Germ Cell Tumors Of Testis Research Articles

Role of chemotherapy and surgery in the treatment of thoracic metastases from nonseminomatous germ cell testis tumor.

The role of chemotherapy and of surgery in the management of pulmonary metastases from nonseminomatous germ cell tumors (NSGCT) has been analyzed. Thoracic metastases were classified as minimal, if the diameter of the largest was 2 cm or less and five or fewer nodules were present in each lung, and advanced if any metastasis was over 2 cm in diameter and/or six or more nodules were present in either lung field, and/or mediastinal disease, hilar metastasis or pleural effusion was present. Complete thoracic remission (CR) with chemotherapy alone occurred in 49/67 (73%) patients, 86% with minimal and 68% with advanced disease. Absence of concomitant retroperitoneal metastases at the beginning of chemotherapy was associated with better prognosis than when retroperitoneal metastases were present (CR 85% vs 68%, respectively). The histologic type of testis tumors did not influence CR rates of pulmonary metastases. Approximately one half of patients with clinical evidence of retroperitoneal metastases at the beginning of chemotherapy achieving pulmonary CR with chemotherapy alone had clinical evidence of retroperitoneal disease after chemotherapy. Six patients had thoracotomy to document CR to chemotherapy by resection of necrotic tissue. Six patients had thoracotomy to achieve CR by resection of residual neoplasm. The keys to success were a favorable response to chemotherapy and complete resection of any residual tumor. Considering all stages of NSGCT and provided no adjuvant chemotherapy was given, thoracic surgery will be responsible for elimination of thoracic metastases in an estimated 2–5% of patients after adequate chemotherapy. Such intervention is curative in patients with pulmonary metastases only but in those with concomitant retroperitoneal metastases, the final outcome will frequently be decided by the response to chemotherapy and/or the resectability of retroperitoneal metastatic deposits.

Accuracy of Preoperative Staging in Stages A and B Nonseminomatous Germ Cell Testis Tumors

Primary radical retroperitoneal lymphadenectomy currently is used for pathologic staging of nonseminomatous germ cell testis tumors unless advanced disease is present initially. Many attempts have been made with serum markers, lymphangiograms, excretory urograms, gallium and ultrasound scans, and computerized tomography for accurate staging of these tumors preoperatively. We reviewed the accuracy of alpha-fetoprotein and beta-human chorionic gonadotropin serum markers, and abdominal ultrasound and computerized tomography scans in preoperatively staging 64 patients with stage A or B nonseminomatous germ cell testis tumors seen at our university between 1977 and 1980. The results of the preoperative staging studies were correlated with the pathologic stages obtained by retroperitoneal lymphadenectomy.The combined results of serum markers, ultrasound and computerized tomography staged correctly 24 of 32 cases of pathologic stage A disease (75 per cent) and 21 of 32 of pathologic stage B disease (66 per cent). In patients with stage B disease the accuracy improved as the amount of tumor increased: 6 of 13 cases of stage B1 disease (46 per cent), 8 of 12 of B2 (67 per cent) and 7 of 7 of B3 (100 per cent) were staged correctly preoperatively.Over-all, the correct results were obtained in 61 per cent of the patients with alpha-fetoprotein, 64 per cent with beta-human chorionic gonadotropin, 53 per cent with ultrasound and 67 per cent with computerized tomography. Occasionally, alpha-fetoprotein or beta-human chorionic gonadotropin, or computerized tomography alone would be positive in a patient with stage B disease but ultrasound was never positive unless the computerized tomography scan also was positive.Based upon these results ultrasound scanning has been eliminated from the preoperative staging routine. Also, since the over-all accuracy in preoperatively evaluating patients with stages A and B nonseminomatous germ cell testis tumors is 70 per cent retroperitoneal lymphadenectomy still is needed for accurate staging as well as for providing therapeutic benefit in the majority of patients with stage B disease.

Bilateral primary germ cell tumors of testis

Bilateral primary germ cell tumors of the testis are rare, but their incidence is likely to rise since the prognosis of metastasized nonseminoma tumors of the testis has improved with polychemotherapy and surgery. Every patient with a tumor of the testis requires lifelong frequent follow-up. Delay in diagnosis and treatment can be prevented. The treatment of bilateral primary germ cell tumors of the testis is highly individual and depends on the histologic diagnosis of the first and the second tumors, metastaticgrowth, and previous treatment.

Elective delayed excision of bulky para-aortic lymph node metastases in advanced non-seminoma germ cell tumours of testis.

Forty-one patients with advanced non-seminoma germ cell testicular tumours were treated by chemotherapy, with or without radiotherapy, followed by excision of residual para-aortic lymph node masses. All para-aortic metastases were initially greater than 2 cm, 35 were larger than 5 cm, and 9 were over 10 cm in diameter. Seven patients also had nodal deposits above the diaphragm and 18 had distant metastases. The residual masses were excised completely in all except 3 cases. Residual malignancy was found in 7 (18%) of 38 operable cases; of these 7, only 2 remain alive and disease-free. In contrast, 28 (90%) of 31 operable cases with necrosis and fibrosis, or with fully differentiated teratoma, are alive and disease-free. Elevated serum markers were found in 6 of 9 cases with resectable or unresectable residual malignancy, but in only 1 of 32 who were tumour-free. Residual malignancy was found in 3 (9%) of 34 cases with normal marker levels. Malignancy was not found in any residual mass less than 4 cm diameter. We conclude that excision of para-aortic lymph node masses should be electively delayed until serum markers become normal and until shrinkage of the mass has ceased. The presence of residual malignancy in the excised tissue then provides a clear indication for further chemotherapy.

Retroperitoneal lymphadenectomy for germ cell tumor of testis in association with horseshoe kidney

Four of 310 patients (1.3 per cent) who underwent retroperitoneal lymphadenectomy for germ cell tumor of the testis at Memorial Sloan-Kettering Cancer Center (MSKCC) between July, 1971, and July, 1978, had incidental finding of horseshoe kidney. The management of these 4 patients is presented, with specific reference to the surgical technique of retroperitoneal lymphadenectomy. Retroperitoneal lymphadenectomy can be performed by adequate mobilization of the renal isthmus without the need of its division.

Pathology of Germ Cell Tumors of Testis: A Progress Report.

Since the last National Conference on Urological Tumors, there has been major progress in pathology of testicular tumors. An international histological classification of these tumors has been proposed, which is based on the sound principle that pathological examination must specify the exact components that are present in a tumor and give an estimate of relative proportions of each. The WHO classification, using generally accepted principles of tumor typing, has provided a standard method of pathological reporting of these tumors so that results of research from different parts of the world can be compared. The WHO system published in 1977 is readily convertible to the system in use in the American Testicular Tumor Registry. Its convertibility to the Friedman-Moore and Pugh-Cameron Testicular Tumor classifications is limited. Though it is generally believed that embryonal carcinoma can differentiate along extra-embryonic lines to form yolk sac tumor and choriocarcinoma or along embryonic lines to form teratoma, the malignant germ cell itself seems to have the potential to develop along any of these lines without first going through the embryonal carcinoma phase. Seminomas with high mitotic index and seminomas that contain syncytiotrophoblasts appear to have a less favorable prognosis than classic seminomas or spermatocytic seminomas. HCG is readily demonstrable in syncytiotrophoblasts whether alone or forming choriocarcinoma. AFP is demonstrable in yolk sac tumors and in some embryonal carcinomas. Histological demonstration of AFP and HCG can and should be correlated with clinical findings. Such correlation can readily be made with the WHO histological classification of these tumors.

Adjuvant chemotherapy in resected nonseminomatous germ cell tumors of testis: stages I and II.

T ESTICULAR CARCINOMAS constitute only 1% of malignant tumors in males yet are the second most common cause of death from malignancy in the 15-34-yr-old age group.’ In the United States, it was estimated for 1977 that 3600 men would develop malignant germ cell tumors of the testis: 1750 seminomatous and 1850 nonseminomatous germ cell tumors (NSGCT). At the time of diagnosis, approximately 44% of patients with NSGCT have localized disease (Stage I), 23% have regional disease (Stage II), and 33% have distant metastases (Stages 111 and IV).2.3 Thus, 1240 patients with NSGCT were estimated to have localized tumor or regional metastases and 610 distant metastases. The 5-yr survival rate for patients with distant metastases was 12% in the years 19501954 and probably most of these survivors were patients with pure seminomas. Presently, chemotherapy has been found capable of inducing significant tumor regression in 80%-100% of patients with disseminated NSGCT and complete remission in 50%-70%.4.m6 Traditionally, Stages I and II NSGCT have been treated with surgery and/or irradiation. However, a certain proportion of patients will recur with distant metastases and the established efficacy of chemotherapy in advanced disease makes it attractive for use in an adjuvant setting.

Carcinoma of the testis

Patients with Stage I or II malignant testis germ cell tumors underwent a randomized prospective study at Walter Reed Hospital, Washington, D.C., from 1968 to 1973. Pure cell lines of seminoma or choriocarcinoma were excluded. Forty patients had inguinal orchiectomy followed by irradiation to the inguinal, iliac, lumbar para-aortic, mediastinal and supraclavicular lymph nodes. Thirty-four patients (85%) in this group are alive and free of tumor a minimum of 3 years. Fifty-one patients received pre- and postoperative irradiation to primary lymphatic pathways in association with bilateral retroperitoneal lymphadenectomy as well as elective irradiation to the mediastinum and supraclavicular regions. Forty-six patients (90%) in this second group are alive and free of tumor a minimum of three years. Both treatment methods represent marked improvement in cure rates compared to lymphadenectomy and postoperative irradiation utilized prior to 1968, but no statistically significant difference from each other.

Bilateral sequential germ cell tumors of testis

Eight cases of bilateral sequential germ cell tumors of the testis are presented. Current treatment regimens are discussed in view of postlymphangiographic findings in patients with prior abdominal radiation and retroperitoneal surgery. Prognosis reflects the stage of disease at diagnosis with 6 patients in this series alive without evidence of metastases for as long as ten years following treatment for their second testicular tumor.

Diamminodichloroplatinum in the chemotherapy of testicular tumors.

No AccessJournal of Urology1 Jul 1974Diamminodichloroplatinum in the Chemotherapy of Testicular Tumors Donald J. Higby, H.J. Wallace, David Albert, and James F. Holland Donald J. HigbyDonald J. Higby More articles by this author , H.J. WallaceH.J. Wallace More articles by this author , David AlbertDavid Albert Current address:Sisters of Charity Hospital, Buffalo, New York 14214. More articles by this author , and James F. HollandJames F. Holland Current address:Sisters of Charity Hospital, Buffalo, New York 14214. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)59652-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1974 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySrougi M, Simon S and de Góes G (2018) Vinblastine, Actinomycin D, Bleomycin, Cyclophosphamide and Cis-Platinum for Advanced Germ Cell Testis Tumors: Brazilian ExperienceJournal of Urology, VOL. 134, NO. 1, (65-69), Online publication date: 1-Jul-1985.Richie J (2018) Editorial CommentJournal of Urology, VOL. 134, NO. 1, (69-69), Online publication date: 1-Jul-1985.Bracken R, Johnson D, Frazier O, Logothetis C, Trindade A and Samuels M (2018) The Role of Surgery Following Chemotherapy in Stage III Germ Cell NeoplasmsJournal of Urology, VOL. 129, NO. 1, (39-43), Online publication date: 1-Jan-1983.Mendenhall W, Williams S, Einhorn L and Donohue J (2018) Disseminated Seminoma: Re-Evaluation of Treatment ProtocolsJournal of Urology, VOL. 126, NO. 4, (493-496), Online publication date: 1-Oct-1981.Smith R, Dekernion J and Skinner D (2018) Management of Advanced Testicular SeminomaJournal of Urology, VOL. 121, NO. 4, (429-431), Online publication date: 1-Apr-1979.Whitmore W (2018) Editorial CommentJournal of Urology, VOL. 121, NO. 4, (431-431), Online publication date: 1-Apr-1979.Carey R, Weitzman S, Wilkins E, Chu A and Prout G (2018) Long-Term Unmaintained Remissions after Aggressive Multidisciplinary Treatment of Advanced Non-Seminomatous Testicular Germ Cell TumorsJournal of Urology, VOL. 118, NO. 4, (597-600), Online publication date: 1-Oct-1977.Einhorn L and Donohue J (2018) Improved Chemotherapy in Disseminated Testicular CancerJournal of Urology, VOL. 117, NO. 1, (65-69), Online publication date: 1-Jan-1977.Dekernion J and Lupu A (2018) The Response of Metastatic Retroperitoneal Seminoma to ChemotherapyJournal of Urology, VOL. 117, NO. 6, (736-738), Online publication date: 1-Jun-1977.E.E.F (2018) CommentJournal of Urology, VOL. 117, NO. 6, (738-738), Online publication date: 1-Jun-1977.Skinner D (2018) Non-Seminomatous Testis Tumors: a Plan of Management Based on 96 Patients to Improve Survival in All Stages by Combined Therapeutic ModalitiesJournal of Urology, VOL. 115, NO. 1, (65-69), Online publication date: 1-Jan-1976. Volume 112Issue 1July 1974Page: 100-104 Advertisement Copyright & Permissions© 1974 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Donald J. Higby More articles by this author H.J. Wallace More articles by this author David Albert Current address:Sisters of Charity Hospital, Buffalo, New York 14214. More articles by this author James F. Holland Current address:Sisters of Charity Hospital, Buffalo, New York 14214. More articles by this author Expand All Advertisement PDF DownloadLoading ...

Association of Two Contiguous Urological Tumors with Adult Wilms Tumor

No AccessJournal of Urology1 Mar 1973Association of Two Contiguous Urological Tumors with Adult Wilms Tumor Irving Orlin Irving OrlinIrving Orlin Current address: Urology Service, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland 20331. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)60425-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1973 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMatzkin H and Braf Z (2018) Multiple Primary Malignant Neoplasms in the Genitourinary Tract: Occurrence and EtiologyJournal of Urology, VOL. 142, NO. 1, (1-12), Online publication date: 1-Jul-1989.Hara T, Fujime M, Kawabe K, Ueno A, Koiso K and Niijima T (2018) Adult Wilms Tumor and Bilateral Germ Cell Tumors of Testes: A Case ReportJournal of Urology, VOL. 128, NO. 6, (1296-1298), Online publication date: 1-Dec-1982.Byrd R, Evans A and D’angiot G (2018) Adult Wilms Tumor: Effect of Combined Therapy on SurvivalJournal of Urology, VOL. 127, NO. 4, (648-651), Online publication date: 1-Apr-1982. Volume 109Issue 3March 1973Page: 362-365 Advertisement Copyright & Permissions© 1973 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Irving Orlin Current address: Urology Service, Malcolm Grow Medical Center, Andrews Air Force Base, Maryland 20331. More articles by this author Expand All Advertisement PDF downloadLoading ...