Germ Cell Tumors Of Testis Research Articles

Observation After Orchiectomy in Clinical Stage I Nonseminomatous Germ Cell Tumor of Testis

We report a retrospective review of our experience with close observation after orchiectomy in clinical stage I nonseminomatous germ cell tumors (NSGCT) of the testis during a 10-year period. Twenty-four patients were followed between 1977 and 1986 for a median duration of 47 months (24-112 months). Six of 24 (25%) relapsed at a median of 3.5 months (2-46 months) after orchiectomy; all of these were treated with chemotherapy and are in complete remission at a median of 55 months (27-69 months) after diagnosis of recurrence. Eighteen other (75%) who did not relapse are without evidence of disease at a median of 39 months (24-112 months) after orchiectomy. Orchiectomy alone followed by close observation in clinical stage I NSGCT is a reasonable approach in reliable patient populations at well-equipped centers where adequate follow-up is possible.

Predictors of residual mass histologyafter chemotherapy for advanced testis cancer

The records of 15 patients with Stage B 3 or B 2/C germ cell testis tumors who underwentfull surgical debulking of a residual mass after completion of chemotherapy were reviewed retrospectively to look for predictors of residual mass histology. The density, character, and change in volume of the retroperitoneal mass on computerized tomography before and after chemotherapy were compared with the histology in the primary tumor and in the residual mass. One of 6 patients without teratoma in the primary tumor had a 97 percent reduction in the mass which contained residual teratoma. Two patients with residual seminoma had a 50 percent decrease in tumor volume, and both patients died of tumor progression despite salvage chemotherapy. Two patients with pure serninomas had only residual fibrosis in masses that decreased in volume by 77 and 75 percent, respectively. One of these masses was discrete and the other was diffuse. Seven of 9 patients (78 %) with teratoma in the primary tumor had either teratoma (4 of 9, 44 %) or carcinoma (3 of 9, 33 %) in the residual mass, and the change in mass volume ranged from a 93 percent decrease to a 540 percent increase in size. All 7 patients with residual teratoma and/or carcinoma remain free of disease after observation or further chemotherapy. For the entire series, the mass density and character did not correlate consistently with the primary tumor or residual mass histology. Residual fibrosis alone or teratoma and/or carcinoma were seen with least (0 to 50 %) and greatest (more than 90 %) decreases in mass volume.

Germ Cell Tumours of Testis: Prognostic Factors and Results

Prognostic features regarding the outcome of 232 patients with testicular germ cell tumours treated from 1980 to 1987 in Sheffield are reviewed. Delay in diagnosis was a constant feature. The majority had a swelling for over 3 months. After 6 months mortality doubled, compared with patients with a shorter history. Initial serum levels of alpha-fetoprotein and beta-human chorionic gondadotropin, particularly if both were elevated over 100, and more so 500 IU/l, indicated a subsequent mortality in non-seminomatous tumours of 24 and 37%, respectively, while only 1.5% died if both values were below 100. The overall survival rate was 97% in seminomas and 78% in non-seminomas; no patients with well or moderately differentiated tumours died. There were no deaths after the 3rd year. Surveillance treatment in stage-I tumours was safe and mortality-free.

Surgical Treatment of Stage-I Non-Seminomatous Germ Cell Testis Tumor

Final results of a prospective multicenter trial are presented comparing modified (ipsilateral) and radical retroperitoneal lymph node dissection (RLND) with regard to staging accuracy, curativity, and preserved ejaculation in stage-I non-seminomatous testis tumor. In 168 patients after modified and 67 patients after radical RLND, no differences were found in relapse rates (17 and 15%, respectively; median follow-up 30 months); in frequency of retroperitoneal relapse (2.4 and 1.5%, respectively), and intra-/postoperative complications (12 and 10%, respectively). Postoperative ejaculation was antegrade in 74 and 34%, (p less than 0.001), retrograde in 11 and 12% respectively. Normozoospermia was found in 50% of patients postoperatively vs. 20% preoperatively. Results are discussed in view of other alternatives. Modified RLND is considered an optimal approach to stage-I non-seminomatous germ cell testis tumor, outside specific trials.

Orchiectomy only for clinical stage I nonseminomatous germ cell testis tumors: Comparison with pathologic stage I disease

Twenty-three men with nonseminomatous germ cell tumors confined within the tunica albuginea of the testis and negative metastatic evaluation were placed on surveillance after radical orchiectomy. Metastatic disease developed in 3 for a relapse rate of 13 percent. During the same period, 17 men with pathologic Stage I disease were followed up in the same manner, and metastatic disease developed in 3 for a relapse rate of 18 percent. All six men were treated with either combination chemotherapy or retroperitoneal lymphadenectomy, and all are alive without disease for at least two years from end of therapy. If strict criteria are followed, surveillance has a place in the management of carefully selected young men with clinical Stage I disease.

Small Bowel Intussusception: an Unusual Complication of Retroperitoneal Lymph Node Dissection

Modified bilateral retroperitoneal lymph node dissection is used widely in the staging and treatment of patients with nonseminomatous germ cell testis tumors. Complications are uncommon and include vascular injury, infertility and small bowel obstruction from fibrous adhesions. Small bowel intussusception following retroperitoneal lymph node dissection has not been reported previously. We report 2 cases of small bowel intussusception after retroperitoneal lymph node dissection, and discuss the etiology and possible preventive measures. (J. Urol., 142: 826–827, 1989)

Impalpable testicular tumors diagnosed by scrotal ultrasonography

Intrascrotal masses can be identified with a high degree of accuracy using scrotal ultrasonography. Ultrasound, however, is useful to identify occult and incidental testicular neoplasms, too. We report 2 cases of impalpable incidental testis germ cell tumors diagnosed by routine scrotal ultrasonography. One of the 2 patients had an incidental sequential second primary testicular germ cell tumor in the palpably normal testis, identified by routine follow-up ultrasound three months after contralateral radical orchiectomy.

Serum Markers in Testicular Germ-Cell Neoplasms

At the present time, serum determinations of alpha fetoprotein and beta-HCG are the most useful markers in the management of germ-cell testis tumors. Serial determinations are vital to the monitoring of the response of the patient's tumor to therapy. Subsequent elevation of tumor markers is often the first evidence of recurrence of tumor and allows effective treatment to be instigated while the volume of recurrent tumor is extremely low. This markedly increases the likelihood of achieving complete remissions.

AIDS and germ cell tumors of testis

A retrospective analysis of all testicular tumors treated at our institution over a seven-year period was conducted. Twenty-five of 115 patients were found to have acquired immune deficiency syndrome (AIDS), AIDS-related complexes, or to be at risk for AIDS developing. Non-seminomatous germ cell tumors were more common in the AIDS group.

Initial assessment of tumor-associated antigen CA-125 in patients with ovarian, cervical, and testicular tumors.

Serum CA-125, a glycoprotein antigen, has been measured in serum of patients with ovarian cancer, cervical cancer, or nonseminomatous germ-cell tumor of testis. Increased concentrations were found in 21 of 27 patients with epithelial ovarian cancer and two of three patients with ovarian teratoma. Changes in CA-125 concentrations in serum during chemotherapy mirrored the progress of the disease as assessed by clinical and radiological evidence. Although CA-125 provides no real asset for diagnosis, it should have value as a marker for monitoring response to chemotherapy.

Correlation of Computerized Tomographic Changes and Histological Findings in 80 Patients Having Radical Retroperitoneal Lymph Node Dissection after Chemotherapy for Testis Cancer

A total of 80 patients with stage B3 or B2/C germ cell testis tumors underwent computerized tomography before and after chemotherapy. The volume and computerized tomographic density of metastatic retroperitoneal tumor were measured on all scans. The patients then underwent full bilateral retroperitoneal lymphadenectomy. The change in volume and density of retroperitoneal disease was correlated with the histological type of the primary testis tumor and with the histological findings at retroperitoneal lymphadenectomy.In all 15 patients (100 per cent) without teratomatous elements in the original tumor and who had a greater than 90 per cent decrease in the volume of retroperitoneal masses as a response to systemic chemotherapy no teratoma or active cancer was found in the surgical specimen. In contrast, 7 of 9 patients (78 per cent) with teratomatous elements in the original specimen had either teratoma or carcinoma in the retroperitoneal lymphadenectomy specimens despite having a greater than 90 per cent decrease in tumor volume. This difference was significant (p less than 0.05). These data suggest that patients with no teratomatous elements in the original specimen and a greater than 90 per cent decrease in the volume of retroperitoneal masses in response to chemotherapy can be observed carefully for signs of recurrence rather than undergoing post-chemotherapy retroperitoneal lymphadenectomy.

Testicular Cancer: Prognostic Implications of Vascular Invasion

In a retrospective study the primary tumors of 33 patients with seminomas and 53 with nonseminomatous germ cell tumors were re-evaluated for vascular invasion. The significance of vascular invasion was analyzed in respect to the appearance of visceral metastases and the effect of adjuvant chemotherapy. Vascular invasion was demonstrated in 27 per cent of the patients with seminomas and 53 per cent with nonseminomatous germ cell testis tumors, while visceral metastases appeared in 9 and 32 per cent, respectively. Without adjuvant chemotherapy all 13 patients with nonseminomatous germ cell testis tumors and vascular invasion had metastases, compared to only 3 of 13 without vascular invasion (p less than 0.0005). Of 9 patients with seminoma and vascular invasion 3 had tumor progression, compared to 1 of 24 without vascular invasion (p greater than 0.05). With adjuvant chemotherapy only 1 of 15 patients (7 per cent) with nonseminomatous germ cell testis tumors and vascular invasion had metastases, compared to 100 per cent of 13 without this treatment. No significant correlation was noted between pT stage versus vascular invasion and pT stage versus tumor progression. The results demonstrate the importance of vascular invasion in the staging of and choice of treatment for early nonseminomatous germ cell testis tumors.

Nonseminomatous Germ Cell Tumor of the Testicle: Does Extensive Staging of the Primary Tumor Predict the Likelihood of Metastatic Disease?

To assess the hypothesis that local extent of the primary lesion in patients with nonseminomatous germ cell tumors of the testicle can predict disseminated disease, clinicopathological correlations of the primary tumor and metastases were determined in a retrospective review of 120 patients treated at our institution from 1970 to 1982. Pathological staging was available for all 93 patients with subdiaphragmatic disease and the primary tumor was examined by routine histological techniques in all cases. Increased primary tumor stage, as evidenced by invasion into the tunica vasculosa or extension into the rete testis, epididymis and/or lower or upper spermatic cord, was associated with metastatic disease in 91, 96, 97 and 97 per cent of the patients, respectively. Only 9 per cent of the patients with pathological stage A disease had vascular invasion compared to 45 and 67 per cent of those with stages B and C disease, respectively (p less than 0.01). Furthermore, metastases and/or eventual dissemination occurred in 84 per cent of the patients with clinical stage A disease and vascular invasion, and in only 23 per cent of those without vascular invasion (p less than 0.01). Size of the primary tumor was not of predictive value. Local extension of the primary lesion was common with embryonal carcinoma but it was not demonstrated when the predominant histological type was teratoma or teratocarcinoma, although metastases were present in 37 and 46 per cent of the latter cases, respectively. The implications of these findings, especially with regard to expectant management for clinical stage A nonseminomatous germ cell testis tumors, are discussed.

Prognostic relevance of tumor markers in testis germ cell tumors

Prognostic relevance of tumor markers in testis germ cell tumors

Vinblastine, Actinomycin D, Bleomycin, Cyclophosphamide and Cis-Platinum for Advanced Germ Cell Testis Tumors: Brazilian Experience

Disseminated germ cell testicular cancer proved to be highly sensitive to platinum-containing chemotherapy regimens. We present data concerning the treatment of advanced seminoma and nonseminomatous tumors in a developing country. We treated 30 patients with advanced germ cell testis tumors with 3 or 4 cycles of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum. Surgical resection of residual masses was done 30 days after completion of chemotherapy in 18 patients. The histology of the primary tumor was seminoma in 13 patients and nonseminomatous tumors in 17. Toxicity was mild and no treatment-related deaths occurred. All 13 patients (100 per cent) with seminoma and 12 of 17 patients (71 per cent) with nonseminomatous tumors had a complete response to chemotherapy, and 1 of 17 patients was free of disease after a debulking operation and additional chemotherapy. A total of 3 patients with seminoma and 2 with nonseminomatous tumors had recurrences 5 to 8 months after an initial complete response and received additional chemotherapy (VP-16 regimen) with or without radiotherapy. Complete clinical response was achieved in 4 of 5 patients. Median followup was 24 months (range 8 to 38 months) in the 13 patients with seminoma and 28 months (range 9 to 58 months) in those with nonseminomatous tumors, and 13 (100 per cent) and 12 (71 per cent), respectively, are alive without evidence of disease. These data suggest that the protocol of vinblastine, actinomycin D, bleomycin, cyclophosphamide and cis-platinum is highly effective and minimally toxic in the treatment of disseminated germ cell testicular cancer, inducing an 83 per cent long-lasting clinical remission. Seminomas seem to be equally or even more sensitive than nonseminomatous tumors to this platinum-containing chemotherapy regimen. Recurrence after initial complete response can be treated successfully with regimens containing VP-16.

Effect of treatment on fertility and sexual function in males with metastatic nonseminomatous germ cell tumors of testis

The effects of therapy on the sexual ability and fertility of sixty-seven patients with nonseminomatous germ cell tumors of the testis were analyzed. Ten of 38 patients had subfertile sperm counts before therapy. Normal ejaculation was preserved in only 7/61 patients who underwent retroperitoneal lymph node dissection. In five of these patients, sperm analysis was done after chemotherapy; all had complete azoospermia. An effort to restore ejaculation with imipramine yielded only minimal response in 4/9 patients who received this drug. No major long-term effects on the libido were observed.

A Case Combined Germ Cell Tumor in Testic

Primary germ cell tumor of the testis is, rare, which occupies 1 to 2% of all reported malignant male neoplasms. Combined primary germ ceil tumor of the testis composed of embryonal carcinoma and seminoma is more rare tumor. The authors experienced a case of 50-year old male who presented with painless enlargement of right testicle. He has had radical orchiectomy and diagnosed by pathologically as combined germ cell tumor of testis. The testicle is measuring 180 gm in weight and cm in dimension, and almostly replaced by tumor mass. Grossly the tumor is rubbery solid smooth tumor mass, with variegated cut surface with geographically outlined diffuse necrotic area. Histologically the tumor is composed of two components of tumor, which are solid growth pattern of large round to polyhedral cells with clear or granular cytoplasm and distinct cell border, and anastomosing glandular and papillary arrangement of anaplastic epithelial cells. The former corresponds to seminoma, and the latter to embryonal carcinoma. Each tumor lobule is separated by abundant fibrous stroma.

Correlation of Vascular Invasion and Metastasis in Germ Cell Tumors of Testis—A Preliminary Report

A preliminary study was conducted to correlate vascular invasion with metastasis in testicular tumors. A lectin-immunoperoxidase procedure was used to identify the vessels. Together with standard hematoxylin and eosin staining, the presence of tumor cells in vessels was detected. Primary tumor specimens from 37 cases and retroperitoneal lymph nodes from 10 cases of germ cell tumors were studied. The results showed good correlations between vascular invasion in primary tumors and metastasis to lymph nodes in nonseminomatous germ cell tumors, and between vascular invasion in retroperitoneal lymph nodes and the presence of other metastases. Eight of the 9 nonseminomatous germ cell tumor patients with vascular invasion had metastases, and all 4 patients that had vascular invasion in the lymph nodes had other metastases. However, there seemed to be no correlation between vascular invasion and clinical staging in cases with seminoma in which retroperitoneal lymph node dissection was not performed. These observations, although based on a limited number of cases, warrant more extensive investigations.

Adjuvant chemotherapy in resected stage-II nonseminomatous germ cell tumors of testis. In which cases is it necessary?

In an attempt to reduce the recurrence rate and to improve survival in resected stage-II nonseminomatous testicular cancer, two consecutive series of patients were treated with adjuvant vinblastine-bleomycin (VB) continuous infusion, or cisplatin, vinblastine, bleomycin (PVB). 11 former patients who received no adjuvant chemotherapy and 5 who refused the adjuvant treatment were considered historical controls. After a median follow-up of 5 years, relapses were 4 in 15 patients treated with VB (27%), 1 in 29 treated with PVB (3%) and 8 in the untreated (50%). Adjuvant PVB significantly reduced the recurrence rate (p less than 0.001), while VB did not (p = 0.4). However, the advantage of adjuvant PVB was evident only in patients with retroperitoneal metastases larger than 5 cm, macroscopic extranodal spread, and tumor invasion into retroperitoneal veins, who were classified as pathologic stage II-C: no relapse and 100% survival following adjuvant PVB in 11 cases, versus 86% relapses and 28.5% survival in 7 untreated patients (p less than 0.01); 2 relapses and 2 survivors in 3 treated with VB. On the other hand, only 1 of the 39 patients with less extensive retroperitoneal disease died of testicular cancer, and he was in the VB adjuvant treatment group. We conclude that only aggressive adjuvant chemotherapy significantly reduces the recurrence rate and improves survival in resected stage-II nonseminomatous testis cancer. However, it is mandatory only in the very high risk subset II-C of patients, while the others could be carefully followed at monthly intervals and safely treated with aggressive chemotherapy only in the event of relapse.

Second Primary Germ Cell Tumors in Patients with Seminoma of the Testis

In a review of our experience with seminoma 9 cases of bilateral primary testis germ cell tumors were encountered, including 2 simultaneous and 7 successive. Of the 9 cases 6 were bilateral seminomas and 7 were stage I, contributing to the good survival experience. Treatment policy is specified and discussed.