Simultaneous intracranial and testicular germ cell tumors: illustrative 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.

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Mature teratoma identified after postchemotherapy surgery in patients with disseminated nonseminomatous testicular germ cell tumors

Cancer ◽

10.1002/(sici)1097-0142(19980401)82:7<1343::aid-cncr18>3.0.co;2-6 ◽

1998 ◽

Vol 82 (7) ◽

pp. 1343-1351 ◽

Cited By ~ 71

Author(s):

Dirk J.�A. Sonneveld ◽

Dirk Th. Sleijfer ◽

Heimen Schraffordt Koops ◽

Mariel E. Keemers-Gels ◽

Willemina M. Molenaar ◽

...

Keyword(s):

Germ Cell ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Testicular Germ Cell Tumors ◽

Testicular Germ Cell

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Testicular Germ Cell Tumors: Serological and Immunohistochemical Diagnosis

Acta Medica Academica ◽

10.5644/ama2006-124.326 ◽

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

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.Conclusion. 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.

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Mature Teratoma Identified After Postchemotherapy Surgery in Patients With Disseminated Nonseminomatous Testicular Germ Cell Tumors: A Plea for an Aggressive Surgical Approach

The Journal of Urology ◽

10.1016/s0022-5347(01)62318-8 ◽

1998 ◽

Vol 160 (6 Part 1) ◽

pp. 2293-2293 ◽

Cited By ~ 1

Author(s):

D.J.A. Sonneveld ◽

D. Th. Sleijfer ◽

H. Schraffordt Koops ◽

M.E. Keemers-Gels ◽

W.M. Molenaar ◽

...

Keyword(s):

Germ Cell ◽

Surgical Approach ◽

Mature Teratoma ◽

Germ Cell Tumors ◽

Testicular Germ Cell Tumors ◽

Testicular Germ Cell ◽

Aggressive Surgical Approach

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Burned-Out Testicular Cancer: Really a Different History

Case Reports in Oncology ◽

10.1159/000480493 ◽

2017 ◽

Vol 10 (3) ◽

pp. 846-850 ◽

Cited By ~ 3

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.

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Discontinuous Involvement of Spermatic Cord Soft Tissue in Testicular Germ Cell Tumors: A Multi-Institution Experience

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.339 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S155-S156

Author(s):

A Ali ◽

J So ◽

F Khani ◽

M Kvetoslava ◽

H Miyamoto ◽

...

Keyword(s):

Soft Tissue ◽

Germ Cell ◽

Tumor Size ◽

Spermatic Cord ◽

Statistical Significance ◽

Germ Cell Tumors ◽

Testicular Tumor ◽

Distant Metastases ◽

Testicular Germ Cell Tumors ◽

Testicular Germ Cell

Abstract Introduction/Objective In the 8th Edition AJCC Cancer Staging Manual, discontinuous involvement of spermatic cord soft tissue (DISC) by testicular germ cell tumors (GCT) is regarded as metastatic deposit (pM1), placing the patient in clinical prognostic stage group (CPSG) III. We conducted a multi-institution study to corroborate or refute the current recommendations. Methods: Thirty-eight cases of GCT with spermatic cord involvement were collected from 13 institutions in Europe, Phillipines and America. Clinical and pathologic data was obtained. Results Tumors included 28 (73%) non-seminomatous and 10 (26%) seminomatous GCTs. Mean testicular tumor size was 6.6 cm (range 1.3-18). After review by an uropathologist, cases were classified as cord LVI [T2] (n=3), continuous cord involvement (CCI) [T3] (n=13), and DISC (n=22). Mean cord tumor size for DISC was 0.9 cm (range 0.1-4.5). CPSG was available for 33 and follow-up (FU) for22 patients with a mean length of FU of 38 months (range 2-144). Seven (39%) DISC patients were CPSG II (regional LN metastases), and 11 (61%) CPSG III (distant metastases). On FU, 5 (45%) DISC patients had no evidence of disease (NED); 6 (55%) were alive with disease (AWD). Three (25%) CCI patients were CPSG I (local disease), 6 (50%) CPSG II, and 3 (25%) CPSG III. On FU, 6 (60%) CCI patients were NED, 4 (40%) AWD. Cord LVI patients were one in each CPSG. One cord LVI patient was NED, the others were lost at FU. All DISC (100%) patients with available CPSG had advanced disease (CPSG II or III), compared to 75% of CCI, and 67% of cord LVI patients. Conclusion Although it did not reach statistical significance (p=0.054; Fisher’s exact test), DISC patients were more likely to have CPSG II and III compared to CCI patients. Our findings suggest a worse behavior in patients with DISC, supporting a higher pathologic stage than CCI.

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Burned-Out Testicular Tumors in Adolescents: Clinical Aspects and Outcome

Frontiers in Pediatrics ◽

10.3389/fped.2021.688021 ◽

2021 ◽

Vol 9 ◽

Author(s):

Giorgio Persano ◽

Alessandro Crocoli ◽

Maria Debora De Pasquale ◽

Raffaele Cozza ◽

Rita Alaggio ◽

...

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Clinical Manifestations ◽

Testicular Tumor ◽

Clinical Aspects ◽

Testicular Germ Cell Tumors ◽

Testicular Tumors ◽

Testicular Germ Cell ◽

Visceral Metastases ◽

Systemic Symptoms

Purpose: Testicular germ cell tumors are the fourth most common neoplasm in adolescents, accounting for 8% of all tumors in the age group 15–19 years. On rare instances, the primary testicular lesion is not clinically or radiologically evident while nodal or visceral metastases represent the clinical manifestations of the disease. This phenomenon is described as “burned-out testicular tumor.” In this paper, the authors report a single-institution experience with burned-out testicular tumors in adolescents and discuss their clinical implications.Patients and Methods: All the patients diagnosed with metastatic testicular germ cell tumors at Bambino Gesù Children Hospital between January 1, 2010, and June 30, 2020, were included in the study. Patients were categorized into two groups: “primary testicular” and “burned out.” All the patients were staged and treated according to the AIEOP–TCGM 2004 protocol.Results: Eleven patients were classified as “primary testicular,” and five patients were classified as “burned out.” “Burned-out” tumors were associated with the presence of systemic symptoms compared to “primary testicular” tumors (80 vs. 0%; p = 0.0027) and higher aFP, hCG, and LDH levels (p < 0.00001). The “burned-out” population had a statistically significant higher incidence of relevant toxicity than the “primary testicular” population (80 vs. 18%; p = 0.0357) and a worse outcome in terms of both mean overall survival (15 vs. 43 months; p = 0.0299) and mean event-free survival (12 vs. 38 months; p = 0.0164).Conclusion: “Burned-out” testicular tumors seem to be a well-distinct clinical entity with a high treatment-related toxicity and poor prognosis. Further studies are needed to clarify the “burned-out phenomenon” and to identify more effective therapeutic strategies for these patients.

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Dedifferentiated Liposarcoma With Rhabdomyosarcomatous Differentiation Producing HCG: A Case Report of a Diagnostic Pitfall

International Journal of Surgical Pathology ◽

10.1177/1066896918760192 ◽

2018 ◽

Vol 26 (5) ◽

pp. 448-452 ◽

Cited By ~ 4

Author(s):

Elena Maryamchik ◽

Kirill A. Lyapichev ◽

Bradford Halliday ◽

Andrew E. Rosenberg

Keyword(s):

Germ Cell ◽

Germ Cell Tumors ◽

Retroperitoneal Tumor ◽

Dedifferentiated Liposarcoma ◽

Testicular Germ Cell Tumors ◽

Retroperitoneal Mass ◽

Testicular Germ Cell ◽

Diagnostic Pitfall ◽

First Case

We report a first case of paraneoplastic human chorionic gonadotropin (HCG) production in a dedifferentiated liposarcoma with rhabdosarcomatous differentiation in an 83-year-old man with a retroperitoneal mass, unilateral scrotal enlargement, and a serum HCG level of 843 IU/L. Core biopsy of the retroperitoneal mass revealed rhabdomyosarcoma. Orchiectomy revealed a paratesticular dedifferentiated liposarcoma with rhabdosarcomatous differentiation. Fluorescence in situ hybridization analysis performed on both the retroperitoneal and paratesticular masses revealed amplification of MDM2. The retroperitoneal tumor was interpreted as metastatic dedifferentiated liposarcoma with the dedifferentiated component represented by rhabdomyosarcoma. HCG production is a common feature of testicular germ cell tumors, less common in carcinomas, and extremely rare in sarcomas. Accordingly, sarcomas secreting HCG are a potential diagnostic pitfall, and raise the differential diagnosis of germ cell tumors and a variety of carcinomas. HCG production by carcinomas is a known poor prognostic finding, however the significance of its production in sarcomas is unknown.

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