Contemporary options and future perspectives: three examples highlighting the challenges in testicular cancer imaging

Purpose One of the main issues in testicular germ cell tumors (TGCTs) management is to reduce the necessary amount of treatment to achieve cure. Excess treatment burden may arise from late diagnosis of the primary as well as from false positive or negative staging results. Correct imaging is of paramount importance for successful management of TGCT. The aim of this review is to point out the current state of the art as well as innovative developments in TGCT imaging on the basis of three common challenging clinical situations. Methods A selective literature search was performed in PubMed, Medline as well as in recent conference proceedings. Results Regarding small testicular lesions, recent studies using elastography, contrast-enhanced ultrasound or magnetic resonance imaging (MRI) showed promising data for differentiation between benign and malignant histology. For borderline enlarged lymph nodes FDG-PET-CT performance is unsatisfactory, promising new techniques as lymphotropic nanoparticle-enhanced MRI is the subject of research in this field. Regarding the assessment of postchemotherapeutic residual masses, the use of conventional computerized tomography (CT) together with serum tumor markers is still the standard of care. To avoid overtreatment in this setting, new imaging modalities like diffusion-weighted MRI and radiomics are currently under investigation. For follow-up of clinical stage I TGCTs, the use of MRI is non-inferior to CT while omitting radiation exposure. Conclusion Further efforts should be made to refine imaging for TGCT patients, which is of high relevance for the guidance of treatment decisions as well as the associated treatment burdens and oncological outcomes.

Geomineralogical, Physiochemical, Thermal and Kinetic Characterisation of Selected Coals From the Benue Trough and Anambra Basins in Nigeria

This study examined the geomineralogical, physiochemical, thermal, and kinetic characteristics of selected coals from Chikila (CHK), Lafia Obi (LFB) and Okaba (OKB) in the Benue Trough and Anambra Basins of Nigeria. Physicochemical characterisation revealed significant quantities of carbon, volatiles, fixed carbon, and heating values (25–30 MJ/kg) but low moisture, and ash contents. The fuel properties indicate subbituminous to bituminous rank coals. The morphological, microstructure and elemental analyses revealed heterogeneous sized coal particles with a glassy sheen due to clay and aluminosilicate minerals such as quartz, alumina, kaolinite, and hematite. Based on thermal analysis, the coal samples are highly reactive and experienced significant thermal degradation as evident in the high mass losses (ML = 91.59 – 94.04%) and low residual masses (RM = 5.96% - 8.41%), which are observed in the orders LFB > OKB > CHK for ML and CHK > OKB > LFB for RM. LFB experienced the highest ML and lowest RM indicating it is more thermally reactive compared to OKB and CHK. Kinetic analysis by Coats-Redfern model revealed low values of activation energy, Ea (30.07 – 43.91) kJ/mol and frequency factor A (1.16×10-02 – 6.73×10-02) min-1 deduced at high R2 (0.98-0.99). The kinetic parameters demonstrated that the selected coal samples are highly reactive under oxidative conditions which are suited for energy recovery through pulverised coal combustion.

Semi-ResMass Study: Residual masses after salvage chemotherapy in men with pure seminoma—A multicenter retrospective analysis.

420 Background: Only scarce data exist on the management of residual masses in men who have received two lines of chemotherapy for advanced seminoma. Due to the lack of data, the role of PET scanning, surgery and other additional treatments is controversial in these men. Methods: Data from men with pure seminoma and residual masses after salvage chemotherapy were retrospectively collected from 10 high-volume centers in 3 European countries. We analyzed the clinical management of residual masses (imaging, surgery, pathological data, and additional treatment modalities) and long-term outcomes. Residual mass was defined as a lesion of ≥1 cm after two lines of platin-based chemotherapy. Results: To date, data from 48 patients (pts) with non-progressing residual masses after second line (salvage) chemotherapy have been collected and are included in this analysis. Median age at diagnosis was 36 years (range 31; 42). A post-chemotherapy PET-FDG was performed in 32 (67%) pts. Surgery was performed in 20/48 (41%) pts irrespectively of FDG uptake (no, n=8; yes, n=5). Complete necrosis was found in 16 (80%), viable seminoma in 3 (15%), and teratoma in 1 pt, respectively. All pts with a negative PET (PET-) who underwent surgery (8/8) had complete necrosis. 5/11 pts with a positive PET (PET+) underwent surgery: 3 had a complete necrosis while 2 had viable seminoma. Among those with a PET+, 3 pts (28%) experienced either viable seminoma in residual masses or a subsequent relapse. The absence of FDG uptake correlated with absence of viable cancer (p=0.04). A second relapse occurred in 5/48 pts (10%). Only 2/20 pts who had residual masses resected post 1st salvage chemotherapy subsequently relapsed (one had viable seminoma in the residuals). At a median follow up of 4 years (IC95% [3.5-5.5]), 41/48 pts (87%) were alive. 7/48 patients died of cancer progression. Conclusions: Most men with residual masses after 1st salvage chemotherapy for advanced seminoma may achieve a cure. Pending validation with more pts in this rare situation, PET-FDG may help guide who should be selected for post-chemotherapy resection. Updated results will be presented at the congress.

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

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.

O PAPEL DAS ESTRUTURAS LITOLÓGICAS NA DINÂMICA E EVOLUÇÃO DO MACIÇO DE URUBURETAMA, CEARÁ, BRASIL

A estrutura litológica de um determinado relevo tem papel fundamental na sua dinâmica e evolução, tendo em vista as propriedades geomorfológicas das rochas. A Serra de Uruburetama é um dos muitos maciços residuais que pontuam o semiárido cearense, cuja constituição litológica tem relação direta com a gênese e evolução de macroformas e microformas graníticas encontradas nesse relevo serrano. Inserido no Domínio Ceará Central da Província Borborema, na porção norte do estado do Ceará, esse maciço é composto, predominantemente por rochas granitoides, sendo imprescindível o conhecimento da composição litológica para compreensão da sua evolução geomorfológica. O presente artigo tem como objetivo expor as principais litologias encontradas na área de estudo, suas propriedades geomorfológicas e as formas de relevo associadas. Para tanto, foi realizado levantamento de literatura referente às propriedades geomorfológicas das rochas graníticas, assim como do quadro geológico e geomorfológico do Maciço de Uruburetama a fim de compreender sua composição e evolução, além de levantamentos cartográficos e utilização de técnicas de geoprocessamento. O Maciço de Uruburetama apresenta diferentes feições graníticas com formas e dimensões variadas, cuja formação, desenvolvimento e exposição dessas feições se devem ao controle estrutural imposto por litologias graníticas e suas descontinuidades estruturais, bem como pela influência de condições paleoclimáticas e pelos processos de erosão diferencial, a que foram submetidas.Palavras-chave: Evolução geomorfológica; Propriedades geomorfológicas das rochas; Formas graníticas. ABSTRACTThe lithological structure of a given landform plays a fundamental role in its dynamics and evolution, considering the geomorphological properties of the rocks. The Mountain of Uruburetama is one of the many residual masses that punctuate the semi - arid region of Ceará, whose lithological constitution is directly related to the genesis and evolution of macroforms and granitic microforms found in this mountain relief. Located in the Central Ceará Domain of the Borborema Province, in the northern portion of the state of Ceará, this massif is composed predominantly of granitoid rocks, being essential the knowledge of the lithological composition to understand its geomorphological evolution. The present article has as objective to expose the main lithologies found in the study area, its geomorphological properties and the associated relief forms. For that, a literature survey was carried out regarding the geomorphological properties of the granitic rocks, as well as the geological and geomorphological framework of the Uruburetama Massif in order to understand its composition and evolution, as well as cartographic surveys and the use of geoprocessing techniques. The Uruburetama Massif presents different granitic features with different shapes and dimensions, whose formation, development and exposition of these features are due to the structural control imposed by granite lithologies and their structural discontinuities, as well as by the influence of paleoclimatic conditions and the processes of differential erosion, to which they were submitted.Keywords: Geomorphological evolution; Geomorphological properties of rocks; Granite shapes. RESUMENLa estructura litológica de un determinado relieve tiene papel fundamental en su dinámica y evolución, teniendo en vista las propiedades geomorfológicas de las rocas. La Sierra de Uruburetama es uno de los muchos macizos residuales que puntúan el semiárido cearense, cuya constitución litológica tiene relación directa con la génesis y evolución de macroformas y microformas graníticas encontradas en ese relieve Serrano. Insertado en el Dominio Ceará Central de la Provincia Borborema, en la parte norte del estado de Ceará, este macizo está compuesto, predominantemente por rocas granitoides, es imprescindible el conocimiento de la composición litológica para comprender su evolución geomorfológica. El presente artículo tiene como objetivo exponer las principales litologías encontradas en el área de estudio, sus propiedades geomorfológicas y las formas de relieve asociadas. Para ello, se realizó estudio de literatura referente a las propiedades geomorfológicas de las rocas graníticas, así como del cuadro geológico y geomorfológico del macizo de Uruburetama a fin de comprender su composición y evolución, además de encuestas cartográficas y el uso de técnicas de geoprocesamiento. El macizo de Uruburetama presenta diferentes facciones graníticas con formas y dimensiones variadas, cuya formación, desarrollo y exposición de estos rasgos se deben al control estructural impuesto por litologias graníticas y sus discontinuidades estructurales, así como la influencia de las condiciones paleoclimáticas y de los procesos de erosión diferencial a los que han sido sometidas.Palabras clave: Evolución geomorfológica; Propiedades geomorfológicas de las rocas; Formas graníticas.