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3.
Zhonghua Bing Li Xue Za Zhi ; 52(4): 347-352, 2023 Apr 08.
Article in Chinese | MEDLINE | ID: mdl-36973194

ABSTRACT

Objective: To investigate the clinicopathological features and possible mechanisms of burned-out testicular germ cell tumors. Methods: The clinical and imaging data, histology and immunophenotypic characteristics of three cases of burned-out testicular germ cell tumors diagnosed at the Ruijin Hospital, Medical College of the Shanghai Jiaotong University, from 2016 to 2020 were retrospectively analyzed. The relevant literature was reviewed. Results: The mean age of the three patients was 32 years. Case 1 had an elevated preoperative alpha-fetoprotein level (810.18 µg/L) and underwent "radical pancreaticoduodenectomy and retroperitoneal lesion resection" for a retroperitoneal mass. Postoperative pathology showed embryonal carcinoma, which needed to exclude gonadal metastasis. Color Doppler ultrasound showed a solid mass of the right testis, with hypoechoic lesion and scattered calcification in some areas. Case 2 was a "right supraclavicular lymph node biopsy specimen." Chest X-ray showed multiple metastases in both lungs. The biopsy showed metastatic embryonic carcinoma and bilateral testicular color Doppler ultrasound revealed abnormal calcifications in the right testicle. Case 3 showed a cystic mass of the right testis with calcification and solid areas. All 3 patients underwent radical right orchiectomy. Grossly, borders of the testicular scar areas were well defined. Cross sectioning of the tumors showed a gray-brown cut surface and single focus or multiple foci of the tumor. The tumor maximum diameter was 0.6-1.5 cm. Microscopically, lymphocytes, plasma cells infiltration, tubular hyalinization, clustered vascular hyperplasia and hemosiderin laden macrophages were found in the scar. Atrophic and sclerotic seminiferous tubules, proliferation of clustered Leydig cells and small or coarse granular calcifications in seminiferous tubules were present around the scar. Seminoma and germ cell neoplasia in situ were seen in case 1, germ cell neoplasia in situ was seen in case 2 and germ cells with atypical hyperplasia were seen in case 3. Immunohistochemistry showed that embryonic carcinoma expressed SALL4, CKpan(AE1/AE3) and CD30, seminoma and germ cell tumor in situ expressed OCT3/4, SALL4 and CD117, and spermatogenic cells with atypical hyperplasia expressed CD99 and SALL4. The Ki-67 positive index was about 20%, while OCT3/4 and CD117 were both negative. Conclusions: Burned-out testicular germ cell tumors are rare. The possibility of gonad testicular metastasis should be considered first for extragonadal germ cell tumor. If fibrous scar is found in testis, it must be determined whether it is a burned-out testicular germ cell tumor. The burned-out mechanisms may be related to the microenvironment of tumor immune-mediated and local ischemic injury.


Subject(s)
Calcinosis , Carcinoma , Neoplasms, Germ Cell and Embryonal , Seminoma , Testicular Neoplasms , Male , Humans , Adult , Seminoma/diagnosis , Seminoma/pathology , Seminoma/secondary , Cicatrix/pathology , Hyperplasia , Retrospective Studies , China , Testicular Neoplasms/pathology , Neoplasms, Germ Cell and Embryonal/surgery , Tumor Microenvironment
5.
Chinese Journal of Pathology ; (12): 347-352, 2023.
Article in Chinese | WPRIM (Western Pacific) | ID: wpr-985678

ABSTRACT

Objective: To investigate the clinicopathological features and possible mechanisms of burned-out testicular germ cell tumors. Methods: The clinical and imaging data, histology and immunophenotypic characteristics of three cases of burned-out testicular germ cell tumors diagnosed at the Ruijin Hospital, Medical College of the Shanghai Jiaotong University, from 2016 to 2020 were retrospectively analyzed. The relevant literature was reviewed. Results: The mean age of the three patients was 32 years. Case 1 had an elevated preoperative alpha-fetoprotein level (810.18 μg/L) and underwent "radical pancreaticoduodenectomy and retroperitoneal lesion resection" for a retroperitoneal mass. Postoperative pathology showed embryonal carcinoma, which needed to exclude gonadal metastasis. Color Doppler ultrasound showed a solid mass of the right testis, with hypoechoic lesion and scattered calcification in some areas. Case 2 was a "right supraclavicular lymph node biopsy specimen." Chest X-ray showed multiple metastases in both lungs. The biopsy showed metastatic embryonic carcinoma and bilateral testicular color Doppler ultrasound revealed abnormal calcifications in the right testicle. Case 3 showed a cystic mass of the right testis with calcification and solid areas. All 3 patients underwent radical right orchiectomy. Grossly, borders of the testicular scar areas were well defined. Cross sectioning of the tumors showed a gray-brown cut surface and single focus or multiple foci of the tumor. The tumor maximum diameter was 0.6-1.5 cm. Microscopically, lymphocytes, plasma cells infiltration, tubular hyalinization, clustered vascular hyperplasia and hemosiderin laden macrophages were found in the scar. Atrophic and sclerotic seminiferous tubules, proliferation of clustered Leydig cells and small or coarse granular calcifications in seminiferous tubules were present around the scar. Seminoma and germ cell neoplasia in situ were seen in case 1, germ cell neoplasia in situ was seen in case 2 and germ cells with atypical hyperplasia were seen in case 3. Immunohistochemistry showed that embryonic carcinoma expressed SALL4, CKpan(AE1/AE3) and CD30, seminoma and germ cell tumor in situ expressed OCT3/4, SALL4 and CD117, and spermatogenic cells with atypical hyperplasia expressed CD99 and SALL4. The Ki-67 positive index was about 20%, while OCT3/4 and CD117 were both negative. Conclusions: Burned-out testicular germ cell tumors are rare. The possibility of gonad testicular metastasis should be considered first for extragonadal germ cell tumor. If fibrous scar is found in testis, it must be determined whether it is a burned-out testicular germ cell tumor. The burned-out mechanisms may be related to the microenvironment of tumor immune-mediated and local ischemic injury.


Subject(s)
Male , Humans , Adult , Seminoma/secondary , Cicatrix/pathology , Hyperplasia , Retrospective Studies , China , Testicular Neoplasms/pathology , Neoplasms, Germ Cell and Embryonal/surgery , Calcinosis , Carcinoma , Tumor Microenvironment
6.
Eur Urol ; 82(2): 172-179, 2022 08.
Article in English | MEDLINE | ID: mdl-35599187

ABSTRACT

BACKGROUND: In metastatic seminoma, a strategy is needed for selecting patients for less intensive chemotherapy, to limit toxicities. OBJECTIVE: To assess whether men with good-prognosis metastatic seminoma could be treated with two cycles of etoposide-cisplatin (EP) followed by only one cycle of carboplatin (CARBO) based on negative interim fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS: A nonrandomised, multicentre, phase 2 trial was conducted (NCT01887340). INTERVENTION: All patients with baseline-positive FDG-PET/CT received EP for two cycles. After completing the first two cycles, the patients underwent a second FDG-PET/CT to assess the response. Patients with positive FDG-PET/CT proceeded directly to two additional EP cycles; those who achieved FDG-PET/CT negativity received one cycle of CARBO. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The proportion of patients with negative interim FDG-PET/CT who received carboplatin was determined. RESULTS AND LIMITATIONS: Between 2013 and 2017, 102 patients were enrolled. After the first two EP cycles, FDG-PET/CT was available in 98 patients. Overall, 67 patients (68.4%; 95% confidence interval [CI]: 58.2-77.4) had negative FDG-PET/CT and proceeded to a single CARBO cycle. Twenty-seven patients (27.6%; 95% CI: 19.0-37.5) had positive FDG-PET/CT after two EP cycles. The 3-yr progression-free survival rate was 90.0% (95% CI: 74.4-96.5) in the EP group and 90.8% (95% CI: 81.4-95.7) in the CARBO group. The cumulative incidences of peripheral neuropathy and ototoxicity were significantly higher in the EP group. CONCLUSIONS: Omission of two cycles of EP based on negative FDG-PET/CT after two cycles of chemotherapy appears to be feasible. However, the absence of consensus criteria for FDG-PET/CT interpretation and the short follow-up need additional studies. This strategy does not warrant routine integration yet. PATIENT SUMMARY: Men with good-prognosis metastatic seminoma were treated with fewer cycles of chemotherapy based on interim fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). Omission of two cycles of chemotherapy based on negative FDG-PET/CT after two initial cycles appears to be feasible, thereby limiting the burden of treatment and toxicity.


Subject(s)
Seminoma , Testicular Neoplasms , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Carboplatin/adverse effects , Fluorodeoxyglucose F18 , Humans , Male , Positron Emission Tomography Computed Tomography/methods , Positron-Emission Tomography , Prognosis , Radiopharmaceuticals/therapeutic use , Seminoma/diagnostic imaging , Seminoma/drug therapy , Seminoma/secondary , Testicular Neoplasms/diagnostic imaging , Testicular Neoplasms/drug therapy , Testicular Neoplasms/pathology , Treatment Outcome
7.
J Neuroophthalmol ; 41(2): 261-265, 2021 Jun 01.
Article in English | MEDLINE | ID: mdl-33630775

ABSTRACT

ABSTRACT: A 45-year-old man with a history of testicular seminoma treated 8 years earlier presented with chronic progressive truncal and limb ataxia, progressive sensorineural hearing loss, and episodic vertigo. Eye movement and neuro-otology examinations showed localizing abnormalities to the bilateral cerebellar flocculus, vermis, and bilateral cerebellar hemispheres. Audiometric testing showed bilateral symmetric sensorineural hearing loss. There was a normal MRI of the brain. Cerebrospinal fluid (CSF) showed modest lymphocytic pleocytosis, and there was an elevated serum choriogonadotrophic hormone. An abdominal CT scan showed a solitary, large retroperitoneal lymph node, and histopathologic examination of the node biopsy showed granulomatous inflammation without microorganisms; eventually, immunohistochemical markers confirmed the diagnosis of metastatic seminoma. Although normal neuroimaging and inflammatory CSF reaction suggested a paraneoplastic etiology, the initial paraneoplastic antibody testing was negative. Subsequent investigation identified a positive kelch-11 protein antibody, thus confirming the paraneoplastic connection between the metastatic seminoma and the subacute neurologic-cochleovestibular syndrome.


Subject(s)
Ataxia/etiology , Autoantibodies/blood , Carrier Proteins/immunology , Hearing Loss, Sensorineural/etiology , Nystagmus, Pathologic/etiology , Seminoma/secondary , Testicular Neoplasms/pathology , Ataxia/diagnosis , Ataxia/physiopathology , Biomarkers, Tumor/blood , Biomarkers, Tumor/immunology , Carrier Proteins/blood , Eye Movements/physiology , Hearing Loss, Sensorineural/diagnosis , Humans , Male , Middle Aged , Neoplasm Metastasis , Nystagmus, Pathologic/diagnosis , Nystagmus, Pathologic/physiopathology , Paraneoplastic Syndromes, Ocular/blood , Paraneoplastic Syndromes, Ocular/complications , Paraneoplastic Syndromes, Ocular/diagnosis , Seminoma/diagnosis , Seminoma/immunology , Testicular Neoplasms/immunology , Tomography, X-Ray Computed
8.
Biomedica ; 40(Supl. 2): 27-33, 2020 10 30.
Article in English, Spanish | MEDLINE | ID: mdl-33152185

ABSTRACT

COVID-19 is the viral infection caused by SARS-CoV-2 declared by the World Health Organization (WHO) as a pandemic. Patients with cancer have a higher risk to acquire the infection and worse prognosis as they have to attend more medical visits in healthcare institutions, receive medical and surgical treatments, and be subjected to diagnostic studies such as PET/CT in nuclear medicine services where the infection may be an incidental finding. We present here F18-FDG PET/CT (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose), images with findings of COVID-19 from patients with different oncological conditions but no respiratory symptoms.


La COVID-19 es la infección viral causada por el SARS-CoV-2 y declarada por la Organización Mundial de la Salud (OMS) como pandemia. Los pacientes con cáncer tienen un mayor riesgo de adquirir la infección y un peor pronóstico, ya que deben asistir a visitas médicas en diferentes centros hospitalarios, reciben tratamientos médicos y quirúrgicos y deben someterse a estudios diagnósticos como la PET/CT en servicios de medicina nuclear, lo que es ocasión para el hallazgo incidental de la infección. Se presentan las imágenes de tomografías computarizadas por emisión de positrones con 18-fluorodesoxiglucosa (F18) (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose, PET/CT F18-FDG) en las que se evidenció la COVID-19 en pacientes con diversas enfermedades oncológicas, pero sin sintomatología respiratoria.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnostic imaging , Incidental Findings , Neoplasms/complications , Pneumonia, Viral/diagnostic imaging , Positron Emission Tomography Computed Tomography , Adult , Aged , Asymptomatic Diseases , COVID-19 , COVID-19 Testing , Carcinoma, Signet Ring Cell/complications , Carcinoma, Signet Ring Cell/diagnostic imaging , Carcinoma, Signet Ring Cell/secondary , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Female , Fluorine Radioisotopes , Fluorodeoxyglucose F18 , Humans , Lymphatic Metastasis/diagnostic imaging , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnostic imaging , Male , Middle Aged , Neoplasms/diagnostic imaging , Pandemics , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Pneumonia, Viral/complications , Radiopharmaceuticals , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Seminoma/complications , Seminoma/diagnostic imaging , Seminoma/secondary , Stomach Neoplasms
10.
J Urol ; 204(6): 1242-1248, 2020 12.
Article in English | MEDLINE | ID: mdl-32717162

ABSTRACT

PURPOSE: Robotic assisted retroperitoneal lymph node dissection in patients with testicular cancer is controversial. Lately, unusual recurrence patterns with adverse outcomes after robotic assisted retroperitoneal lymph node dissection have been published. In this report we determine the feasibility, safety and early oncologic outcome of robotic assisted retroperitoneal lymph node dissection in patients with small volume metastatic testicular cancer. MATERIALS AND METHODS: We retrospectively evaluated 27 consecutive patients with small volume metastatic testicular cancer (October 2010 to November 2019) who underwent robotic assisted retroperitoneal lymph node dissection (unilateral modified template). Intraoperative and postoperative complications as well as early oncologic outcomes are reported. Surgery was performed in the primary metastatic setting in 22 (81%), post-chemotherapy in 4 (15%) and for late relapse in 1 patient (4%). Initial clinical stage was IIA for 14 (52%), IIB for 12 (43%) and III for 1 (4%) patient. RESULTS: Median operative time, blood loss and length of hospital stay were 175 minutes, 50 ml and 4 days, respectively. Expectedly, viable tumor was found in 21/27 patients (78%) and 6 patients (22%) showed fibrosis, necrosis or no tumor. Overall 3 (11%) patients experienced intraoperative (Satava II) and 1 (4%) postoperative (Clavien-Dindo IIIb) complications, respectively. Median followup was 16.5 months (3-69), and 3 (11%) patients experienced relapse outside of the surgical field after 12, 22 and 36 months. CONCLUSIONS: In highly selected patients with low volume metastatic testicular cancer robotic assisted retroperitoneal lymph node dissection may be indicated, and appears to be technically feasible and comparable with open surgery in terms of complications and early oncologic safety. Prospective data collection in larger series is necessary to clarify the role and specific indications of this approach.


Subject(s)
Lymph Node Excision/adverse effects , Lymphatic Metastasis/therapy , Robotic Surgical Procedures/adverse effects , Seminoma/therapy , Testicular Neoplasms/therapy , Adult , Aged , Blood Loss, Surgical/statistics & numerical data , Chemotherapy, Adjuvant , Feasibility Studies , Follow-Up Studies , Humans , Length of Stay/statistics & numerical data , Lymph Node Excision/methods , Lymph Nodes/pathology , Lymph Nodes/surgery , Lymphatic Metastasis/pathology , Male , Middle Aged , Neoadjuvant Therapy/methods , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/prevention & control , Neoplasm Staging , Operative Time , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Prospective Studies , Retroperitoneal Space/pathology , Retroperitoneal Space/surgery , Retrospective Studies , Seminoma/epidemiology , Seminoma/secondary , Testicular Neoplasms/epidemiology , Testicular Neoplasms/pathology , Treatment Outcome , Young Adult
11.
Andrology ; 8(6): 1687-1698, 2020 11.
Article in English | MEDLINE | ID: mdl-32530514

ABSTRACT

BACKGROUND: Seminomatous germ cell tumours (SGCT) are the most frequent malignancy in young men. Reliable prognostic biomarkers for the prediction of metastasis at diagnosis and the risk of relapse in clinical stage I (CSI) are lacking. Adjuvant therapies carry a risk of overtreatment, whereas salvage therapies have a risk of high toxicities. Thus, the identification of reliable prognostic biomarkers is highly desirable to identify patients who will benefit from early adjuvant treatment. MicroRNAs (miRNAs) regulate tumour development and progression, and their potential as biomarkers has already been proven in a variety of malignancies. OBJECTIVES: The aim of our study was to define a specific miRNA expression pattern that discriminates metastatic from non-metastatic primary SGCT. MATERIALS AND METHODS: Total RNA was isolated from 24 formalin-fixed paraffin-embedded (FFPE) primary SGCT tumours (10 non-metastatic, five metachronously and nine synchronously metastatic) and from 10 normal testicular tissue samples. Microarray analysis was performed for global miRNA expression profiling. The results were validated by quantitative real-time polymerase chain reaction (qRT-PCR). Statistical analysis was performed using SPSS. RESULTS: Microarray analyses revealed a specific miRNA pattern that distinguishes metastatic from non-metastatic SGCT. Sixty-three miRNAs were differentially expressed in metastatic compared to non-metastatic tumours (P < .01). Microarray results were confirmed by qRT-PCR for three out of five selected miRNAs (miR-29c-5p, miR-506-3p and miR-371a-5p; P < .05). All five miRNAs (miR-29c-5p, miR-506-3p, miR-1307-5p, miR-371a-5p and miR-371a-3p) showed differential expression between tumour and normal tissues (P < .05). CONCLUSION: Metastatic primary SGCTs are characterized by a specific miRNA expression pattern. Therefore, specific miRNAs could represent a new tool to predict the metastatic potential in SGCT patients.


Subject(s)
Biomarkers, Tumor/genetics , Gene Expression Profiling , MicroRNAs/genetics , Neoplasms, Germ Cell and Embryonal/genetics , Seminoma/genetics , Testicular Neoplasms/genetics , Transcriptome , Adult , Biomarkers, Tumor/metabolism , Gene Expression Regulation, Neoplastic , Humans , Male , MicroRNAs/metabolism , Middle Aged , Neoplasms, Germ Cell and Embryonal/metabolism , Neoplasms, Germ Cell and Embryonal/secondary , Oligonucleotide Array Sequence Analysis , Predictive Value of Tests , Seminoma/metabolism , Seminoma/secondary , Testicular Neoplasms/metabolism , Testicular Neoplasms/pathology
12.
Urol Int ; 104(5-6): 489-496, 2020.
Article in English | MEDLINE | ID: mdl-32241010

ABSTRACT

BACKGROUND: The aim of this study was to examine clinical/pathological characteristics, prognosis and tendency to metastasis of mixed germ cell tumours (MGCTs) that contain a seminoma component. METHODS: A total of 111 MGCT cases between 2008 and 2018 were retrospectively enrolled. The patients were divided into 2 groups according to the absence (group 1) or presence (group 2) of seminoma component in MGCTs. Patients' age, complaints at admission to our clinic, primary tumour localization, primary tumour size, preoperative testicular tumour markers, MGCT histopathological components and percentages, lymphovascular invasion, pathological tumour stage, postoperative testicular tumour markers, presence of lymph node involvement in abdominal tomography, lung metastasis based on thorax tomography, clinical tumour stage, adjunctive therapies performed, state of recurrence and survival were compared in 2 groups. RESULTS: The mean age of the patients was 24.51 ± 4.79 years. The mean age, initial complaint rates, primary tumour size, postoperative testicular tumour markers, presence of lymphovascular invasion, presence of lymph node involvement and lung metastasis were found to be higher in group 2 than in group 1, although these differences were not statistically significant. Especially, it was found that a seminoma component rate of 30% and higher had a higher tendency for a poor prognosis. CONCLUSION: Although the word "seminoma" may be initially interpreted as an indication of good prognosis, a seminoma component in MGCTs is actually not a good prognostic factor. MGCTs that contain a seminoma component (especially 30% and higher) can have a higher tendency for occult metastatic disease.


Subject(s)
Neoplasms, Germ Cell and Embryonal/pathology , Neoplasms, Multiple Primary/pathology , Seminoma/pathology , Testicular Neoplasms/pathology , Adult , Humans , Male , Neoplasms, Germ Cell and Embryonal/secondary , Prognosis , Retrospective Studies , Seminoma/secondary , Young Adult
13.
BMJ Case Rep ; 13(4)2020 Apr 22.
Article in English | MEDLINE | ID: mdl-32327457

ABSTRACT

Two male patients, aged 55 and 75 years, were referred to the ENT and haematology team respectively, with an asymptomatic left supraclavicular neck mass. Investigations revealed metastatic primary testicular seminoma. CT contrast study of the thorax, abdomen and pelvis demonstrated an additional left para-aortic nodal mass in both cases. The initial presentation of a solitary left neck lump from a metastatic testicular seminoma is extremely unusual, especially in an older age group. The pattern of metastatic spread to the supraclavicular neck nodes from a single para-aortic lymph node is also an interesting finding. Although the majority of seminomas present in younger patients in the early stages when confined to the testis, seminoma can also occur in older patients and can present in an atypical manner. The ability to recognise an atypical presentation in an older patient is invaluable for prompt diagnosis, treatment and follow-up of disease. This case also highlights the importance of a multisystematic structured and an open-minded approach to investigating and diagnosing a neck mass.


Subject(s)
Head and Neck Neoplasms/secondary , Seminoma/secondary , Testicular Neoplasms/pathology , Aged , Biopsy, Large-Core Needle , Contrast Media , Diagnosis, Differential , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/therapy , Humans , Male , Middle Aged , Seminoma/diagnostic imaging , Seminoma/therapy , Tomography, X-Ray Computed , Ultrasonography
14.
Asian Pac J Cancer Prev ; 21(2): 511-515, 2020 Feb 01.
Article in English | MEDLINE | ID: mdl-32102532

ABSTRACT

OBJECTIVES: The present study aims to evaluate the role of Positron emission tomography (PET) -computed tomography (CT) with 18F-fluorodeoxyglucose (18F-FDG) in the restaging of high-risk testicular cancer. METHODS: Forty-five patients (mean age of 38.1±11.3 years and range 23-81 years) with testicular carcinoma, underwent 18F-FDG PET-CT during their clinical course were prospectively selected. PET positivity was defined as a site of abnormal 18F-FDG uptake in tissue histologically proven or clinically or radiographically suspected to represent tissue involvement. The sites of disease were characterized as either nodal or extranodal. All patients were followed-up for at least 12 months with a diagnostic and/or functional imaging modality. RESULTS: Of the 45 patients 38 (84%) patient presented with seminoma and 7 (16%) were Non-seminomatous germ cell tumors. Analysis of secondary disease spectrum showed nodal involvement in 65%, osseous involvement in 23% and mixed visceral/soft tissue lesions in 12% of patients. Nineteen (42%) were negative for any metastatic disease. All negative patients remain disease free in the follow-up of one year. Out of the positive 26/45 patients, PET-CT showed progressive disease in 3/26, stable disease 1/26 and partial response in 2/26 and complete metabolic resolution in 20/26 patients. 18F-FDG PET-CT was able to characterize all patients leading to significant change of primary decision of wait and watch to go for treatment and vice versa. CONCLUSION: 18F-FDG PET-CT scan is potentially an excellent tool for characterization of equivocal lesions on CT scan in the restaging settings and follow up of high-risk testicular cancer patients.


Subject(s)
Lymph Nodes/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasms, Germ Cell and Embryonal/diagnostic imaging , Positron Emission Tomography Computed Tomography , Seminoma/diagnostic imaging , Testicular Neoplasms/diagnostic imaging , Adult , Aged , Aged, 80 and over , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/secondary , Fluorodeoxyglucose F18 , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/secondary , Male , Middle Aged , Neoplasm Staging , Neoplasms, Germ Cell and Embryonal/secondary , Radiopharmaceuticals , Seminoma/secondary , Testicular Neoplasms/pathology , Testicular Neoplasms/secondary , Young Adult
15.
World J Urol ; 38(6): 1535-1544, 2020 Jun.
Article in English | MEDLINE | ID: mdl-31463562

ABSTRACT

BACKGROUND: The International Germ Cell Consensus Classification (IGCCC) is the recommended stratification scheme for newly diagnosed metastatic seminoma (mSGCT) and non-seminoma germ cell tumor (mNSGCT) patients. However, a contemporary North-American population-based validation has never been completed and represented our focus. MATERIALS AND METHODS: We identified mSGCT and mNSGCT patients within the SEER database (2004-2015). The IGCCC criteria were used for stratification into prognostic groups. Kaplan-Meier (KM) derived actuarial 5-year overall survival (OS) rates were calculated. In addition, cumulative incidence plots tested cancer-specific (CSM) and other-cause mortality (OCM) rates. RESULTS: Of 321 mSGCT patients, 190 (59.2%) and 131 (40.8%), respectively, fulfilled good and intermediate prognosis criteria. Of 803 mNSGCT patients, 209 (26.1%), 100 (12.4%), and 494 (61.5%), respectively, fulfilled good, intermediate, and poor prognosis criteria. In mSGCT patients, actuarial KM derived 5-year OS was 87% and 78% for, respectively, good and intermediate prognosis groups (p = 0.02). In cumulative incidence analyses, statistically significant differences were recorded for CSM but not for OCM between good versus intermediate prognosis groups. In mNSGCT patients, actuarial KM derived 5-year OS was 89%, 75% and 60% for, respectively, good, intermediate, and poor prognosis groups (p < 0.001). In cumulative incidence analyses, statistically significant differences were recorded for both CSM and OCM between good, intermediate, and poor prognosis groups. CONCLUSIONS: Our findings represent the first population-based validation of the IGCCC in contemporary North-American mSGCT and mNSGCT patients. The recorded OM rates closely replicate those of the original publication, except for better survival of poor prognosis mNSGCT patients.


Subject(s)
Neoplasms, Germ Cell and Embryonal/classification , Neoplasms, Germ Cell and Embryonal/secondary , Seminoma/classification , Seminoma/secondary , Testicular Neoplasms/pathology , Adult , Consensus Development Conferences as Topic , Humans , International Cooperation , Male , Middle Aged , Neoplasms, Germ Cell and Embryonal/mortality , Prognosis , Retrospective Studies , Seminoma/mortality , Survival Rate , Testicular Neoplasms/classification , Testicular Neoplasms/mortality , Testicular Neoplasms/secondary
16.
Hum Pathol ; 94: 16-22, 2019 12.
Article in English | MEDLINE | ID: mdl-31666197

ABSTRACT

Management of clinical stage (CS) 1 testicular seminoma is controversial. Treatment choice is based on a number of pathological risk factors. However, they have been inconsistently associated with risk of metastatic disease. The eighth edition of the American Joint Committee on Cancer Tumor-Node-Metastasis staging system has separated pT1a and pT1b tumors according to a 3-cm size cutoff and upstaged invasion of hilar soft tissue and epididymis as pT2. We investigated pathological predictors of metastatic disease at presentation in 332 testicular seminomas. Age, tumor size, invasion of vessels, hilar soft tissue, rete testis, epididymis, spermatic cord, tunica vaginalis and tumor at spermatic cord margin were assessed and correlated with CS at presentation. A total of 290 (87%) tumors were CS 1; 42 (13%) were CS 2/3. Median patient age of CS 1 was 36 years (20-81); that of CS 2/3 was 36 years (26-63). Mean tumor size of CS 1 was 38 mm (5-95 mm); that of CS 2/3 was 54 mm (8-95 mm). On univariate analysis, lymphovascular invasion (P = .044), epididymal invasion (P = .009) and tumor size (P = .0001) were associated with higher CS. On multivariate analysis, tumor size (P = .0001) and epididymis invasion (P = .023) remained significant. Optimal tumor size cutoff was 4.25 cm. We conclude that tumor size and epididymal invasion are the strongest predictors of metastatic disease at presentation. The results validate changes in American Joint Committee on Cancer Tumor-Node-Metastasis staging eighth edition but suggest a tumor size of 4 cm as better cutoff value.


Subject(s)
Neoplasm Staging , Seminoma/secondary , Testicular Neoplasms/pathology , Adult , Age Factors , Aged , Aged, 80 and over , Databases, Factual , Epididymis/pathology , Humans , Male , Middle Aged , Neoplasm Invasiveness , Predictive Value of Tests , Retrospective Studies , Risk Assessment , Risk Factors , Seminoma/therapy , Testicular Neoplasms/therapy , Tumor Burden , Young Adult
17.
Eur J Cancer ; 115: 128-135, 2019 07.
Article in English | MEDLINE | ID: mdl-31136925

ABSTRACT

INTRODUCTION: Carboplatin monotherapy for metastatic seminoma at a dose of AUC-10 has shown promising activity. Three or four cycles have been given with most haematological side-effects seen with the 4th cycle. An early response might allow de-escalation of therapy. METHODS: Forty-eight patients with metastatic seminoma (International Germ Cell Cancer Collaborative Group good prognosis) were recruited. Positron emission tomography (PET) scanning was performed before and after one cycle of carboplatin. Those with a Deauville score of 3 or less were given a total of three cycles of carboplatin, the rest received four. RESULTS: PET scanning allowed 44% to receive three cycles of carboplatin. With a median follow-up of 31.2 months, 95.6% (95% confidence interval: 83.5%-98.9%) were progression free. The overall survival at 2-years was 100%. Lower stage (2A and 2B) disease was significantly (P = 0.001) associated with the better metabolic response, but the association was not strong (correlation coefficient = -0.48). Over a third of the blood products given were used to support the 4th cycle. The regimen was well tolerated with a low incidence of grade III neutropenic sepsis or nausea and vomiting (<3% cycles). CONCLUSION: Carboplatin AUC-10 monotherapy is effective with low toxicity. Early changes during PET scanning may allow de-escalation of therapy in high volume disease-comparison against combination therapy is warranted. CLINICALTRIALS. GOV IDENTIFIER: NCT02272816. EUDRACT NUMBER: 2009-009882-33.


Subject(s)
Antineoplastic Agents/administration & dosage , Carboplatin/administration & dosage , Positron Emission Tomography Computed Tomography , Seminoma/drug therapy , Testicular Neoplasms/drug therapy , Adult , Aged , Antineoplastic Agents/adverse effects , Carboplatin/adverse effects , Clinical Decision-Making , Disease Progression , Humans , London , Male , Middle Aged , Neoplasm Staging , Predictive Value of Tests , Progression-Free Survival , Risk Assessment , Risk Factors , Seminoma/diagnostic imaging , Seminoma/metabolism , Seminoma/secondary , Testicular Neoplasms/diagnostic imaging , Testicular Neoplasms/metabolism , Testicular Neoplasms/pathology , Time Factors , Young Adult
18.
Future Oncol ; 15(12): 1347-1352, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30880465

ABSTRACT

Germ cell tumors represent 11% of the cancers diagnosed in adolescent males and are the most common solid tumors in adult men between the ages of 20 and 35. Pure seminoma accounts for around 50% of all testicular germ cell tumors. The prognostic classification of the International Germ Cell Cancer Collaborative Group for good-prognosis seminoma includes both nodal disease and pulmonary visceral metastases. In this article, we analyzed recent data on prognosis and outcome of good-prognosis seminoma to revise the traditional classification of the disease and improve tailored treatment.


Subject(s)
Biomarkers, Tumor/analysis , Lung Neoplasms/mortality , Seminoma/classification , Testicular Neoplasms/classification , Disease-Free Survival , Humans , Lung Neoplasms/secondary , Lung Neoplasms/therapy , Male , Neoplasm Staging , Prognosis , Risk Assessment , Seminoma/mortality , Seminoma/secondary , Seminoma/therapy , Testicular Neoplasms/mortality , Testicular Neoplasms/secondary , Testicular Neoplasms/therapy , Testis/pathology
20.
Arch Soc Esp Oftalmol (Engl Ed) ; 93(9): 417-422, 2018 Sep.
Article in English, Spanish | MEDLINE | ID: mdl-29907347

ABSTRACT

INTRODUCTION: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases.


Subject(s)
Choroid Neoplasms/secondary , Neoplasms, Germ Cell and Embryonal/secondary , Posterior Eye Segment/pathology , Retinal Neoplasms/secondary , Testicular Neoplasms/complications , Adolescent , Adult , Choroid Neoplasms/diagnosis , Cross-Sectional Studies , Early Detection of Cancer , Ethnicity , Hospitals, General , Humans , Male , Mexico , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/therapy , Retinal Neoplasms/diagnosis , Retinal Pigment Epithelium/pathology , Retinal Vessels/pathology , Seminoma/diagnosis , Seminoma/secondary , Seminoma/therapy , Testicular Neoplasms/therapy , Visual Acuity , Young Adult
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