During twenty years of Cisplatin-based therapy the face of nonseminomatous testicular germ cell tumors is still changing: an evaluation of presentation, management, predictive factors and survival

Purpose: To assess the changing presentation and treatment of nonseminomatous testicular germ cell tumors (NSGCT) and to investigate predictive factors for the status of metastasis at diagnosis and on relapse and death. Materials and Methods: Retrospective record review of 147 patients that underwent inguinal orchiectomy from 1987-2007. Follow-up data was available for 102 patients (median follow-up: 80 months (0-243); 96 patients alive). Results: Mean patients age increased (p = 0.015) and more patients were diagnosed in clinical stage I (CSI) (p = 0.040). The fraction of yolk sac (YS) elements inclined (p = 0.030) and pT2 tumors increased (p < 0.001). Retroperitoneal lymph node dissection (RPLND) declined whereas more patients were treated with chemotherapy (p < 0.001; p = 0.004). There was an increase in relapse free (RFS) and cancer specific survival (CSS) due to an improvement in patients with disseminated disease (p = 0.014; p < 0.001). The presence of YS and teratoma elements showed a reduction in the odds ratio (OR) for metastasis at diagnosis (p = 0.002, OR: 0.262; p = 0.009, OR: 0.428) whereas higher pT-stage was associated to their presence (p = 0.039). Patients with disseminated disease (CS > I) showed a declined CSS compared to CSI patients (p = 0.055). The presence of YS elements was associated to an improved RFS (p = 0.038). Conclusions: In our single institution study the face of NSGCT markedly changed over 20 years even after the introduction of Cisplatin-based chemotherapy. These changes were accompanied by an improvement in RFS and CSS. When dealing with NSGCT patients such observations now and in the future should be taken into account. .

Embryonal Rhabdomyosarcoma Arising from a Mediastinal Teratoma: An Unusual Case Report

We report an unusual case of 9.5-cm-sized embryonal rhabdomyosarcoma arose from a mediastinal mature teratoma in a 46-yr-old man. A man presented with chest trauma as a result of an accident at 10 September 2011. On chest X-ray, an anterior mediastinal mass was detected. To obtain further information, chest computed tomography (CT) with contrast enhancement was performed, revealing an anterior mediastinal mass. Complete surgical excision was performed and entire specimen was evaluated. Pathologic diagnosis was embryonal rhabdomyosarcoma arising in mature cystic teratoma. After surgical excision, two cycles of dactinomycin-based chemotherapy were performed. Lung metastasis was detected on follow up CT in September 2012, and wedge resection was performed. Pathological finding of the lung lesion showed same feature with that of primary rhabdomyosarcoma.

Acute respiratory distress syndrome in poor prognostic germ cell tumor with multiple lung metastases: a case report

We report a case which is unique as this patient was diagnosed pathologically as adenocarcinoma of the endometrium but clinically progressed as germ cell tumor. This was evident by progressive and rapid raised tumor markers [BHCG and LDH] with the development of multiple bilateral lung metastases. She was treated by administrating low doses of systemic combination chemotherapy as per the literature. Unfortunately, she developed acute respiratory distress syndrome as the complication of treatment and died due to it

Conservative treatment of ovarian cancer, Safety, ovarian function preservation, reproductive ability, and emotional attitude of the patients in Saudi Arabia

To evaluate the safety, ovarian function preservation, reproductive ability, and the emotional attitude after a conservative surgery for ovarian cancer. This is a retrospective study of women conservatively treated for primary ovarian cancer between January 2000 and December 2010 at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Patient's charts were reviewed for pathology, stage, requirement of adjuvant chemotherapy, and recurrent, as well as menstrual history, and pregnancy after treatment. During follow up the patients were asked 3 questions about their emotional attitude toward their disease. There were 39 patients identified [mean age 22 years]. Thirty-one [80%] patients were presented with stage I and 20 [52%] were Germ cell tumor. Fifteen [39%] patients received initial chemotherapy after primary surgery. Three [8%] patients had recurrent. Thirty-eight [98%] patients retuned to a regular menstruation after treatment. Eight patients [20%] had a normal pregnancy. Of the respondents to the given questions, 10 [44%] patients claimed that their disease did not have any impact on their desire to have children and 12 patients [52%] feared that their ovarian disease could have damage in their reproductive potential. Only 9 patients [39%] had no concerned about the effect of the treatment they received on the offspring. Fertility sparing surgery in ovarian cancer appears to be safe, and a practical treatment option in selected cases with ovarian cancer diagnosis. Most patients can have ovarian preservation after treatment and should not be discouraged from getting pregnant

Sarcoma indiferenciado (embrionario) de hígado en el adulto / Undifferentiated (embryonal) sarcoma of the liver in adults

We report a 48 years old women presenting with a painful abdominal mass and hepatomegaly. An abdominal CAT scan showed a focal lesion of 14 cm diameter in liver segment 4. The patient was subjected to a left hepatectomy with a normal postoperative evolution. The pathological diagnosis of the surgical piece was an undifferentiated sarcoma. Nine months later, a local relapse was detected and the patient died 22 months after the operation.

Introducción: Los sarcomas indiferenciados (embrionario) del hígado (SIEH) son neoplasias infrecuentes. Se presentan principalmente en edad pediátrica y son considerados de mal pronóstico. En adultos, existen 71 pacientes publicados en el mundo, y en nuestro país no hay casos descritos en este grupo etario. Objetivos: Presentar el caso de una paciente adulta portadora de un SIEH, que fue sometida a cirugía resectiva y realizar una revisión del tema. Caso clínico: Mujer de 48 años de edad, con historia de dolor abdominal, masa palpable en epigastrio y hepatomegalia. Marcadores tumorales negativos, tomografía abdominal revela lesión focal de 14 centímetros en segmento 4. Se aborda quirúrgicamente, biopsia rápida revela tumor sólido maligno indiferenciado, y se realiza hepatectomía izquierda. Evolución postoperatoria favorable. Mediante el análisis histopatológico, histoquímico e inmunohistoquímico se diagnostica un SIEH y se corrobora una resección R0. Al noveno mes de evolución se pesquisa foco de recidiva hepática, inicia progresivo compromiso del estado general, falleciendo 22 meses después de la cirugía. Discusión: Actualmente se recomienda resección completa del tumor seguido de quimioterapia coadyuvante, con lo cual se han logrado sobrevidas libres de enfermedad mayores a 5 años. El dar a conocer las experiencias de casos aislados en esta patología tan infrecuente, permitiría aumentar la casuística mundial, mejorar las técnicas de enfrentamiento, y evaluar el impacto de la quimioterapia en el pronóstico.

Long-term clinical outcome in patients with stage-i nonseminomatous germ cell cancer: a critical review of own treatment modalities in a retrospective study

PURPOSE: The optimal management of patients with clinical stage I non-seminomatous germ cell testicular cancer (NSGCT I) was considered controversial until the European Germ Cell Cancer Consensus Group determined unambiguous treatment strategies. In order to assess the long-term outcome we evaluated the data of patients with NSGCT I. MATERIALS AND METHODS: In a retrospective evaluation, we included 52 patients with a mean age of 26 years (range 15-58) who were treated with different modalities at our department between 1989 and 2003. Mean follow-up was 5.9 years (range 2-14 years). After orchiectomy, 39 patients were treated with chemotherapy, 7 patients underwent retroperitoneal lymph node dissection and 6 men were managed using a surveillance strategy. Survival, recurrence rate and time of recurrence were evaluated. The histological staging and treatment modality was related to the relapse. RESULTS: Tumor specific overall mortality was 3.8 percent. The mortality and relapse rate of the surveillance strategy, retroperitoneal lymph node dissection and chemotherapy was 16.7 percent / 50 percent, 14.3 percent / 14.3 percent and 0 percent / 2.5 percent respectively. All relapsed patients in the surveillance group as well as in the RPLND group had at least one risk factor for developing metastatic disease. CONCLUSIONS: Following the European consensus on diagnosis and treatment of germ cell cancer in patients with NSGCT Stage I any treatment decision must be individually related to the patient according to prognostic factors and care capacity of the treating centre. In case of doubt, adjuvant chemotherapy should be the treatment of choice, as it provides the lowest risk of relapse or tumor related death.

Treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs. VIP) for poor-prognosis metastatic germ cell tumors.

BACKGROUND: In patients with small-volume disseminated disease of germ cell tumors, cure can be achieved with four cycles of bleomycin, etoposide, and cisplatin (BEP). However, around 20% of these cases are not curable. Strategies to improve cure rates have shown that none of the currently available modalities were superior to the others. Among the most used ones, BEP and VIP (etoposide, cisplatin, and ifosfamide) have been the most studied. However, there are no reports comparing the two, except for a few in abstract forms from southern India. Therefore, we did a treatment outcome and cost-effectiveness analysis of two chemotherapeutic regimens (BEP vs VIP) that are used in poor-prognosis metastatic germ cell tumors. MATERIALS AND METHODS: All male patients with germ cell tumors, diagnosed as having poor risk by IGCCCG, between January 2002 and December 2004 were included in the study. Clinical, laboratory, and other data were recorded. The patients were stratified into two categories on the basis of the type of chemotherapeutic regimen they received. RESULTS: In all, 46 patients were analyzed, with a median follow up of 26.6 months. The baseline characteristics (age, stage, PS, histology, and serum markers) were not different in the two treatment arms. There is no significant difference in the outcome with either of the chemotherapeutic modalities. VIP is less cost effective and more toxic compared to BEP. CONCLUSION: In view of the greater toxicity and cost of therapy, as well as lack of either overall or disease free survival advantage, VIP is not a preferred option for patients with high-risk germ cell tumors in the Indian setting and it is still advisable to treat patients with BEP.

Ciclo único de quimioterapia adyuvante en cáncer testicular no seminoma Etapa I / Single cycle adyuvant chemotherapy in stage I nonseminomatous testis cancer

El cáncer de testículo es la neoplasia sólida más frecuente en el hombre entre los 15-35 años de edad y su incidencia a nivel mundial ha aumentado en los últimos 40 años. Ello puede ser el resultado de efectos exógenos, como influencia prenatal, o predisposición genética. A pesar del aumento de la incidencia, su mortalidad ha disminuido a cifras menores del 5 por ciento gracias a la combinación de métodos diagnósticos adecuados, marcadores tumorales sensibles y tratamientos efectivos. El tratamiento de esta enfermedad es un ejemplo de manejo multimodal del cáncer, ya que luego de orquiectomía el paciente puede requerir cirugía de estadiaje, radioterapia o quimioterapia complementaria o entrará a un régimen de observación vigilada, dependiendo de la histología y etapa tumoral. En el caso del tumor testicular de células germinales no seminomatoso (NSCGT) etapa I (pT1-4NxMoSo), la recomendación es determinar la presencia de factores pronósticos que pueden predecir la presencia de ganglios retroperitoneales metastásicos luego del tratamiento o recaída luego de orquiectomía con linfadenectomía retroperitoneal. Los principales factores de riesgo analizados son la etapa del tumor primario >pT1, invasión vascular y/o linfática, presencia de carcinoma embrionario, ausencia de elementos de tumor de saco vitelino y marcadores tumorales elevados preorquiectomía.

The cancer of testicle is the most frequent solid neoplasia in the man between 15-35 years of age and his(her,your) incident worldwide has increased in the last ones 40 años. It can be the result of exogenous effects, as prenatal influence, or genetic predisposition. In spite of the increase of the incident, his(her,your) mortality has diminished minor numbers(figures) of 5 percent thanks to the combination of diagnostic methods tumour sensitive scoreboards and treatments efectivos. The treatment of this disease is an example of multimodal managing of the cancer, since after orquiectomía the patient can need surgery of estadiaje, radiotherapy or complementary chemotherapy or it(he,she) will enter to a regime(diet) of monitored observation, depending on the histology and tumour stage. In case of the tumor testicular of cells they germinate Not seminomatoso (NSCGT) stage I (pT1-4NxMoSo), the recommendation is the presence of factors determines forecasts(predictions) that can predict the presence of ganglions retroperitoneales metastásicos after the treatment or relapse after orquiectomía with linfadenectomía retroperitoneal. The principal factors of risk analyzed are the stage of the primary tumor> pT1, vascular and / or lymphatic invasion, presence of carcinoma Embryonic, absence of elements of tumor of sack vitelino and tumour high scoreboards preorquiectomía.

Laparotomy for post chemotherapy residue in ovarian germ cell tumors.

BACKGROUND: Primary conservative surgery and cisplatin-based chemotherapy have resulted in high cure rates in malignant ovarian germ cell tumors. A significant proportion of advanced tumors may have post-chemotherapy residue and it is important to distinguish necrosis or fibrosis without viable tumor from persistent viable tumor and teratoma. AIMS: To evaluate the role of laparotomy in assessing the nature of post-chemotherapy residue in ovarian germ cell tumors. MATERIALS AND METHODS: Eighty-three patients with malignant ovarian germ cell tumors seen at Cancer Institute, Chennai between 1992 and 2002 were studied. Sixty-eight patients completed combination chemotherapy with cisplatin regimes, of whom 35 had radiological residual masses. Twenty-nine out of these 35 patients underwent laparotomy to assess the nature of the residue. RESULTS: On laparotomy, three patients had viable tumor, seven immature teratoma, three mature teratoma and 16 only necrosis or fibrosis. None of our patients with dysgerminoma, embryonal carcinoma, absence of teratoma element in the primary tumor and radiological residue of < 5 cm had viable tumor whereas all patients with tumors containing teratoma component initially had residual tumor. Absence of viable disease was higher in patients who had normalization of serum markers by two cycles of chemotherapy. CONCLUSION: Our study suggests that patients with absence of teratoma element initially, radiological residue of< 5 cm and normalization of serum markers after two cycles of chemotherapy do not require surgery to assess the nature of post-chemotherapy residue. However, laparotomy should be performed in patients with tumors that initially contain teratoma element and in those with sluggish tumor marker response after two cycles of chemotherapy since they have a high chance of having viable post chemotherapy residue.

O papel da alfa-feto-proteína no tumor embrionário do ovário / Role of the alpha-fetoprotein in the embryonal tumor of the ovary

Os autores, através de revisäo bibliográfica, apresentam a relaçäo da alfa-feto-proteína (AFP) como marcador tumoral em neoplasias de células germinativas do ovário. Analisam os aspectos diagnósticos, o manejo terapêutico e o prognóstico desses tumores.

Management of malignant germ cell tumours of ovary.

Ten patients of the advanced malignant germ cell tumours of the ovary were treated by cisplatin based combination chemotherapy after initial conservation surgery. Eight patients completed course containing cisplatinum, vinblastine and bleomycin. Five patients (62.5%) achieved CR while 2 (25%) attained PR. One patient died due to tumour lysis and respiratory infection. Rest two patients did not turn up in follow up. Long term follow up indicates above regimen to be highly effective. However poor performance status, advanced stage of disease and post operative gross residual disease were poor prognostic factors in our patients.

Remissäo completa em câncer avançado do testículo com o emprego do esquema VAB6: experiência com 40 casos / Total remission of advanced cancer of the testis with the use of the VAB6 schedule: esperience with 40 cases

O prognóstico dos pacientes com câncer disseminado do testículo melhorou de forma significativa com o advento de esquemas de quimioterapia citotóxica contendo cis-platinum, vinblastina e bleomicina. O objetivo do presente trabalho foi o de avaliar a eficiência desta abordagem em pacientes com tumores germinativos metastáticos do testículo em estádios IIc e III. Quarenta pacientes, 14 portadores de seminoma e 26 portadores de tumores näo-seminomatosos, foram tratados com quimioterapia sistêmica seguida de cirurgia cito-redutiva. Nestes casos foi empregado o esquema VAB6, representado pela administraçäo de vinblastina, actinomicina-D, bleomicina, cis-platinum e ciclofosfamida por 3 ou 4 ciclos de 21 dias. Nos pacientes com persistência ou recorrência posterior da neplasia foram feitas novas reinduçöes com esquemas contendo VP-16-213 e cis-platinum. A análise deste material, após um período de seguimento que variou de 8 a 46 meses (mediana = 29 meses) em seminomas e de 3 a 64 meses (mediana = 33 meses) em tumores näo-seminomatosos, evidenciou remissäo completa e prolongada da neoplasia em 34 dos 40 pacientes (85%), incluindo todos os 14 pacientes com seminoma (100%) e 20 dos 26 pacientes com tumores näo-seminomatosos (77%). Os dados do presente estudo demostram que o cancêr do testículo representa doença consistentemente curável, mesmo em fases de apresentaçäo mais avançada