Clinical presentation and outcomes of patients with testicular tumors in cryptorchid testis.

428 Background: Undescended testis which occurs in 2-4% of all boys confers a natural risk for development of testicular cancer. Cryptorchidism accounts for 10% of all testicular germ cell tumours. The presentation, natural history and outcomes of testicular tumours occurring in cryptorchid testis has not been described in literature so far. Methods: Case records of patients enlisted in the prospectively maintained ‘ testicular cancer database’ at our tertiary cancer care hospital were retrospectively reviewed. Any patient who presented with testicular germ cell tumour with the testis being absent in the scrotum was considered as ‘undescended testis’. Results: From our database of 490 patients with testicular tumours presenting from the year 2014 -2018, 42 patients had testicular cancer in cryptorchid testis. The mean age was 32.9 years (Range:17-56). 24(57.14%) had seminoma and 18(42.86%) had non seminomatous tumors. Orchidopexy was done in 22(52.3%) patients at median age of 30 yrs (Range 2-33). 23 patients had prior undescended testis underwent high inguinal orchidectomy, 13 patients had testis located in pelvis and 6 patient had testis located in the upper abdomen. The average maximum size of tumours presenting with after orchidopexy was 7.34cm (4-10.5cm), in those presenting with pelvic tumours was 9.86cm (7-12.6cm) and in those with intraabdominal tumours was 14.3cm (9-20cm). The median follow-up for these patients was 36 months (3-64 months). There were 6 patients who relapsed after front line therapy whom 3 were salvaged with second line chemotherapy and 2 patients had residual disease at their last follow up. There was one death due to disseminated tumour with brain metastasis. The disease free survival for the whole cohort was 92.85%. Conclusions: The tumours developing in intraabdominal location of testis presented with a larger size and orchiopexy apart from its role in prevention of testicular cancer also helps in surveillance and early detection leading to effective treatment of these highly curable cancers. In the first of its series on testicular tumours in the cryptorchid, we show that they are also as curable as the germ cell tumours developing in the descended testis.

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The Potential of Artificial Intelligence to Detect Lymphovascular Invasion in Testicular Cancer

Cancers ◽

10.3390/cancers13061325 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1325

Author(s):

Abhisek Ghosh ◽

Korsuk Sirinukunwattana ◽

Nasullah Khalid Alham ◽

Lisa Browning ◽

Richard Colling ◽

...

Keyword(s):

Artificial Intelligence ◽

Testicular Cancer ◽

Germ Cell ◽

Lymphovascular Invasion ◽

Automatic Segmentation ◽

Prognostic Significance ◽

Germ Cell Tumours ◽

Testicular Germ Cell ◽

Testicular Germ Cell Tumours ◽

Whole Slide Images

Testicular cancer is the most common cancer in men aged from 15 to 34 years. Lymphovascular invasion refers to the presence of tumours within endothelial-lined lymphatic or vascular channels, and has been shown to have prognostic significance in testicular germ cell tumours. In non-seminomatous tumours, lymphovascular invasion is the most powerful prognostic factor for stage 1 disease. For the pathologist, searching multiple slides for lymphovascular invasion can be highly time-consuming. The aim of this retrospective study was to develop and assess an artificial intelligence algorithm that can identify areas suspicious for lymphovascular invasion in histological digital whole slide images. Areas of possible lymphovascular invasion were annotated in a total of 184 whole slide images of haematoxylin and eosin (H&E) stained tissue from 19 patients with testicular germ cell tumours, including a mixture of seminoma and non-seminomatous cases. Following consensus review by specialist uropathologists, we trained a deep learning classifier for automatic segmentation of areas suspicious for lymphovascular invasion. The classifier identified 34 areas within a validation set of 118 whole slide images from 10 patients, each of which was reviewed by three expert pathologists to form a majority consensus. The precision was 0.68 for areas which were considered to be appropriate to flag, and 0.56 for areas considered to be definite lymphovascular invasion. An artificial intelligence tool which highlights areas of possible lymphovascular invasion to reporting pathologists, who then make a final judgement on its presence or absence, has been demonstrated as feasible in this proof-of-concept study. Further development is required before clinical deployment.

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The utility of lactate dehydrogenase in the follow-up of testicular germ cell tumours

BJU International ◽

10.1111/j.1464-410x.2007.06905.x ◽

2007 ◽

Vol 100 (1) ◽

pp. 30-32 ◽

Cited By ~ 27

Author(s):

Ramachandran Venkitaraman ◽

Bernadette Johnson ◽

Robert A. Huddart ◽

Chris C. Parker ◽

Alan Horwich ◽

...

Keyword(s):

Lactate Dehydrogenase ◽

Germ Cell ◽

Germ Cell Tumours ◽

Testicular Germ Cell ◽

Testicular Germ Cell Tumours

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MANAGEMENT OF BILATERAL TESTICULAR GERM CELL TUMOURS – EXPERIENCE OF THE GERMAN TESTICULAR CANCER STUDY GROUP (GTCSG)

European Urology Supplements ◽

10.1016/s1569-9056(06)60305-9 ◽

2006 ◽

Vol 5 (2) ◽

pp. 97 ◽

Cited By ~ 23

Author(s):

A. Heidenreich ◽

P. Albers ◽

S. Krege

Keyword(s):

Testicular Cancer ◽

Germ Cell ◽

Study Group ◽

Germ Cell Tumours ◽

Testicular Germ Cell ◽

Cancer Study ◽

Testicular Germ Cell Tumours ◽

Cancer Study Group

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Cisplatin related cardiotoxicity – acute and chronic cardiovascular morbidity in a testicular cancer survivor

Scottish Medical Journal ◽

10.1177/0036933019897347 ◽

2019 ◽

Vol 65 (1) ◽

pp. 24-27 ◽

Cited By ~ 1

Author(s):

Andrew J Morrow ◽

Alan C Cameron ◽

Alexander R Payne ◽

Jeff White ◽

Ninian N Lang

Keyword(s):

Testicular Cancer ◽

Germ Cell ◽

Metabolic Dysfunction ◽

Germ Cell Tumours ◽

Cardiovascular Risks ◽

Testicular Germ Cell ◽

St Segment Elevation ◽

Obstructive Lesion ◽

Almost All ◽

Proximal Occlusion

Testicular germ cell tumours are the most common malignancy in men aged 20 to 40 years. They are subdivided into seminoma and non-seminomatous germ cell tumours (NSGCTs). Both seminoma and NSGCT occur at about the same rate, however some tumours contain a combination of both. Cisplatin-based chemotherapy is used adjuvantly in high-risk stage 1 mixed and NSGCT patients and contributes towards oncological cure in almost all metastatic cases, regardless of histology. However, cardiovascular toxicity is a major concern. In addition to acute endothelial toxicity and associated risk of arterial thrombosis, accelerated atherosclerosis may be the result of chemotherapy-associated latent cardio-metabolic dysfunction. A 45-year-old man began treatment with cisplatin-based chemotherapy for testicular cancer. On day 9, he suffered an anterior ST segment elevation myocardial infarction (STEMI). There was proximal occlusion of the left anterior descending (LAD) artery but otherwise normal coronary arteries. Ten months following chemotherapy, he had another STEMI. There was a fresh obstructive lesion in the previously angiographically normal mid LAD, new diffuse coronary atheroma elsewhere and a deterioration in lipid profile despite statin therapy. Acute and longer-term cardiovascular risks of cisplatin-based chemotherapy may have different underlying pathophysiological mechanisms. These issues are of growing relevance in a population of patients expected to have excellent cancer-related outcomes.

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Late relapse of testicular cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.5.1170 ◽

1995 ◽

Vol 13 (5) ◽

pp. 1170-1176 ◽

Cited By ~ 234

Author(s):

J Baniel ◽

R S Foster ◽

R Gonin ◽

J E Messemer ◽

J P Donohue ◽

...

Keyword(s):

Testicular Cancer ◽

Germ Cell ◽

Cell Cancer ◽

Germ Cell Cancer ◽

Stage I ◽

Late Relapse ◽

Testicular Germ Cell ◽

Testicular Germ Cell Cancer ◽

Disease Free

PURPOSE This study analyzed a large group of patients with testicular germ cell cancer in complete remission, who relapsed more than 2 years after completion of treatment. PATIENTS AND METHODS A review of all patients treated at Indiana University Medical Center from 1979 through 1992 for late relapse was conducted. Eighty-one patients were treated for late relapse of testicular cancer. Forty-seven patients relapsed more than 5 years after successful management of their initial disease. RESULTS At initial diagnosis, 35 patients had clinical stage I, 18 stage II, and 28 stage III disease. Twenty-three of 35 stage I, all 18 stage II, and all 28 stage III patients were treated by chemotherapy before their late relapse. The median follow-up duration of patients post-management of late relapse was 4.8 years. Twenty-one patients (25.9%) are continuously disease-free. Nineteen of these 21 patients had surgical resection of carcinoma or teratoma as a component of their therapy. Of sixty-five patients treated for late relapse by chemotherapy, 17 (26.2%) had a complete response, but only two have been continuously disease-free with chemotherapy alone. These two never received prior chemotherapy. CONCLUSION Late relapse of testis cancer is more common than previously thought. Surgery is the preferred mode of therapy. Chemotherapy has only modest success in this entity, in contrast to the excellent results in de novo germ cell tumors. Patients treated for testicular germ cell cancer need annual follow-up evaluations throughout their life due to the possibility of late relapse.

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Prognostic factors for relapse in patients with clinical stage I testicular cancer: protocol for a Danish nationwide cohort study

BMJ Open ◽

10.1136/bmjopen-2019-033713 ◽

2019 ◽

Vol 9 (10) ◽

pp. e033713 ◽

Cited By ~ 2

Author(s):

Thomas Wagner ◽

Birgitte Grønkær Toft ◽

Birte Engvad ◽

Jakob Lauritsen ◽

Michael Kreiberg ◽

...

Keyword(s):

Risk Factors ◽

Testicular Cancer ◽

Germ Cell ◽

Clinical Stage ◽

Cell Cancer ◽

Germ Cell Cancer ◽

Stage I ◽

Testicular Germ Cell ◽

Testicular Germ Cell Cancer

IntroductionApproximately one-fourth of patients with clinical stage I testicular germ cell cancer will relapse within 5 years of follow-up. Certain histopathological features in the primary tumour have been associated with an increased risk of relapse. The available evidence on the prognostic value of the risk factors, however, is hampered by heterogeneity of the study populations included and variable reporting of the histopathological features. The aim of this study is to identify pathological risk factors for relapse in an unselected large nationwide cohort of patients with stage I disease.Methods and analysisAll incident cases of stage I testicular germ cell cancer diagnosed in Denmark between 2013 and 2018 will be identified using the nationwide prospective Danish Testicular Cancer (DaTeCa) database. Archived microscopic slides from the orchiectomy specimens will be retrieved through linkage to the Danish Pathology Data Bank and reviewed blinded to the clinical outcome. The DaTeCa database includes 960 stage I seminoma patients with expected 185 relapses and 480 patients with stage I non-seminoma with expected 150 relapses. A minimum follow-up period of 3 years of all patients will be ensured. Predefined prognostic variables will be investigated with regard to relapse in univariable and multivariable analysis using the Cox proportional hazards model.Ethics and disseminationThis study protocol has been approved by the Regional Ethics Committee (Region Zealand, Denmark) and the Danish Data Protection Agency. All data will be managed confidentially according to legislation. Study results will be presented at international conferences and published in peer-review journals.

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Excellent outcomes in bilateral testicular germ cell tumors over four decades.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.7_suppl.523 ◽

2019 ◽

Vol 37 (7_suppl) ◽

pp. 523-523

Author(s):

Ning-Ning Lu ◽

Aaron Richard Hansen ◽

Philippe L. Bedard ◽

Padraig Richard Warde ◽

Joan Sweet ◽

...

Keyword(s):

Testicular Cancer ◽

Germ Cell ◽

Germ Cell Tumors ◽

Patient Characteristics ◽

Stage I ◽

Second Primary ◽

Time Interval ◽

Testicular Germ Cell ◽

Prior Therapy

523 Background: Bilateral testicular germ cell tumours (BTC) form a small minority of testicular cancer and detailed management data are sparse. Methods: Bilateral testicular cancer (BTC) patients managed at a single cancer centre were retrospectively analyzed. Synchronous BTC was defined as uni+contralateral presentation within 3 months. Patient characteristics, treatment and outcomes were collected. Kaplan-Meier method was used to calculate the overall survival (OS) and relapse-free survival (RFS). Results: Between Jan 1971 to Jun 2018, 118 pts were included. Nine patients (7.6%) had cryptorchidism. Twenty-two patients (18.6%) had synchronous BTC at median age of 30(21-54) years, 11 presented with concordant histology (10-seminoma). Median follow-up time was 96(1-220) months. Two of 14 patients (14%) with stage I disease on surveillance had retroperitoneal nodal recurrence, other 3 (21%) had testicular recurrence after partial orchiectomy alone. No recurrence occurred for 8 stage II/III patients (36%) who received stage-appropriate treatment. All patients were alive without disease at last follow-up. For metachronous BTC, the median age was 27(16-68) and 37(19-78) years for first and second diagnosis, respectively. The median time interval was 88 (8-352) months, with shorter interval when second primary was non-seminoma, median 69 vs. 92 months. Concordant histology was present in 58 (38-seminoma) patients and discordant in 38 patients. There were 66, 23, 7 and 84, 9, 3 patients with stage I, II, III disease for first and second testicular cancer (TC), respectively. For all stage I disease, 69% of non-seminoma (n = 33) and 79% of seminoma (n = 81) were on surveillance, of whom the crude relapse rate was 15%. The median follow-up time after second diagnosis was 87 months. In all, 35 patients (30%) with recurrence except 1 were successfully salvaged. The 10-year OS and RFS for whole cohort was 99% and 69.8%, respectively. Conclusions: In our series, seminoma was the more common pathology, and management based on pathology and stage yielded excellent outcomes regardless of prior therapy. Metachronous BTC may occur at extremely long time intervals such that longer follow-up is needed to capture the majority of contralateral primary TC.

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