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PubMed1984

[Case of immature teratoma of the testicle metastasizing as completely mature teratoma].

A case of immature teratoma of the testicle metastasizing as completely mature teratoma is presented. A 23-year-old man underwent right inguinal orchiectomy for an immature teratoma of the testicle on September 14, 1982. At retroperitoneal lymph node dissection, 12 lymph nodes were removed, all of which were negative for cancer. He was well until March 1983, when bloody sputum and left chest pain occurred. Since full lung tomography revealed two pulmonary nodules, he was treated with a course of VP-16 and three courses of vinblastine, bleomycin and CDDP. In September 1983, after completion of the combination chemo-therapy, the two pulmonary nodules were noticed to be slightly enlarging. A thoracotomy was scheduled to remove these nodules, since they were believed to be his only remaining tumors. Pathologic examination of the extirpated nodules disclosed completely benign teratoma. Mediastinal lymph nodes had no metastatic involvement histologically. It is our intention in this paper to emphasize, by means of several case reports, the frequently benign nature of these residual lesions and also to emphasize a recently recognized phenomenon--the apparent induction of benign teratomas by this intensive chemotherapy.

Adult↗
PubMed1982

Surgical treatment of clinical stage I nonseminomatous germ gell tumors of the testis.

The rationale for further treatment after orchiectomy and the logical basis of the principle therapeutic alternatives in the management of clinical state I nonseminomatous germ cell tumors of the testis have been reviewed. Retroperitoneal lymph node dissection provides the epitome of staging accuracy and a high degree of therapeutic effectiveness in clinical stage I nonseminomatous germ cell tumors of the testis and is associated with minimal early and late morbidity and a low mortality. However, all methods of further active therapy after radical orchiectomy are under legitimate scrutiny in view of the burden of unnecessary therapy, the accuracy of clinical staging, the ability to recognize failures early, and the high probability of successful treatment of such failures.

Dysgerminoma↗
PubMed1994

Neovascularization in clinical stage A testicular germ cell tumor: prediction of metastatic disease.

Increased numbers of blood vessels (angiogenesis or neovascularization) in certain primary tumors correlates with an increased risk for metastatic disease. We therefore conducted a blinded review of the resected testicular germ cell tumors of 65 clinical stage A patients to evaluate the usefulness of angiogenesis in identifying those patients with clinically occult nodal metastases (pathological stage B). Angiogenesis was assessed in the primary tumors using an immunohistochemical stain for factor VIII-related antigen assay for quantitation of microvessel counts. Of 65 clinical stage A patients, 43 had pathological stage B disease at retroperitoneal lymph node dissection. Eleven patients had microvessel counts > 30 microvessels/x 400 high powered field, and all of these patients had pathological stage B disease (P = 0.02 in univariate analysis). Multiple regression analysis using microvessel count and other histological findings found to be prognostic (venous invasion, lymphatic invasion, presence of embryonal carcinoma, and absence of yolk sac tumor) showed that only the absence of a yolk sac tumor component was significantly predictive of occult metastases. This study shows that angiogenesis, as measured by quantitation of microvessel counts in the primary tumor of germ cell neoplasms, is significantly predictive of occult nodal metastatic disease by univariate analysis in clinical stage A patients. The prospective use of angiogenesis quantitation needs to be defined.

Germinoma↗
PubMed1995

Prognostic significance of immunohistochemical proliferation markers (Ki-67/MIB-1 and proliferation-associated nuclear antigen), p53 protein accumulation, and neovascularization in clinical stage A nonseminomatous testicular germ cell tumors.

Histopathologic features alone fail to reliably stratify patients with clinical Stage A nonseminomatous germ cell tumors of the testis into groups with high and low risk for occult metastatic disease. Previous flow cytometric studies at Indiana University demonstrated a significant correlation between high proliferative activity and metastatic disease. The current study evaluated the prognostic significance of immunohistochemical markers related to tumor proliferation and aggressiveness in a consecutive series of clinical Stage A nonseminomatous germ cell tumors patients who underwent retroperitoneal lymph node dissection. Archival material of the orchiectomy specimens of 62 patients (45 pathologic Stage A, 17 with metastatic disease) was reviewed and immunohistochemically stained for Ki-67 antigen (MIB-1), proliferation-associated nuclear antigen (PC10), p53 protein (Pab1801), and Factor-VIII-related antigen (neovascularization). Staining with MIB-1 was significantly higher in the metastatic group (mean 80.2%, standard deviation [SD] 15.5) than in pathologic Stage A cases (66.3%, SD 27.9; P = 0.0032) and was predictive of metastatic status with a sensitivity of 82% and specificity of 69%. In this study, no patient with a MIB-1 value less than 52% had metastases. Proliferation-associated nuclear antigen and p53 staining correlated with MIB-1 values (R = 0.63 and 0.55, respectively) but did not correlate with metastatic status. Tumor angiogenesis was also not predictive of metastatic status. Assessment of proliferation rates using MIB-1 antibody in clinical Stage A nonseminomatous germ-cell-tumor patients may prove helpful in predicting metastatic status.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomarkers, Tumor↗
PubMed1995

[New parameters for prediction of pathological stage in clinical stage I non-seminomatous testicular tumors].

Traditional histopathological risk factors have failed to predict pathological stage accurately in clinical stage I nonseminomatous testicular germ cell tumours. Histopathology, flow cytometry, cytophotometry, and immunohistochemical staining techniques were used in an effort to define high- and low-risk groups for occult metastasis in a consecutive series of 105 patients who underwent retroperitoneal lymph node dissection. After multiple logistic regression analysis, the proliferative S + G2M cell cycle fraction of the aneuploid tumour stemline was the most highly predictive parameter of pathological stage (P = 0.0004). Using a cut-off of 41%, pathological stage II patients were predicted with a sensitivity of 71%. There were 61 patients with S + G2M values below 41%, and 43 of them had pathological stage I disease (negative predictive value 87%). A low volume of embryonal carcinoma was predominant in low-risk patients, and MIB-1 immunohistochemical staining identified a subgroup of 23% of patients with pathological stage I disease and at extremely low risk of metastatic disease. Assessment of tumour cell proliferation does not allow accurate classification of high-risk patients at a level that is adequate for clinical application. Patients who are at low risk of metastasis, however, can be identified by flow cytometry, immunohistochemical proliferation markers and volume of embryonal carcinoma with 90% certainty. These parameters deserve further study, since identification of a subgroup of patients at extremely low risk of metastasis could potentially reduce the overall morbidity in the management of clinical stage I nonseminomatous testis cancer.

Animals↗
PubMed1995

[Clinical study on 78 cases of testicular tumor].

Seventy eight patients with testicular tumor were treated in our hospital between 1982 and 1992. Of 78 patients, 74 had germinal cell tumor (seminoma in 47 patients and non-seminoma in 27), and the other 4 had 3 malignant lymphoma and 1 rhabdomyosarcoma. Ages ranged from 1 to 67 years with the average of 36.1. The age of the patients with seminoma was significantly higher than that of patients with non-seminoma. Most patients complained of painless swelling of the scrotal content, but some patients complained of testicular pain, fever, and so on. Those who complained of such symptoms had significantly worse prognosis than those who had only painless scrotal swelling. Patients with non-seminoma visited us about 4.9 months after the onset of their symptoms and 12.1 months in seminoma. Clinical stages were more progressive in non-seminoma than in seminoma. Inguinal orchiectomy was performed followed by irradiation, chemotherapy, retroperitoneal lymph node dissection or thoracotomy. Recurrence developed in 6 patients and the other 7 patients died of progressive disease within 2 years from the first attendance. The 2-year survival rate calculated by the Kaplan-Meier method was 81 and 70% in seminoma and non-seminoma, respectively, and 100, 88, 63, 75, and 22% in stage I, IIA, IIB, IIIO and IIIA, B, C, respectively.

Adult↗
PubMed1995

Malignant mixed müllerian tumor of the uterine corpus--analysis of 12 cases.

Clinical and histopathological features of 12 patients with malignant mixed müllerian tumor of the uterine corpus presenting to Chang Gung Memorial Hospital from January 1988 to September 1993 were retrospectively investigated. The age distribution ranged from 43 to 76 years with a median of 56, and post-menopausal bleeding was the most common symptom in these patients. There was 60% (6/10) of discrepancy in histologic diagnosis between the specimens of dilatation and curettage and that of hysterectomy. All patients received total hysterectomy and bilateral salpingo-oophorectomy, and 10 with retroperitoneal lymph node dissection. Nine patients received cisplatin based chemotherapy, one received radiation only, one received sequential chemotherapy and irradiation, and one underwent concurrent chemoradiation as adjuvant. Two-year survival in patients with stage I-II was 70% (95% C.I.: 34%, 100%) and that of stage III, 25% (95% C.I.: 0.67%). There was 42% (5 of 12) progression/recurrence rate, all developed within 2 years. An effective adjuvant chemotherapy after comprehensive surgery including a total abdominal hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection may be needed for a satisfactory improvement in the patients' survival.

Adult↗
PubMed1995

[Testicular cancer treated at the regional hospital in Tromsø 1985-1993].

The case histories of 98 patients (47 seminomas and 51 non-seminomas) treated at the Department of Oncology, University Hospital of Tromsø between January 1985 and March 1993 were retrospectively analysed in August 1994. The analysis was undertaken to ascertain whether a small centre can achieve state of the art results. Complete remission was achieved in all cases. During a four year median follow-up period (range 1-10 years), three seminomas and eight non-seminomas relapsed. Only one retroperitoneally located relapse was revealed after retroperitoneal lymph node dissection. Two patients (one seminoma, one non-seminoma) died of progressive disease. A statistically significant correlation was found between stage of disease and human chorionic gonadotropin, lactate dehydrogenate and alpha-fetoprotein in non-seminoma. Our results are similar to those of the major oncological centres. Hence our unit is able to achieve state of the art results in the treatment of testicular carcinomas.

Adolescent↗
PubMed1994

[Well-differentiated liposarcoma of the spermatic cord with dedifferentiation].

We report a case of well-differentiated liposarcoma with dedifferentiation of spermatic cord in a 73-year-old-man. Treatment was by orchiectomy without retroperitoneal lymph node dissection or adjuvant therapy. The patient has survived 10 months with no evidence of recurrence. Liposarcoma localized to the spermatic cord is rare; less than 70 cases have been previously reported. The literature is reviewed with special emphasis on the clinical significance of the dedifferentiation phenomenon.

Aged↗
PubMed1994

[Sclerotherapy of postoperative lymphocele].

Postoperative lymphocele is a well-documented complication of gynecological operations involving pelvic and retroperitoneal lymph node dissection. It is not uncommon following renal transplantation. We report a 77-year-old woman with a lymphocele which developed 4 months after panhysterectomy. Diagnosis was by CT scan, confirmed by aspiration and cytology. Percutaneous drainage and sclerotherapy with tetracycline was curative. This appears to be the treatment of choice for lymphocele and is superior to repeated aspirations and surgical intervention, the current usual treatment.

Aged↗
PubMed1994

[Rare metabolic and cerebral complications after polychemotherapy of a testicular tumor].

In a 21-year-old patient with a tumor of the right testis, CT indicated a pathologically altered lymph node in the interaortocaval region. After high inguinal orchiectomy we performed a modified retroperitoneal lymph node dissection and monitored its success by immediate section for microscopic examination. Pathohistological investigation yielded immature teratoma. The patient was given two courses of adjuvant polychemotherapy containing cisplatin. Two days after the conclusion of the second course he was readmitted with grand mal epilepsy and visual agnosia. Two months later another grand mal epileptic fit occurred. The patient also suffered from marked metabolic disorders, such as hypokalemia, hyperreninism, hyperaldosteronism, kaliuresis, and hypertension. We consider these to be toxic side effects of cisplatin resulting in nephropathy. Evidence of cisplatin-induced encephalopathy was obtained by NMR tomography and EEG which indicated barrier disorders. Symptoms were relieved and continuous normalization of blood pressure, potassium level, and water and electrolyte balance was achieved by the administration of potassium substitution, ACE inhibition, and an aldosterone antagonist. The patient has since remained in a stable condition.

Adult↗
PubMed1994

[Therapy of primary testicular chondrosarcoma].

We describe the clinical course in a patient with a primary testicular chondrosarcoma. The way of metastasizing and cytogenetic analysis proved the germ cell origin of this tumour. After unilateral orchiectomy four cycles of chemotherapy with cisplatin, etoposide and bleomycin and one cycle of vinblastine, ifophosphamide and cisplatin were given. Even though the retroperitoneal metastases continued to grow, a radical retroperitoneal lymph node dissection was performed. Five years after surgery the patient is still in remission.

Adult↗
PubMed1995

Primary yolk sac tumor of the prostate in a patient with Klinefelter's syndrome.

Primary yolk sac (endodermal sinus) tumor of the prostate is extremely rare with only 2 cases reported in the literature. We describe a case of primary yolk sac tumor of the prostate in a man with Klinefelter's syndrome. Treatment included 4 courses of combination chemotherapy followed by retroperitoneal lymph node dissection, cystoprostatectomy and ileal conduit urinary diversion. We review the association of Klinefelter's syndrome with extragonadal germ cell tumor along with the management of this rare disease.

Adult↗
PubMed1995

Patterns of metastatic spread in prepubertal yolk sac tumor of the testis.

Of the 212 patients with yolk sac tumors of the testis registered in the prepubertal testis tumor registry of the American Academy of Pediatrics, Section on Urology, we report on 33 who presented with metastatic disease. Metastases occurred to the retroperitoneum alone in 9 cases, sites consistent with hematogenous spread of disease alone in 13, sites consistent with lymphatic and hematogenous spread in 6, and sites not clearly documented in the registry in 5. These findings, which show a hematogenous predilection in the spread of metastases, suggest that retroperitoneal lymph node dissection has no routine role in the treatment of the child who presents with yolk sac tumor of the testis.

Child↗
PubMed1978

Gallium and bleomycin scans in the clinical staging of testis tumor.

Twenty-one patients with testicular tumors had gallium scans prior to retroperitoneal lymph node dissection. Eleven of 14 patients found to have nodal involvement had positive scans, and 2 of 7 patients with negative nodes had false positive scans. Bleomycin scans were positive in 4 of 5 patients with nodal metastases. While these scans provide a simple, non-invasive and occasionally useful technique for the clinical staging of testis neoplasms, they do not, in our experience, significantly supplement other staging procedures.

Bleomycin↗
PubMed1993

[Renal cell carcinoma in a horseshoe kidney: report of two cases].

We report 2 patients with renal cell carcinoma in a horseshoe kidney. A renal tumor was diagnosed during evaluation of right humeral metastatic cancer of unknown origin in case 1 (64-year-old male) and gross hematuria in case 2 (54-year-old male). Both patients underwent radical nephrectomy with division of isthmus and retroperitoneal lymph node dissection. The tumors were staged pathologically as pT2bpN0pV0pM1(oss) and pT3pN0pV1bM0, respectively. Only 27 cases of renal cell carcinoma developed in a horseshoe kidney, including the present two cases, have been reported in the Japanese literature. The blood supply to the horseshoe kidney and its evaluation by preoperative angiography were discussed.

Carcinoma, Renal Cell↗
PubMed1995

[Long-term results of surgical treatment for renal pelvic and ureteral tumors].

Fifty eight cases of primary tumors in the renal pelvis and ureter were treated at Toranomon Hospital between 1983 and 1992. They consisted of 32 renal pelvic tumors, 21 ureteral tumors and 5 tumors at both sites. The age of the patients ranged from 30 to 84 years (mean 63.1). Surgery was performed in 56 cases. Radical nephroureterectomy with concomitant ipsilateral retroperitoneal lymph node dissection was performed in 38 cases. The other surgeries were radical nephroureterectomy without lymph node dissection in 9, nephrectomy in 4, resection of ureter and reanastomosis in 3, radical nephroureterectomy and cystectomy in 1 and partial nephrectomy in 1. Pathologically, 53 were transitional cell carcinoma (TCC), 2 were TCC plus squamous cell carcinoma and 1 was TCC plus adenocarcinoma. Over-all survival rates (Kaplan-Meier) of 56 surgical cases at 1, 3, 5 years were 92.2, 83.7 and 72.8%, respectively. Combination chemotherapy (M-VAC or CAP) was performed in 9 cases of metastatic disease and 1 case of bilateral disease. Of these 10 cases, one achieved complete remission, 2 no change and 7 had progressive disease. Adjuvant chemotherapy was performed in 21 cases after surgery. These 21 patients were of high risk in recurrence either Grade 3 or pT3. However, the 5-year survival rate was 77.3% in these patients. Thus we conclude that the adjuvant chemotherapy in high risk patients was effective in our cases.

Adult↗
PubMed1996

Tumor proliferative activity is predictive of pathological stage in clinical stage A nonseminomatous testicular germ cell tumors.

PURPOSE: Traditional histopathological features have failed to predict accurately the pathological stage of clinical stage A nonseminomatous germ cell tumors of the testis. Based on pilot studies in nonconsecutive patients at our university, we evaluated nontraditional risk factors (cell cycle analysis by flow cytometry, deoxyribonucleic acid analysis by single cell cytophotometry [image analysis] and assessment of proliferative activity by immunohistochemistry) combined with histopathological features in consecutive patients with clinical stage A nonseminomatous testis cancer. MATERIALS AND METHODS: Orchiectomy specimens from 105 consecutive patients with clinical stage A nonseminomatous germ cell tumors who underwent retroperitoneal lymph node dissection (76 with pathological stage A disease and 29 with proved metastasis) were recut, histopathologically reviewed, immunohistochemically stained with proliferation markers (for example Ki-67/MIB-1), and examined by flow cytometry and image analysis. RESULTS: After multiple logistic regression analysis, the G2M+S cell cycle fraction of the aneuploid tumor stemline was the most predictive parameter of pathological stage (p = 0.0004). Using a cutoff of 41%, patients with metastasis were predicted with a sensitivity of 71%. Of 61 patients with a G2M+S value of less than 41%, 53 had pathological stage A cancer (negative predictive value 87%). A low volume of embryonal carcinoma was predominant in patients at low risk for metastasis and MIB-1 immunohistochemical staining identified 23% of patients with pathological stage A tumor who were at extremely low risk for metastatic disease. CONCLUSIONS: Assessment of tumor cell proliferation cannot classify accurately high risk patients at a clinically applicable level. However, identification of patients at low risk for metastasis by flow cytometry, immunohistochemical proliferation markers and volume of embryonal carcinoma may be possible at the 90% level. MIB-1 staining is able to classify patients at extremely low risk for metastasis. These parameters deserve further study, since identification of patients at extremely low risk for metastasis could potentially decrease overall morbidity in the management of clinical stage A nonseminomatous testis cancer.

Cell Division↗