Primary carcinoid of the testis with metastases. Case report and review of the literature.

Primary carcinoid of the testis is an extremely rare neoplasm, making up 0.23% of all testicular neoplasms. The vast majority of the reported cases are primary carcinoids and 20-25% are associated with teratomas. Approximately 10% of these tumors will develop metastases. We present a case of a 50-year-old man with a primary testicular carcinoid who developed lymph node and lung metastases 4 months after left inguinal orchidectomy. Our case was not associated with testicular teratoma or carcinoid syndrome. Vigorous efforts were done postoperatively to exclude the possibility of carcinoid tumor metastatic to the testis. Our patient achieved a mixed response (lung metastases: complete response, lymph node metastases: partial response) with combined therapy that included chemotherapy (cisplatin, etoposide, ifosfamide, epirubicin), octreotide and radiotherapy to the metastatic lymph nodes. He remains well and asymptomatic. We herein review the literature and discuss all the possibilities to explain the origin of carcinoid tumors of the testis.

Irinotecan and vinorelbine in patients with non-small cell lung cancer previously treated with platinum-based chemotherapy. A phase II study of the Hellenic Cooperative Oncology Group.

PURPOSE: To evaluate the efficacy and tolerability of irinotecan plus vinorelbine every 2 weeks in patients with advanced non-small cell lung cancer (NSCLC), previously treated with platinum-based chemotherapy. PATIENTS AND METHODS: Forty-one patients with advanced NSCLC, refractory or resistant to platinum derivatives, were treated on an out-patient basis with irinotecan 150 mg/m2 intravenous (i.v.) and vinorelbine 25 mg/m2 on days 1 and 15. Chemotherapy was repeated every 4 weeks. The response was evaluated every two cycles. RESULTS: On an intent-to-treat analysis, 6 patients (14.6%) [95% confidence interval (CI) 5.57% to 29.17%] achieved partial response (PR), 15 (36.6%) stable disease (SD) and 20 (48.8%) progressive disease (PD). The median time to tumor progression (TTP) was 4.9 months (range 0.17-15.5 months), the median survival time was 7.8 months (range 0.9 to 19.6 months) and the 1-year survival rate was 37%. Symptomatic benefit response including improvement of performance status (PS), dyspnea, anorexia and fatigue, cessation of hemoptysis, fever and reduction of cough and pain was seen in 10 to 42% of patients. No patient experienced grade 3/4 anemia. Grade 3/4 thrombocytopenia occurred in 2 (5%) patients. Five patients (12%) developed grade 3/4 neutropenia and 5 (12%) had neutropenic fever that required hospitalization, but was successfully treated with antibiotics and G-CSF support. One patient (2%) developed grade 4 fatigue and was withdrawn. Other grade 3/4 adverse events included diarrhea (n = 3; 2 required hospitalization), alopecia (n = 5) and neurotoxicity (n = 1). Six patients required a dose reduction. CONCLUSION: The combination of irinotecan plus vinorelbine administered every 2 weeks demonstrated rather low activity in advanced NSCLC patients who had previously failed platinum-based chemotherapy, but it was well-tolerated and was associated with increased 1-year survival rate and improvement in cancer related symptoms.