Prolonged survival after thoracic metastasectomy in patients with nonseminomatous testicular cancer

Abstract Introduction Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates. Methods Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method. Results Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality. Conclusion Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.

Primary orbital yolk sac tumor in an infant: A rare entity

We report a case of pure orbital yolk sac tumor (YST) in an 11-month-old infant, which is a rare entity. The child presented with progressive painless swelling of the right eye and on examination had proptosis, chemosis, and lid edema. Systemic examination was within normal limits. Magnetic resonance imaging (MRI) orbit revealed a lobulated heterogeneously enhancing right retroocular mass extending up to the orbital apex, displacing the optic nerve and eroding the medial orbital wall. Biopsy of the lesion revealed pure YST histology. Serum alpha-fetoprotein (AFP) was markedly raised at 76900 ng/mL. She was started on infant bleomycin etoposide cisplatin (BEP) chemotherapy protocol. There was a good clinical and radiological response. A high index of malignancy is required in young children presenting with orbital proptosis. A multidisciplinary approach and early intervention are essential to save both vision and life.

Síndrome de teratoma creciente. Reporte de caso / Growing Teratoma Syndrome. A Case Report

Resumen El síndrome de teratoma creciente es una entidad en la cual existen modificaciones histológicas de un teratoma maligno inmaduro tratado con quimioterapia y con marcadores tumorales negativos a un teratoma maduro. Dada la baja incidencia de la patología, se presenta el caso de una paciente con antecedente de tumoración ovárica con reporte de teratoma inmaduro la cual fue extraída. Recibió quimioterapia y normalización de marcadores séricos. Posteriormente presentó la aparición de una tumoración pélvica, retroperitoneal y hepática que nuevamente requirió intervención quirúrgica, con reporte patológico de teratoma quístico maduro.

Abstract Growing teratoma syndrome is an entity in which there are histological modifications of an immature malignant teratoma treated with chemotherapy and with negative tumor markers to a mature teratoma. Given the low incidence of the pathology, a case of a patient with a history of ovarian tumors with report of immature teratoma which was extracted is reported. The patient received chemotherapy with normalization of serum markers. Subsequently she presented a pelvic, retroperitoneal and hepatic tumor that again required surgical intervention with pathological report of mature cystic teratoma.

Postchemotherapy retroperitoneal residual mass resection for germ cell testicular tumors: a single-center experience

SUMMARY Objective: Postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) plays an important role in the management of advanced germ cell testicular tumors. Bilateral template lymph node dissection is considered a standard treatment in postchemotherapy residual masses; however, modified unilateral templates have gained acceptance in patients with unilateral residual disease. In this study, we aimed to demonstrate the perioperative and oncological outcomes of the patients with advanced testicular cancer who underwent unilateral modified template PC-RPLND in our center. Methods: This is a retrospective study in which patients who underwent PC-RPLND in a referred center between 2004 and 2021 were investigated. All patients had three or four cycles of chemotherapy and retroperitoneal residual masses. Data were retrospectively collected from medical, operative, radiology, and pathology records and analyzed. Results: A total of 57 patients underwent PC-RPLND. The mean age was 32.7±8.1 years (19-50). According to the disease stage at presentation, there were 39 patients with stage 2 and 18 patients with stage 3. The average tumor size after chemotherapy was 57.6±2.7 mm (25-117). The overall complication rate was 35% (20/57 patients). No grade 4 and 5 complications were observed. Pathologic review demonstrated the presence of teratoma in 28 (49.1%) patients, fibrosis and/or necrosis in 15 (26.3%) patients, and viable germ cell tumor in 14 (24.5%) patients. The mean follow-up was 69.4 months (8-201). During follow-up after surgery, 14 (24.5%) deaths occurred due to advanced disease. Conclusion: PC-RPLND is a major component of the management of advanced testicular germ cell cancer. Our study demonstrated that modified unilateral template is an effective and safe procedure in the postchemotherapy setting for selected patients.

Disgerminoma ovariano na gestação: relato de caso / Ovarian dysgerminoma in pregnancy: a case report

Os disgerminomas são tumores malignos de células germinativas ovarianas, são raros, geralmente acometem mulheres em idade fértil e têm bom prognóstico e sobrevida elevada. Paciente de 20 anos, primigesta com 26 semanas de gestação, foi admitida no centro obstétrico da Fundação Hospitalar Santo Antônio em Blumenau- SC com quadro de dor abdominal intensa refratária à analgesia e desconforto respiratório. Ressonância magnética demonstrou derrame pleural, moderada ascite e volumosa lesão expansiva de aspecto sólido-cístico em anexo direito. Foram realizadas salpingo-oforectomia à direita e omentectomia parcial e coletado lavado peritoneal. Anatomopatológico evidenciou disgerminoma. A paciente seguiu acompanhamento gestacional nos serviços de pré-natal de alto risco e oncologia. Devido à imaturidade fetal, manteve-se conduta expectante e, após o parto normal com 37 semanas, foi realizado estadiamento e iniciada quimioterapia adjuvante. Devido à baixa incidência e à raridade de tumores de células malignas ovarianas, relatos de casos como este são importantes para discutir as melhores estratégias de manejo clínico.(AU)

Dysgerminomas are rare malignant ovarian germ cell tumors that generally affect adolescence and early adulthood, have a good prognosis and high survival. Patient 20 years old, gestation 1, at 26 weeks of gestation, was hospitalized at the obstetric center of Fundação Hospitalar Santo Antônio in Blumenau-SC, with severe abdominal pain refractory to analgesia and respiratory discomfort. Magnetic resonance showed pleural effusion, moderate ascites and a massive expansive lesion with a solid cystic aspect in the right ovary. Right salpingoophorectomy, partial omentectomy and peritoneal lavage were collected. Anatomopathological evidence showed dysgerminoma. Patient followed gestational follow-up at high-risk prenatal and oncology services. Due to fetal immaturity, expectant management was maintained and after vaginal delivery at 37 weeks, staging was performed and adjuvant chemotherapy was started. Due to the low incidence and rarity of ovarian malignant cell tumors, case reports such as this one are important to discuss the best clinical management strategies.(AU)

Manejo de pacientes con tumores de células germinales en primera recaída / Management of patients with germinal cell tumors in first relapse

Resumen Los tumores de células germinales (TCG) son las neoplasias malignas más comunes y afectan especialmente a hombres jóvenes de 15 a 35 años de edad. Los pacientes con estadios 2 y 3 que recaen ofrecen un gran reto para el tratamiento inicial de la primera recaída. La terapia óptima para estos pacientes depende de su tratamiento inicial y está pobremente definida. Las opciones incluyen regímenes de segunda línea de quimioterapia a dosis convencionales que combinan cisplatino e ifosfamida, con vinblastina, etopósido o paclitaxel, o quimioterapia de altas dosis con soporte de células madre. En vista de que todavía no hay evidencia concluyente en los ensayos clínicos, las indicaciones para el uso de quimioterapia de altas dosis permanecen poco claras y se basan en estudios fundamentalmente retrospectivos. El tratamiento en la segunda recaída debe individualizarse según el paciente y el tratamiento previo. La resección quirúrgica de masas residuales luego de la quimioterapia es un elemento clave para una terapia exitosa en pacientes con marcadores tumorales negativos. Actualmente, en Venezuela los pacientes que presentan recaídas deben recibir tratamiento con cualquiera de los regímenes establecidos que se utilizan a dosis convencionales en segunda línea. En algunos casos, los pacientes deben recibir tratamiento en centros de oncología con un manejo multidisciplinario que permita el acceso a tratamiento con altas dosis de quimioterapia y a cirujanos oncólogos expertos en esta patología.

Abstract Germ cell tumors (GCT) are the most common malignant neoplasms affecting young men aged 15 to 35 years. Patients with previous stage 2 and 3 who relapse offer a great challenge to the Medical team. The optimal therapy for these patients with recurrent disease is still poorly defined. Options include second-line chemotherapy regimens at conventional doses which combine cisplatin and ifosfamide, with vinblastine, etoposide or paclitaxel, or alternatively high-dose chemotherapy with stem cell support. As there is still no conclusive evidence from clinical trials, the indications for the use of high-dose chemotherapy remain unclear. Most of the present literature is based in retrospective studies. Second relapse treatment options should be individualized according to the patient and his previous treatment. Surgical resection of residual masses in patients with negative markers after chemotherapy is a key element for successful therapy. Currently, patients in Venezuela who have relapses should receive treatment with any of the established regimens that are used at conventional doses in the second line, however in some cases they should receive treatment in an oncology center with a multidisciplinary team having access to treatment with high dose chemotherapy and to oncologist surgeons who are experts in this area.

Malignant struma ovarii: from a perspective of thyroid surgery / 中华内分泌外科杂志

Struma ovarii is a highly specialized form of monoderal ovarian teratoma, in which thyroid tissue has exceeded all other tissues or only thyroid tissue malignant struma ovarii is a very rare disease. Studies have confirmed that the pathogenesis is basically consistent with primary thyroid cancer. Preoperative diagnosis is difficult and the diagnosis should be based on postoperative paraffin pathology. It’s important to emphasize that the histologic malignance does not represent malignant ovarian behavior. Transabdominal hysterectomy+bilateral salpingo-oophorectomy has a better prognosis, and there are different opinions on the management of the mainstream thyroid. Most patients take active thyroid excision followed by chemotherapy and radiotherapy and 131I for postoperative follow-up in accordance with the principle of primary thyroid cancer.

One case of misdiagnosis of 22q11.2 deletion syndrome with ovarian mixed germ cell tumor / 中华内分泌代谢杂志

Idiopathic hypoparathyroidism is a rare endocrine disease. It is often manifested as neuropsychiatric symptoms, especially epileptic seizures. Thus, it is easy to be misdiagnosed as primary epilepsy. The following case report details the diagnosis of a 17-year-old girl who had been misdiagnosed as primary epilepsy for a long time. She was found hypoparathyroidism during the hospitalization for the operation of ovarian mixed germ cell tumor. After whole exome sequencing, she was ultimately diagnosed as 22q11.2 deletion syndrome. This case suggested that clinicians should be aware of the possibility of hypoparathyroidism in adolescent epilepsy, especially hereditary hypoparathyroidism. At the same time, the possible high risk of tumors should also be considered in hereditary hypoparathyroidism.

Assessment of Prognostic Factors of Racial Disparities in Testicular Germ Cell Tumor Survival in the United States (1992-2015) / 生物医学与环境科学（英文）

Objective@#Testicular germ cell tumors (TGCT) are the most common cancer among men aged 15 to 39 years. Previous studies have considered factors related to TGCT survival rate and race/ethnicity, but histological type of the diagnosed cancer has not yet been thoroughly assessed.@*Methods@#The data came from 42,854 eligible patients from 1992 to 2015 in the Surveillance Epidemiology and End Results 18. Frequencies and column percent by seminoma and nonseminoma subtypes were determined for each covariates. We used Cox proportional hazard regression to assess the impact of multiple factors on post-diagnostic mortality of TGCT.@*Results@#Black males were diagnosed at a later stage, more commonly with local or distant metastases. The incidence of TGCT in black non-seminoma tumors increased most significantly. The difference in survival rates between different ethnic and histological subtypes, overall survival (OS) in patients with non-seminoma was significantly worse than in patients with seminoma. The most important quantitative predictor of death was the stage at the time of diagnosis, and older diagnostic age is also important factor affecting mortality.@*Conclusion@#Histological type of testicular germ cell tumor is an important factor in determining the prognosis of testicular cancer in males of different ethnic groups.

Characterization of progression-related alternative splicing events in testicular germ cell tumors / 亚洲男科学杂志(英文版)

Accumulating evidence supports the significance of aberrant alternative splicing (AS) events in cancer; however, genome-wide profiling of progression-free survival (PFS)-related AS events in testicular germ cell tumors (TGCT) has not been reported. Here, we analyzed high-throughput RNA-sequencing data and percent-spliced-in values for 150 patients with TGCT. Using univariate and multivariate Cox regression analysis and a least absolute shrinkage and selection operator method, we identified the top 15 AS events most closely associated with disease progression. A risk-associated AS score (ASS) for the 15 AS events was calculated for each patient. ASS, pathological stage, and T stage were significantly associated with disease progression by univariate analysis, but only ASS and pathological stage remained significant by multivariate analysis. The ability of these variables to predict 5-year progression was assessed using receiver operating characteristic curve analysis. ASS had stronger predictive value than a combination of age, pathological stage, and T stage (area under the curve = 0.899 and 0.715, respectively). Furthermore, Kaplan-Meier analysis of patients with low and high ASS demonstrated that high ASS was associated with significantly worse PFS than low ASS (P = 1.46 × 10

Histomorphological Spectrum of Ovarian Lesions in a Tertiary Care Institute in Gujarat with Special Emphasis on Ovarian Tumors

Introduction: Ovarian cancer is the third most common cancer among women of India. Microscopic examination is the goldstandard for diagnosing ovarian tumors and plays an important role in determining prognosis.Purpose: The aim of the study is to assess the frequency of non-neoplastic and neoplastic lesions in ovarian specimens andbiopsies and to study the histomorphological spectrum, gross features, and age distribution of the ovarian tumors.Materials and Methods: The present study was an observational retrospective study conducted over a period of 1 year(February 2019–January 2020) in the Department of Pathology in a Tertiary Care Hospital in South Gujarat. A total of cases (8ovarian biopsies and 82 ovarian specimens) were analyzed. Tumors were classified according to the WHO classification 2014.Results: Of 90 cases, eight were of non-neoplastic lesions, 13 were tumor-like lesions, and nine neoplastic lesions. Amongneoplastic lesions, 43 cases (62.3%) were benign, 3 (4.4%) were borderline, while 23 (33.3%) cases were malignant.Histopathologically, surface epithelial tumors (76.7%) were the most common subtype followed by germ cell tumors (13.3%)and then sex cord tumors (10%). Malignant surface epithelial tumors constitute 78.2% of the total malignant ovarian tumors. Themost common neoplastic lesion was serous cystadenoma. 30–39 years age group was the most common age group overall inovarian tumors. Benign tumors were most common in the 30–39 years age group, while malignant tumors were most commonin the 60–69 years age group. Bilaterality was seen in 10 (16.4%) of 61 gross specimens of ovarian tumors.Conclusion: The frequency of malignant ovarian tumors was higher in our institute. Accurate histopathological diagnosis isessential for management and determining prognosis

Tumor maligno mixto de células germinales de ovario. Reporte de caso / Ovarian malignant mixed germ cell tumor. A case report

RESUMEN Los tumores malignos de células germinales del ovario, aunque poco frecuentes, son el tipo más común de neoplasias ováricas malignas en niñas y adolescentes; aproximadamente dos tercios de ellas menores de 20 años. Representan 2% a 5% de todos los tumores ováricos de origen germinal. Los tumores comprenden dos o más tipos de componentes de células germinales, e incluyen al disgerminoma acompañado de tumores del seno endodérmico, carcinoma de células embrionarias, teratoma maduro o inmaduro y/o coriocarcinoma. Existen pocos informes de casos de tumores de células germinales mixtas con diferentes combinaciones de componentes malignos. La alfafetoproteína y la gonadotropina coriónica humana son los marcadores tumorales más característicos. Los hallazgos inmunohistoquímicos son importantes para el diagnóstico. La cirugía más quimioterapia adyuvante es la primera opción para preservar la fertilidad en cualquier niña o adolescente que presente con un tumor pélvico en rápido crecimiento. Se presenta un caso de tumor maligno mixto de células germinales de ovario.

ABSTRACT Ovarian malignant germ cell tumors, although rare, are the most common type of malignant ovarian neoplasms in girls and adolescents; approximately two thirds of all cases occur in women under 20 years old. These tumors represent 2%-5% of all ovarian germinal tumors. Tumors comprise two or more types of germ cell components that include dysgerminoma accompanied by tumors of the endodermal sinus, embryonal cell carcinoma, mature or immature teratoma and/or choriocarcinoma. There are few case reports of mixed germ cell tumors with different combinations of malignant components. Alpha-fetoprotein and human chorionic gonadotropin are the most characteristic tumor markers, and immunohistochemical findings are important in the diagnosis of mixed malignant ovarian germ cell tumors. Surgery plus adjuvant chemotherapy is the first option to preserve fertility in any girl or adolescent who presents a rapidly growing pelvic tumor with high concentrations of alpha-fetoprotein or human chorionic gonadotropin. We present a case of ovarian malignant mixed germ cell tumor.

Tumor de células germinales mixto de ovario y una inusual combinación / Mixed ovarian germ cell tumor, an unusual combination

Resumen ANTECEDENTES: Los tumores de células germinales del ovario son poco frecuentes. Desde el punto de vista clínico y biológico son heterogéneos. Están formados por varios tipos de tumores histopatológicamente diferentes, que derivan de células primitivas y que se anidan de forma ectópica, proliferan y sufren transformación maligna. CASO CLÍNICO: Paciente de 10 años llevada a la consulta debido a la pérdida de peso en un periodo corto, dolor abdominal y aumento del perímetro abdominal. En la exploración se encontró una tumoración abdominopélvica de 20 x 20 cm, fija, pétrea, con un ganglio cervical izquierdo palpable. Los marcadores tumorales reportaron: alfafetoproteína 1104 ng/mL, B-HCG 865.6 mUi/mL. La TAC mostró una lesión que ocupaba el abdomen y la pelvis con densidad heterogénea de 14 x 12 x 10 cm. Se intervino para extirpación del tumor y enseguida se le indicó un esquema de quimiterapia. El reporte de patología reportó ser una tumoración germinal mixta con 5 tipos histológicos, muy agresiva, que terminó con la vida de la paciente 9 meses después. CONCLUSIÓN: Los tumores malignos de las células germinales son extremadamente malignos y de crecimiento rápido, con un pico de incidencia en niñas, adolescentes y mujeres jóvenes. Los síntomas se relacionan con el crecimiento rápido que se caracteriza por dolor pélvico-abdominal relacionado con la distensión capsular, hemorragia o necrosis. La estadificación quirúrgica es el primer paso en el tratamiento del cáncer de células germinales de ovario. La tasa de supervivencia es mayor de 95% en etapa temprana (l-ll), 80% en etapa lll y 60% en etapa lV, por lo que el diagnóstico y tratamiento oportuno son lo más importante.

Abstract BACKGROUND: Ovarian germ cell tumors are rare, clinically and biologically heterogeneous tumors, formed by several types of histopathologically different tumors that derive from primitive cells and that are nested ectopically, proliferate and undergo malignant transformation. CLINICAL CASE: A 10-year-old patient who came to consult for weight loss and abdominal pain as well as an increase in abdominal perimeter of rapid growth. A fixed abdominal tumor of 20 x 20 cm is scanned and found, as well as palpable left cervical lymph node. Tumor markers showing alphafetoprotein were taken. 1104 ng/mL, B-HCG 865.6 mUi/mL. The CT scan showed a lesion that occupies abdomen and pelvis with a heterogeneous density of 14 x 12 x 10 cm. It was decided to intervene surgically and complement with chemotherapy; The pathology report reported being a mixed germ tumor with 5 very aggressive histological types that ended with the patient´s life 9 months later. CONCLUSION: Malignant germ cell tumors are extremely malignant and rapidly growing, with a peak incidence in girls, adolescents and young women. Symptoms are related to rapid growth characterized by pelvic-abdominal pain related to capsular distention, hemorrhage or necrosis. Surgical staging is the first step in the treatment of ovarian germ cell cancer. The survival rate is greater than 95% in early stage (l-ll), 80% in stage lll and 60% in stage lV, so the diagnosis and timely treatment is the most important.

Trends in cancer incidence in Uruguay: 2002 -2015 / Tendencias de la incidencia de cáncer en Uruguay: 2002-2015

Abstract Background: Uruguay is the south American country which has the highest cancer incidence and mortality rates. The National Cancer Registry collects data on cancer cases nationwide since 1989 and has reached high quality standards in the last decades. This is the first report on incidence trends. Methods: Data from the National Cancer Registry of all new cases of invasive cancer from twelve sites diagnosed in 2002-2015 was analyzed. Age-standardized rates were calculated. Trends of incidence rates were analyzed using joinpoint regression models. Results: For both, men and women, incidence rates trends for all cancer sites, colo-rectal and bladder cancer remained stable. Esophageal and gastric cancers descended while thyroid and kidney cancer incidence increased. In men lung cancer decreased; testicular cancer increased, and prostate cancer increased at the beginning of the period and decreased in the final years. In women, lung cancer increased, breast cancer remained stable and cervical cancer presented a significant decline from 2005 to 2010 and reached a plateau since then. Conclusion: Cancer incidence dynamics are complex and affected not only by Public Health policies such as tobacco control, vaccination and screening programs, but also by environmental and life style changes and the attitude of the medical community towards the application of diagnostic and therapeutic tools. The aim of this paper is to analyze cancer incidence time trends in the country and provide possible explanations to them.

Resumen Introducción: Uruguay es el país de Sudamerica que tiene las mayores tasas de incidencia y mortalidad por cáncer. El Registro Nacional de Cáncer recoge los datos de cáncer de todo el país desde 1989 y en las últimas décadas ha alcanzado los más altos estándares de calidad. Este es el primer reporte de tendencias de incidencia de cáncer de Uruguay. Métodos: Se analizaron los datos de todos los casos de cáncer invasivo diagnosticados entre 2002 y 2015 incluidos en el Registro Nacional de Cáncer y los de once topografías en particular. Se calcularon las tasas de incidencia estandarizada y se analizaron las tendencias utilizando los modelos de regresión de Joinpoint. Resultados: Las tasas de incidencia de cáncer colorrectal, vejiga y todos los sitios reunidos se mantuvieron estables tanto en hombres como en mujeres. La tasa de incidencia de cáncer de estómago y esófago disminuyeron mientras que las de tiroides y riñón aumentaron. En los hombres, el cáncer de pulmón disminuyó, el cáncer de testículo aumentó y el de próstata aumentó en un lapso inicial y decreció en los últimos años. En las mujeres el cáncer de pulmón aumentó y el de mama se mantuvo estable mientras que el cáncer de cérvix presentó un descenso significativo entre 2005 y 2010 alcanzando una meseta desde entonces. Conclusión: La dinámica de la incidencia de cáncer es compleja y está afectada no sólo por las políticas de Salud Pública como las campañas de control de tabaco, vacunación y programas de tamizaje sino por los cambios ambientales y de los estilos de vida y la actitud de los médicos respecto a la aplicación de técnicas diagnósticas y terapéuticas. En este trabajo se analizan las tendencias de incidencia en el país y se plantean posibles explicaciones para los cambios.

Analysis of cytology of germ cell tumors with histopathological and serum tumor marker correlation: a tertiary care centre experience

Background: Germ cell tumors are found primarily in children and young adults usually arising from gonads and rarely from extragonadal sites like mediastinum, retroperitoneum, pineal gland and sacrococcygeal region. Involvement of lymphnodes or bodycavities (pleural/peritoneal cavity) is usually associated with metastatic disease.Methods: This is a retrospective analysis of 96 cases of germ cell tumor for which a primary diagnosis of germ cell tumor was given by cytology from primary and metastatic sites. The study period is from January 1993- December 2013. Pap stained and Romanowsky stained smears and cell block sections (10cases) were studied. Serum tumor markers (LDH, BetaHCG and AFP) were correlated in all cases along with histopathology in available cases.Results: Among 96 cases 34 were diagnosed as seminoma/dysgerminoma,10 as embryonal carcinoma,9 as yolk sac tumor,6 as teratoma and 2 as mixed germ ell tumor. In 25 cases the cytology report was suggestive of germ cell tumor and in 10 cases malignant cells favouring germ cell tumor. Among the 10 cases the serum markers were high in six of the cases and the clinician after discussing with the pathologist treated them as germ cell tumors. 47 cases had histopathology and it correlated with cytology except in 14 cases which showed no residual neoplasm after chemotherapy. 15 cases expired immediately after the diagnosis or during the course of treatment 12cases were lost to follow up. Rest of the cases have completed the treatment. In our study the serum tumor markers showed a sensitivity of 92.75% and positive predictive value was 71.11%.Conclusions: The study highlights the importance of picking up the diagnosis of germ cell tumors by fine needle aspiration cytology so that patient can get an early diagnosis, effective treatment and a multidisciplinary approach is essential in diagnosing a difficult case of germ cell tumor. Previous history, radiology, clinical features and serum tumor markers all aid in the cytological diagnosis of germ cell tumor.

Testicular mixed germ cell tumor presenting with seizure as the initial symptom: a case report and literature review

Abstract Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue. Longer follow up is required to assess the impact of our treatment strategy.

Clinicopathological study of testicular lesions

Background: Testis is affected by both neoplastic and non neoplastic conditions. Non neoplastic lesions of the testis include epididymo-orchitis, testicular atrophy, undescended testis, testicular abscess etc. Testicular tumors are relatively rare. They constitute the 4th most common cause of death from neoplasia in the young males. This study was undertaken to study the histopathological spectrum, age wise distribution and clinical symptoms of testicular lesions.Methods: This is a retrospective study of three years conducted in the department of pathology, Aurangabad from June 2015 to May 2018. It included all the orchidectomy specimens received from the department of surgery and excluded the orchidectomy specimens sent for infertility and prostatic carcinoma. A detail clinical history was taken. Histopathological examination was done after routine processing and staining with H and E. The data collected was tabulated, analysed and compared to other similar studies.Results: We studied 70 cases. Non neoplastic testicular lesions were 57 and 13 were neoplastic. Non neoplastic testicular lesions were more common than the neoplastic ones. Non neoplastic testicular lesions presented most commonly in the 2nd decade. Most common non neoplastic lesion was epididymo-orchitis followed by torsion, atrophy and testicular abscess. Most common neoplasm was malignant mixed germ cell tumor. Most of the patients of neoplasms presented in the 3rd decade. The most common complaint was testicular swelling and pain.Conclusions: Majority of testicular lesions are non neoplastic. Neoplastic lesions are rare. Non neoplastic lesions mimic neoplastic ones clinically, as testicular swelling is the most common complaint. So histopathological diagnosis is necessary for an accurate diagnosis of testicular lesions.

Teratocarcinoma gigante de mediastino anterosuperior / Giant teratocarcinoma of anterosuperior mediastinum

RESUMEN Los tumores de células germinales no son tan frecuentes, dentro de ellos se encuentra el teratoma como el más usual en ubicación mediastinal, es más habitual en hombres jóvenes cuando es maligno (teratocarcinoma), con una relación por género de 13,5:1, y una edad promedio de 26 años. Se describe la evolución de un hombre de 19 años de edad con un tumor mediastinal, con metástasis pulmonares e infiltración intracardíaca, resecado satisfactoriamente, cuyos síntomas más frecuentes fueron: disnea, dolor retroesternal, fiebre, tos, pérdida de peso y síndrome de vena cava superior. El diagnóstico se realizó por radiografía de tórax y tomografía axial computarizada. Se logró realizar la excéresis total del tumor y las metástasis, así como la tumoración intracardíaca, con reparación de la válvula tricúspide. El paciente ha tenido una evolución satisfactoria durante el primer año de seguimiento.

ABSTRACT Germ cell tumors are not so frequent; among them, teratomas are most common in the mediastinal location. Teratomas in young men are usually malignant (teratocarcinoma), with a gender ratio of 13.5:1, and an average age of 26 years. We describe the evolution of a 19-year-old man with a mediastinal tumor, with pulmonary metastases and intracardiac infiltration, successfully removed; whose most frequent symptoms were: dyspnea, retrosternal pain, fever, cough, weight loss and superior vena cava syndrome. The diagnosis was made by chest x-ray and computed tomography. Total removal of the tumor and metastases was achieved, as well as the intracardiac tumor, with tricuspid valve repair. The patient had a satisfactory outcome during the first follow-up year.

Transformación de teratoma en rabdomiosarcoma / Transformation of teratoma in rabdomiosarcoma

Los teratomas son tumores germinales malignos compuestos por dos o más capas de tejido, que ocasionalmente se transforman en estirpes con crecimiento agresivo. Se presenta el caso de un paciente de 29 años con un tumor germinal gonadal localizado en testículo, cuya evolución fue desfavorable por presentar transformación en un fenotipo correspondiente a un rabdomiosarcoma. La patología aquí descripta deviene del crecimiento diferencial de un componente ya existente en el tumor original o la transformación en un linaje somático que se hace dominante. Los tumores transformados como el del caso descripto son raros y presentan características diferentes de la mayoría de las neoplasias germinales respecto del comportamiento, el pronóstico y la sensibilidad a los tratamientos establecidos.

Teratomas are malign germ cell tumors composed of two or more tissue layers. When there is specific organ differentiation they are called mature teratoma. They rarely grow aggressively. We report the case of a 29 year-old man with a diagnosis of gonadal germ cell tumor whose evolution was unfavorable owing to transformation into a different phenotype corresponding to a rhabdomyosarcoma. This phenomenon occurs through differential growth of a single histological component of the original tumor or transformation of a somatic lineage that becomes dominant. Transformed tumors such as the one herein described differ from most germ cell neoplasms regarding behavior, prognosis, and susceptibility to established treatments.

Conservative Surgery for a young nulligravid with ovarian yolk sac tumor and concurrent contralateral mature teratoma

@#<p>Ovarian cancer is the second most common gynecologic cancer worldwide and the six most common cancer among females. Germ cell tumorbs are the most common ovarian neoplasm in the first two decades of life constituting approximately two-thirds of all ovarian tumors. Malignant germ cell tumors constitute one-third of germ cell origin tutors and two-thirds of all ovarian malignancy in this age-group. This paper presents a case of a 19 year-old nulligravid who presented at the emergency room with abdominal pain, and was intraoperatively diagnosed with yolk sac tutor of the right ovary, stage 1A mature cystic teratoma of the left ovary. She subsequently underwent unilateral salpingooophorectomy and contralateral oophorocystectomy, left. Patient is advised chemotherapy postoperatively, with Bleomycin, Etoposide and Paclitaxel. This paper discusses the incidence, risk factors, prognosis and management of yolk of sac tutor in a young nulligravid.</p>