesenteric adenopathy are gastrointestinal and lymphoma. To the best of our knowledge, there are no reports of germ cell tumor (GCT) presenting with mesenteric adenopathy. Methods: Four patients with GCTs presenting with mesenteric adenopathies were treated in two academic centers (OHSU and USC) by a single surgeon since 2004. All pathologies were non-seminomatous GCT. Their presentation, clinico-pathologic findings and outcome are reviewed. Results: Two cases (19 and 51 yo) were IGCCC poor risk, stage II, testicular GCTs presenting with bulky retroperitoneal, periportal and mesenteric adenopathy. They both underwent post-chemo RPLND with mesenteric lymph node biopsy/resection. The intraoperative mesenteric lymph node frozen section study in one case revealed embryonal cell carcinoma and teratoma; he had early postoperative recurrence and is awaiting high dose chemotherapy and autologous stem cell transplant (HDC/ASCT). The other was teratoma and underwent resection, however he developed lung metastases with elevated AFP 6 months later and was treated with HDC/ASCT, being disease free for 2.5 years. The third case was a 29 yo IGCCC good risk testicular GCT who presented with retroperitoneal (II B) and mesenteric lymphadenopathy. He underwent post-chemo exploration and intraoperative frozen section of the mesenteric lymph nodes showed fibrosis and histiocytic infiltration; therefore classic RPLND was completed. The fourth case was a 24 yo HIV (-) patient with extragonadal GCT originating from the rectosigmoid. At presentation, he had a widespread mesenteric adenopathy, partially responded to primary (BEP) and salvage chemotherapy (VIP); he underwent recto/sigmoid resection, RPLND and PLND and had 52/104 lymph nodes positive for yolk sac tumor. He was referred for HDC/ASCT. Three cases were done recently with limited follow-up. Conclusions: The most common etiologies for mesenteric adenopathy are inflammatory, infection and neoplastic diseases. In the presence of germ cell tumor however, mesenteric adenopathy is most likely secondary to metastasis rather than secondary pathology.

Glypican 3 (GPC3) expression in a lethal subgroup of refractory cisplatin-resistant testicular germ cell tumor (TGCT).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 559-559
Author(s):  
Jad Chahoud ◽  
Miao Zhang ◽  
Song-Chang Lin ◽  
Sue-Hwa Lin ◽  
Shi-Ming Tu
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumor ◽  
Cell Tumor ◽  
Next Generation Sequencing Data ◽  
High Dose ◽  
Cell Transplant ◽  
Primary Tumors ◽  
Heavily Pretreated ◽  
Somatic Transformation ◽  
Gpc3 Expression

559 Background: The oncofetal protein GPC3 has been tested as a therapy target. Early phase clinical trials established the safety and efficacy of anti-GPC3 chimeric antigen receptor modified T cells in patients with refractory or relapsed GPC3+ hepatocellular carcinoma. In TGCT, GPC3 is preferentially expressed at presentation in certain germ cell histological phenotypes (yolk sac tumor [YST], choriocarcinoma), but not in others (embryonal carcinoma, teratoma, seminoma). The aim of this study is to evaluate GPC3 expression in a lethal subgroup of refractory cisplatin-resistant TGCT. Methods: We retrospectively evaluated 615 patients diagnosed with TGCT from January 2000 to December 2010. We identified patients who died from their TGCT. The histologic makeup of primary tumors, next-generation sequencing data and the clinical course of disease were determined for each patient. We prospectively evaluated GPC3 expression by immunohistochemistry (IHC) using a mouse monoclonal antibody (YP7), on tumor tissue from these patients with lethal, heavily pretreated, cisplatin-resistant TGCT. Results: We identified seven patients with fatal and cisplatin-resistant TGCT, with a median age of 30 (28-50) years and a median number of prior therapies of 5 (2-8), including 3 patients who received high-dose chemotherapy with autologous stem-cell transplant. The prospectively collected samples were from different sites of metastasis: lymph nodes (n = 4), peritoneal carcinomatosis (n = 2), and lung (n = 1). The tissue histology comprised YST (n = 2), YST + choriocarcinoma (n = 1), YST + teratoma (n = 1), teratoma (n = 1), and somatic transformation (n = 2). No consistent genetic aberration was detected. The viable germ cell tumor components comprising YST and choriocarcinoma (n = 4) stained strongly positive in a membranous distribution for GPC3. While samples with teratoma and somatic transformation histology (n = 3) did not stain for GPC3. Conclusions: Potentially lethal, heavily pretreated, cisplatin-resistant viable germ cell tumors have enhanced expression of GPC3. Targeted therapy directed against GPC3 could benefit patients harboring such tumors and further investigation is of value.

Decision Making in a Data-Poor Environment: Management of Brain Metastases From Testicular and Extragonadal Germ Cell Tumors

2016 ◽  
Vol 34 (4) ◽  
pp. 303-306 ◽  
Author(s):  
Timothy Gilligan
Keyword(s):  
Lymph Node ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Brain Magnetic Resonance Imaging ◽  
Acute Onset ◽  
Yolk Sac ◽  
Cell Tumor ◽  
High Dose ◽  
Hematopoietic Stem ◽  
History Of

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 32-year-old man with a history of a mixed germ cell tumor of the testis presented with acute-onset, right-sided weakness and numbness. His previous treatment included orchiectomy, which revealed a 5-cm tumor that was 95% yolk sac tumor and 5% embryonal carcinoma, and retroperitoneal lymph node dissection for clinical stage I disease in January 2010, which revealed no nodal metastases. Starting in June 2010, he was treated with four cycles of etoposide and cisplatin for pulmonary and thoracic lymph node metastases and a rising serum alpha-fetoprotein (AFP) level. He subsequently received four cycles of paclitaxel, ifosfamide, and cisplatin for relapse in the lungs and mediastinal nodes with a rising AFP level starting in January 2011. He reported having a 2-week history of intermittent headaches in December 2011, when he presented with acute-onset, right-sided weakness and numbness. Computed tomographs of the head was obtained and demonstrated a left parietal intracranial hemorrhage without midline shift or hydrocephalus. Brain magnetic resonance imaging (MRI) showed a complex, 4.5-cm mass consistent with a hemorrhagic metastasis. His serum AFP level was elevated at 47 ng/mL. The patient became progressively obtunded and underwent emergency surgical decompression and resection of the tumor. Histopathologic evaluation of the resected tissue showed metastatic germ cell tumor predominantly consisting of a yolk sac element ( Fig 1 ). His AFP level declined rapidly after resection, and computed tomography of the chest, abdomen, and pelvis showed no evidence of metastatic disease. However, 2 weeks later, his AFP level rose again, and repeat MRI of the brain showed a 3-cm mass in the left mesial parietal lobe adjacent to the resection site. He started treatment with filgrastim to facilitate collection of circulating hematopoietic stem cells. Several days later, after apheresis, he received his first of two cycles of high-dose carboplatin 700 mg/m2 on days −5, −4, and −3 and etoposide 750 mg/m2 on days −5, −4, and −3. The patient had a complete response to high-dose chemotherapy and no major acute complications. His cancer remains in complete remission 3 years later without additional treatment. His three lines of chemotherapy left him with chronic peripheral neuropathy.

Prognostic Impact of Lymphadenectomy in Different Stages of Malignant Germ Cell Tumor of the Ovary Based on Propensity Score Matching

2019 ◽  
Vol 21 (9) ◽  
pp. 652-661 ◽  
Author(s):  
Ying Chen ◽  
Yang Ning ◽  
Qinghua Zhang ◽  
Ying Xie
Keyword(s):  
Lymph Node ◽  
Propensity Score ◽  
Germ Cell ◽  
Propensity Score Matching ◽  
Germ Cell Tumor ◽  
Cell Tumor ◽  
Stage I ◽  
Prognostic Impact ◽  
Lymph Node Resection ◽  
Malignant Germ Cell Tumor

Background: Lymphadenectomy has been widely used in the treatment of malignant germ cell tumor of the ovary (OGCT), which is a kind of ovarian cancers occurred mostly in young women and adolescent girls. But the clinical decision mainly depends on the doctor’s experience without a well-defined guideline. This population-based study aimed to evaluate the prognostic impact of lymphadenectomy in different stages of malignant germ cell tumors of the ovary. Methods: Patients with known status of lymphadenectomy in different stages of OGCT were explored from the Surveillance, Epidemiology, and End Results (SEER) program database from 1973 to 2013. We used propensity score matching algorithm to reduce the selection bias between the two study groups. Survival curves, univariate and multivariate Cox proportional hazards model were applied to evaluate the prognostic impact of lymphadenectomy in different stages of OGCT. Results: We included 1,996 OGCT patients in the study, and 818 (41%) of them had lymph node resection. Compared to the LND- group, patients with lymph node resection tended to be at stage II and III, had larger tumor sizes and diagnosed as dysgerminoma. The influence of diagnosis ages, marital status and tumor grades were significantly decreased by applying the propensity score matching. Lymphadenectomy-positive (LND+) group demonstrated significantly worse survival than the lymphadenectomy-negative (LND-) group in later stages (stage III, overall, P=0.027, cancerspecific, P=0.006; stage IV, overall, P=0.034, cancer-specific, P=0.037). While, both the overall and cancer-specific survival showed no significant differences between LND+ and LND- in stage I (overall, P=0.411, cancer-specific, P=0.876) and stage II (overall, P=12, cancer-specific, P=0.061). Univariate (overall, HR=1.497, CI=1.010-2.217, P=0.044; cancer-specific, HR=1.524, CI=1.067- 2.404, P=0.050) and multivariate (overall, HR=1.580, CI=1.046-2.387, P=0.030; cancer-specific, HR=1.661, CI=1.027-2.686, P=0.039) Cox proportional model both verified the association between the lymph node resection and better survival in the whole cohort. Conclusion: Lymphadenectomy significantly increased the survival probability of OGCT patients in stage III and IV, but had no significant influence on early-stage patients (stage I and II), indicating lymphadenectomy should be performed in a stage-dependent manner in clinical utility.

Viable malignant germ cell tumor in the postchemotherapy retroperitoneal lymph node dissection specimen

Cancer ◽  
2006 ◽  
Vol 107 (7) ◽  
pp. 1503-1510 ◽  
Author(s):  
Philippe E. Spiess ◽  
Gordon A. Brown ◽  
Louis L. Pisters ◽  
Ping Liu ◽  
Shi-Ming Tu ◽  
...  
Keyword(s):  
Lymph Node ◽  
Germ Cell ◽  
Lymph Node Dissection ◽  
Germ Cell Tumor ◽  
Cell Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Node Dissection ◽  
Retroperitoneal Lymph Node ◽  
Malignant Germ Cell Tumor

Spontaneous Complete Regression of Testicular Germ Cell Tumor: A Case Report

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
S Shawn Liu ◽  
Sara Avalos Hernandez ◽  
Valeria Dal Zotto ◽  
Guillermo Herrera
Keyword(s):  
Lymph Node ◽  
Germ Cell ◽  
Germ Cell Tumor ◽  
Spontaneous Regression ◽  
Cell Tumor ◽  
Complete Regression ◽  
Retroperitoneal Lymph Node ◽  
Testicular Germ Cell ◽  
Current Case ◽  
Histological Features

Abstract Testicular germ cell tumors (TGCTs) may spontaneously regress, making it a diagnostic challenge. We present here a case of 39-year-old African American male with constant abdominal pain radiating into the back. Computed tomography identified bulky retroperitoneal lymphadenopathy. There was no history of testicular trauma. Ultrasonography of right testicle revealed multiple microcalcifications, and a laboratory test indicated elevated beta-hCG and LDH. Patient underwent right orchiectomy, which revealed a grossly well-demarcated white oval lesion (3.1 cm). Histologic examination identified a fibrotic lesion in a background of atrophic parenchyma consistent with scar tissue. The specimen was completely submitted for microscopic evaluation, but neoplasia was not identified. A placental alkaline phosphatase (PLAP) immunohistochemical stain failed to reveal residual germ cell neoplasm in situ. Biopsy of retroperitoneal lymph node identified malignant neoplastic cells expressing PLAP, CD117, CD30, and cytokeratin AE1/AE3. The morphology and immunophenotype were consistent with metastatic germ cell tumor. Spontaneous regression of TGCT is defined as partial or complete tumor disappearance without any treatment. The clinical presentation could be nonspecific. Histologically, tumor regression is indicated by formation of fibrous scar, testicular atrophy, microcalcification, lymphoplasmacytic infiltration, and hemosiderin-phagocytosed macrophages, all of which were present in the current case. However, similar histological features could be identified in testicular ischemia or infraction. Therefore, the diagnosis of complete regression of TGCT is challenging and frequently relies on the present of extragonadal germ cell tumor. In the current case, we reported a spontaneous complete regression of TGCT, supported by a spectrum of histological features and metastasis to retroperitoneal lymph node. Spontaneous regression of TGCT is rare, with less than 150 cases reported in the literature. Since there is a lack of definitive histologic criteria to diagnose complete spontaneous regression of TGCT, when scarring is seen in the testis, additional clinical and imaging evaluation should be followed.

scholarly journals The indication for postchemotherapy lymph node dissection in clinical stage IS nonseminomatous germ cell tumor

Cancer ◽  
2008 ◽  
Vol 112 (4) ◽  
pp. 800-805 ◽  
Author(s):  
Atreya Dash ◽  
Brett S. Carver ◽  
Jason Stasi ◽  
Dean F. Bajorin ◽  
Robert J. Motzer ◽  
...  
Keyword(s):  
Lymph Node ◽  
Germ Cell ◽  
Lymph Node Dissection ◽  
Germ Cell Tumor ◽  
Clinical Stage ◽  
Cell Tumor ◽  
Node Dissection ◽  
Nonseminomatous Germ Cell Tumor

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.

Robot-Assisted Retroperitoneal Lymph Node Dissection for Nonseminomatous Germ Cell Tumor in the Postchemotherapy Setting

Videourology ◽  
2016 ◽  
Vol 30 (5) ◽  
Author(s):  
Michael T. Marshall ◽  
Jonathan H. Berger ◽  
Haidar M. Abdul-Muhsin ◽  
Sean P. Stroup ◽  
Ithaar H. Derweesh ◽  
...  
Keyword(s):  
Lymph Node ◽  
Germ Cell ◽  
Lymph Node Dissection ◽  
Germ Cell Tumor ◽  
Cell Tumor ◽  
Retroperitoneal Lymph Node Dissection ◽  
Node Dissection ◽  
Retroperitoneal Lymph Node ◽  
Robot Assisted ◽  
Nonseminomatous Germ Cell Tumor
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