Mixed Germ Cell Testicular Tumor Research Articles

Commentary on “Genomic characterization of testis cancer: Association of alterations with outcome of clinical stage mixed germ cell non-seminomatous germ cell tumor of the testis.” Mohamed GH, Gelfond JAL, Nicolas MM, et alMohamed GH, Gelfond JA, Nicolas MM, Brand TC, Sarvis JA, Leach RJ, Johnson-Pais TL, Department of Pathology, University of Texas Health Science Center, San Antonio, TX 78229, USA:

ObjectiveTo identify genomic markers that are reliable in predicting lymph node metastases in clinical stage 1 non-seminomatous germ cell tumors (NSGCTs). MethodsComparative genomic array technology was used to identify regions of genomic amplification or deletion in clinical stage 1 NSGCTs. Twelve stage 1 mixed germ cell testicular tumors were analyzed, which were obtained from 8 patients who had no evidence of nodal metastasis when retroperitoneal lymph node dissection (RPLND) had been performed (i.e., were RPLND negative) and 4 patients who had nodal metastases (i.e., were RPLND positive). ResultsDifferences between the genomic alterations associated with the two classes of tumors were identified. Genomic alterations previously reported in other subtypes of testicular tumors were observed in both metastatic and nonmetastatic cases. Statistically suggestive differences in mean copy number of the Y chromosome were found between metastatic and nonmetastatic cases (P = 0.0142). ConclusionThis finding suggests the presence of chromosome Y deletions to be a potential genetic marker for prediction of mixed germ cell tumor progression. This is a first step toward identifying chromosomal markers of progression in testicular cancer in clinical stage 1 mixed germ cell NSGCT.

Suture Granuloma Showing False-Positive Findings on FDG-PET

We report a case of a 33-year-old male with a mixed germ-cell testicular tumor. Postoperative follow-up FDG-PET revealed concentration of FDG in the left inguinal area which is not tumor metastasis or local recurrence but suture reactivity granuloma. In this paper, we reviewed suture granulomas associated with false-positive findings on FDG-PET after surgery. If FDG-PET will be used more frequently in the future, it will be necessary to refrain from using silk thread in order to prevent any unnecessary surgery.

Mixed germ-cell testicular tumor in a liver transplant recipient.

The development of malignancies after solid organ transplants is a well-known complication. Cancer is associated with significant consequences for the organ transplant patient. It is expected that cancer will surpass cardiovascular complications as the leading cause of death in transplant patients within the next few years. We report on a 36-year-old male patient who developed mixed germ-cell testicular tumor seven years after liver transplantation for alcoholic cirrhosis. He was treated with orchiectomy, retroperitoneal lymph node dissection and post-operative chemotherapy.

Genomic Characterization of Testis Cancer: Association of Alterations With Outcome of Clinical Stage 1 Mixed Germ Cell Nonseminomatous Germ Cell Tumor of the Testis

To identify genomic markers that are reliable in predicting lymph node metastases in clinical stage 1 non-seminomatous germ cell tumors (NSGCTs). Comparative genomic array technology was used to identify regions of genomic amplification or deletion in clinical stage 1 NSGCTs. Twelve stage 1 mixed germ cell testicular tumors were analyzed, which were obtained from 8 patients who had no evidence of nodal metastasis when retroperitoneal lymph node dissection (RPLND) had been performed (ie, were RPLND negative) and 4 patients who had nodal metastases (ie, were RPLND positive). Differences between the genomic alterations associated with the two classes of tumors were identified. Genomic alterations previously reported in other subtypes of testicular tumors were observed in both metastatic and nonmetastatic cases. Statistically suggestive differences in mean copy number of the Y chromosome were found between metastatic and nonmetastatic cases (P = .0142). This finding suggests the presence of chromosome Y deletions to be a potential genetic marker for prediction of mixed germ cell tumor progression. This is a first step toward identifying chromosomal markers of progression in testicular cancer in clinical stage 1 mixed germ cell NSGCT.

Spontaneous Rupture Of An Intra-Abdominal Testicular Tumor: A Case Report

The rupture of an intra-abdominal testicular tumor is a rare cause of acute abdomen with haemoperitoneum. We report a case of a 25-year-old male presenting with acute abdomen with haemoperitoneum caused by the rupture of intra-abdominal a nonseminomatous, mixed germ cell testicular tumor (NSMGCT), a predominantly yolk sac tumor and embryonal carcinoma in an undescended testis. The clinical details and difficulties in diagnosis of this testicular tumor are discussed.

"Mixed germ cell testicular tumor" in an adult female

The androgen insensitivity (testicular feminization) syndrome was described by Morris in phenotypic females with 46XY karyotype, presenting with primary amenorrhea, adequate breast development, and absent or scanty pubic or axillary hair. Gonads consist usually of seminiferous tubules without spermatogenesis. These patients have a 5–10% risk of developing germ cell tumors, usually after the complete development of secondary female sexual characteristics. We hereby report a case considered as a female with married life of 15 years, who was operated for severe abdominal pain. Phenotype characters were that of female. Microscopic examination of the tumor from the abdomen revealed germinoma and yolk sac tumor with adjacent seminiferous tubules. Karyotyping showed 46XY. Final diagnosis of malignant mixed germ cell tumor in androgen insensitivity syndrome was made. Surveillance may be the most appropriate option when these conditions are initially diagnosed in adulthood to prevent development of germ cell tumors.

Mixed germ cell testicular tumor presenting as metastatic cutaneous choriocarcinoma

To the Editor: A 38-year-old man, with polysubstance abuse and hepatitis C infection, was admitted to the hospital with nausea and coffee-ground emesis. He reported a 2-week history of two anterior chest nodules. Cutaneous examination revealed a 2.1- × 1.7-cm firm, pink nodule with punctate hemorrhagic crust and overlying pseudovesiculation on his right upper lateral chest wall. Adjacent to this nodule was a 0.5- × 0.5-cm papule with similar features (Fig 1). Additionally, he was found to have a unilateral enlarged, firm testicular mass with greatest dimension of 4.2 cm. The remainder of his physical examination was unremarkable. Laboratory tests showed a hemoglobin level of 4.9 g/dL. The patient had a normal basic metabolic panel, white blood cell and platelet count, as well as liver and coagulation function tests. The β-human chorionic gonadotropin (β-hCG) was remarkably elevated at 55,540.0 mIU/mL. The erythrocyte sedimentation rate was 44 mm/h. Values for antinuclear antibodies, carcinoembryonic antigen, CA19-9, α-fetoprotein, prostate-specific antigen, and haptoglobin were all normal. His hepatitis C virus quantitative viral load was 143,577 IU/mL. Metastatic workup revealed retroperitoneal lymphadenopathy, numerous bilateral lung masses, and a duodenal mass. Brain magnetic resonance imaging showed multiple enhancing hemorrhagic masses. The cells were negative for placental alkaline phosphatase, a marker for seminoma. Testicular orchiectomy revealed mixed germ cell tumor, with more than 95% of choriocarcinoma and less than 5% seminoma. Biopsy of the chest nodule revealed cutaneous metastasis of choriocarcinoma. Within the dermis was a dense, nodular, and interstitial infiltrate of poorly differentiated atypical and hyperchromatic cytotrophoblasts, admixed with several multinucleated hyperchromatic and atypical syncytiotrophoblasts (Fig 2, A and B). The β-hCG was diffusely positive in the cytoplasm of syncytiotrophoblastic cells and placental alkaline phosphatase was negative, thus confirming the diagnosis (Fig 2, C). In a mixed germ cell tumor, any admixture of a pure germ cell tumor, such as choriocarcinoma, can exist. Choriocarcinoma can rarely be found in its pure form; however, it is most commonly seen as a component of a mixed germ cell tumor. In both forms, choriocarcinoma has a biphasic pattern consisting of mononucleated cytotrophoblast cells that lie in sheets to form villus-like structures and a plexiform arrangement of syncytiotrophoblast cells that secrete β-hCG.1Ulbright T.M. The most common, clinically significant misdiagnoses in testicular tumor pathology, and how to avoid them.Adv Anat Pathol. 2008; 15: 18-27Crossref PubMed Scopus (52) Google Scholar Choriocarcinoma has a marked tendency to metastasize early. Skin metastasis is rare with only 12 cases previously reported and generally correlates with a poor prognosis.2Chen X. Xu L. Chen X. Teng X. Zheng S. Testicular choriocarcinoma metastatic to skin and multiple organs. Two case reports and review of literature.J Cutan Pathol. 2009; 37: 486-490Crossref Scopus (13) Google Scholar Cosnow and Fretzin3Cosnow I. Fretzin D.F. Choriocarcinoma metastatic to skin.Arch Dermatol. 1974; 109: 551-553Crossref PubMed Scopus (26) Google Scholar reported the first case in 1974, and a patient with these findings died 10 days after the initiation of chemotherapy.4Cheng D.C. Jennings T.A. Slominski A. Mihm Jr., C.M. Choriocarcinoma presenting as a cutaneous metastasis.J Cutan Pathol. 1995; 22: 374-377Crossref PubMed Scopus (30) Google Scholar A third case described a patient who died 3 months after the appearance of his cutaneous metastatic lesion to the upper back.5Satoko S. Yoshihiro N. Hiroshi H. Metastatic testicular choriocarcinoma of the skin: report and review of the literature.Am J Dermatopathol. 1996; 18: 633-636Crossref PubMed Scopus (37) Google Scholar First-line treatment of testicular choriocarcinoma is chemotherapy. Our patient was treated with right radical orchiectomy and chemotherapy. He received whole-brain radiation therapy and two cycles of chemotherapy with etoposide and cisplatin. The patient is currently alive 6 months after his presentation. Mixed germ cell tumors usually present with testicular enlargement, pain, or distant metastases. Cutaneous metastases are usually violaceous to red, hemorrhagic, infiltrative subcutaneous nodules located on the trunk, back, head, and scalp.5Satoko S. Yoshihiro N. Hiroshi H. Metastatic testicular choriocarcinoma of the skin: report and review of the literature.Am J Dermatopathol. 1996; 18: 633-636Crossref PubMed Scopus (37) Google Scholar In young men, metastatic testicular choriocarcinoma should be included in the differential diagnosis of papules or nodules in these locations.

Testicular Microlithiasis Preceding Metastatic Mixed Germ Cell Tumor—First Pediatric Report and Recommended Management of Testicular Microlithiasis in the Pediatric Population

Testicular microlithiasis is a condition that has been associated with testis cancer in men and boys. We report the case of a 16-year-old boy who developed metastatic mixed germ cell testicular tumor in the setting of testicular microlithiasis detected by previous ultrasonography. The tumor developed in between semiannual visits and was detected by self-examination. Chest imaging revealed 2 lung lesions, and the beta-human chorionic gonadotropin level was elevated at presentation. Because of the particular nature of healthcare surveillance in the pediatric population, we recommend annual surveillance of boys with testicular microlithiasis, including physical examination, repeated instruction regarding self-examination, and ultrasonography.

Linfadenectomía retroperitoneal vía laparoscópica postquimioterapia

To describe the laparoscopic excision of a postchemotherapy retroperitoneal residual mass in a patient with mixed germ cell testicular tumor. We report the operative technique of laparoscopic excision of a retroperitoneal mass in a 33 year old patient with mixed germ cell testicular tumor. The patient is placed in a lateral decubitus right lumbotomy position and trocars are introduced into the abdominal cavity. Once the retroperitoneum is approached, and after a Kocher manoeuvre of the duodenum, the interaortocaval mass is identified and excised. The operation is completed with lympadenectomy down to the common iliac artery bifurcation bilaterally. The laparoscopic approach is another option for the surgical treatment of residual masses after chemotherapy in testicular tumors. Nevertheless, previous laparoscopic experience is necessary due to its difficulty.

Bilateral testicular germ-cell tumors--a single centre long-term experience.

The incidence of bilateral testicular tumors (BTT) had increased over the preceding decade. The aim of the present study is to analyse a group of patients with BTT and to high-light the need for long-term follow-up of patients treated in a single centre. 27 (2.8%) out of 960 patients with germ-cell testicular tumors (GCTT), treated between 4/1977 and 8/2001, developed bilateral disease. All of them underwent radical orchiectomy (in one patient was done delayed orchiectomy after primary chemotherapy due to advanced disease). Additional treatment was planned according to the histologic type and clinical stage of the disease, and previous treatment as well. The survival data were reviewed. 24 out of 27 patients (88.9%) developed the 2nd tumor metachronously (median interval 66 months, range, 4-197 months) and three (11.1%) had synchronous BTT. Only 7 patients (25.9%) had identical histological types on both sides (6 of them with pure seminomas, one with embryonal carcinoma). Two of three synchronously developed BTT had different histologic types on both sides. GCTT of one histologic type were observed in respect of the first tumor: 11 seminomas, three embryonal carcinomas, in respect of the 2nd tumor: 10 seminomas, three embryonal carcinomas, in respect of the 2nd tumor: 10 seminomas, three embryonal carcinomas and one mature teratoma. GCTT of more than one histologic type were observed in respect of the first and the 2nd tumors: 6 mixed GCTT with seminoma component and 7 without seminoma component. Majority of BTT was presented in clinical stage I (in respect of the first tumor in 70.4%, in respect of the 2nd tumor in 62.9%). The median duration of the follow-up after the diagnosis of the first GCTT was 149 months (range, 13-288 months) and after the diagnosis of the contralateral GCTT was 68 months (range, 1-167 months). Twenty-five patients (92.6%) were alive with NED at their last follow-up visit. Two patients died by mean of 22.5 months (range, 21-24 months) after the 2nd orchiectomy. All patients with unilateral GCTT have an increased risk of developing a contralateral testicular tumor, even decades after diagnosis. Management should be individualised for each patient.

Retroaortic Left Renal Vein in Testicular Cancer Patient: Potential Staging and Treatment Pitfall

A 20-year-old man was diagnosed with a left mixed germ cell testicular tumor and clinical staging with computerized tomography suggested left para-aortic subhilar retroperitoneal adenopathy. The patient received 4 cycles of cisplatin, vinblastine and bleomycin chemotherapy but the mass in the left renal hilus area remained unchanged. Subsequent retroperitoneal lymphadenectomy revealed the mass to be a retroaortic left renal vein type 2. Further confusion occurred during followup in differentiating this anomaly from recurrent neoplasm necessitating evaluation by magnetic resonance imaging. Retroaortic left renal vein represents a potential imaging pitfall in testicular cancer that may facilitate suboptimal staging, treatment and followup.

The Growing Teratoma Syndrome

A 26-year-old man presented with multiple pulmonary nodules and a left testicular mass. Combination chemotherapy for a malignant, mixed germ cell testicular tumor resulted in shrinkage of the pulmonary nodules and normalization of the tumor markers (beta-HCG, LDH and AFP). Subsequent surgical excision performed for enlargement of the pulmonary nodules revealed mature teratomas, diagnostic of the GTS.

Clinical Stage I Nonseminomatous and Mixed Germ Cell Tumors of the Testis: A Clinicopathologic Study of 93 Patients on a Surveillance Protocol after Orchiectomy Alone

This study of 93 patients with Stage I nonseminomatous and mixed germ cell testicular tumors who were placed in a surveillance study following orchiectomy was designed to evaluate pathologic prognostic factors. Follow-up was at least 12 months post-orchiectomy except for one patient who was followed for 9 months. Lymphatic invasion was identified in 26 patients, 62% of whom developed distant metastases; metastasis developed in only 18% of 67 patients without lymphatic invasion (P less than 0.01). Relapse was also associated with the presence of embryonal carcinoma. Of 81 patients with an embryonal carcinoma component, 35% developed metastases, whereas none of those without an embryonal carcinoma developed metastasis (P = 0.05). Effects of other histologic features and tumor size were not significant. Lymphatic invasion appeared to be a significant poor prognostic factor, and embryonal carcinoma was an independent poor prognostic factor.

Clinical stage I nonseminomatous and mixed germ cell tumors of the testis. A clinicopathologic study of 93 patients on a surveillance protocol after orchiectomy alone.

This study of 93 patients with Stage I nonseminomatous and mixed germ cell testicular tumors who were placed in a surveillance study following orchiectomy was designed to evaluate pathologic prognostic factors. Follow-up was at least 12 months post-orchiectomy except for one patient who was followed for 9 months. Lymphatic invasion was identified in 26 patients, 62% of whom developed distant metastases; metastasis developed in only 18% of 67 patients without lymphatic invasion (P less than 0.01). Relapse was also associated with the presence of embryonal carcinoma. Of 81 patients with an embryonal carcinoma component, 35% developed metastases, whereas none of those without an embryonal carcinoma developed metastasis (P = 0.05). Effects of other histologic features and tumor size were not significant. Lymphatic invasion appeared to be a significant poor prognostic factor, and embryonal carcinoma was an independent poor prognostic factor.