Nonseminomatous Testicular Tumors Research Articles

Validation of AGR2 and KRT19 as specific proteins being significantly and differentially expressed in teratoma compared to necrosis in retroperitoneal lymph node resections after chemotherapy (pcRPLND).

412 Background: Metastatic non-seminomatous testicular tumor patients with residual retroperitoneal tumor masses > 1cm after chemotherapy are treated with pcRPLND. The goal of pcRPLND is to remove viable tumors (V) and teratoma (T), which are present in approximately 10% and 40% of cases, respectively. However, histopathologically, only scar/necrosis (N) is identified in the remaining 50% of patients. In those patients, surgical therapy is not necessary, resulting in a relevant overtreatment. So far, no adequate distinction between the histologies exists preoperatively. Recently, the first biomarker was described with miR371a-3p in serum, which is highly specific for V, but not for T. In 2022 we reported AGR2 and KRT19 to be significantly and differentially expressed in teratoma compared to necrosis in pcRPLND tissue on protein and mRNA level. The aim of this study was to validate these proteins on an independent cohort. Methods: All consecutive pcRPLND patients from 2021 who were treated in the University Hospital of Cologne, Germany, were selected (n=66). All patients had residual masses > 1 cm and normalized or plateaued tumor markers. For immunohistochemistry, the monoclonal antibodies KRT19 and AGR2 were applied to representative Formalin-Fixed Paraffin-Embedded tissue. To quantify the results, the H-score was used. The investigators were blinded to the final pathohistological results. Results: The cohort was composed of 66 patients, 23 patients with T, 24 patients with V and 19 patients with N. Significantly higher H-scores were shown for AGR2 and KRT19 when comparing T vs. N and T vs. V (both p < 0.0001). The discriminatory ability of the two proteins AGR2 and KRT19 was calculated by AUCs for T vs. N and was 1.0 in each case with a corresponding sensitivity and specificity for T of 100%. Conclusions: With AGR2 and KRT19, we could validate the two proteins that are significantly and differentially expressed in the pcRPLND specimen in the clinically relevant groups T vs. N. In perspective, these proteins could be targeted by radiolabeled ligands as a tracer in order to reliably distinguish patients with teratoma from those with necrosis by means of functional imaging. Thus, overtreatment with pcRPLND of patients with N could be safely reduced.

Differentially expressed mRNA/proteins can distinguish viable germ cell tumors and teratomas from necrosis in retroperitoneal lymph node resections after chemotherapy (pcRPLND).

408 Background: Metastatic non-seminomatous testicular tumor patients with residual retroperitoneal tumor masses > 1cm after chemotherapy are treated with pcRPLND. The goal of pcRPLND is to remove viable tumors (V) and teratoma (T), which are present in approximately 10% and 40% of cases, respectively. However, histopathologically, only scar/necrosis (N) is identified in the remaining 50% of patients. In those patients, surgical therapy is not necessary, resulting in a relevant overtreatment. So far, no adequate distinction between the histologies exists preoperatively. Recently, the first biomarker was described with miR371a-3p in serum, which is highly specific for V, but not for T. Therefore, our goal was to identify mRNAs and proteins that are differentially expressed between V/T vs N, in particular between T and N, in pcRPLND resected cells. Methods: Forty-eight patients were identified, n = 16 each with T/V/N. Representative regions of T/V/N were microdissected and subsequently mRNA was extracted. Initially, 770 genes were analyzed using the nCounter PanCancer Progression Panel (Nanostring). For each group comparison, genes with a fold change of < -2/ > 2 and a p-value of < 0.05 were identified. Hereafter, quantitative protein analysis (proteomics) was performed on the same samples. Finally, the proteins of the 5 mRNAs with the most different and significant expression levels between T vs. N were validated by immunohistochemistry and H-score calculation. Results: By Nanostring, we identified 84 significantly differentially expressed mRNAs for the group comparisons of T vs. N, 63 for V vs. N, and 189 for T vs. V. Quantitative protein analysis revealed 25 significantly differentially expressed proteins in T vs. N, 254 in V vs. N, and 134 between T vs. V. By immunohistochemistry, all 5 antibodies showed significantly increased H scores when comparing T vs. N and T vs. V. In accordance with the objective, we found two proteins, AGR2 and KRT19, with their corresponding genes that showed significantly differential expressions for the comparison of T vs. N in both, quantitative protein analysis and Nanostring mRNA analysis, and were successfully validated by immunohistochemistry. Conclusions: With AGR2 and KRT19, we have identified two proteins with their corresponding genes that are significantly and differentially expressed in the pcRPLND specimen in the clinically relevant groups T vs. N. Both were successfully validated by immunohistochemistry. In addition, further group differences (T vs. V/ V vs. N) were revealed depending on the analytical method. In perspective, these proteins could be targeted by radiolabeled ligands as a tracer in order to reliably distinguish patients with teratoma from those with necrosis by means of functional imaging. Thus, overtreatment with pcRPLND of patients with N could be safely reduced.

Retroperitoneal lymph node dissection in patients with advanced non-seminomatous germ cell testicular tumors and incomplete radiological and serological response to chemotherapy: results

Objective: To evaluate the results of retroperitoneal lymph node dissection (RPLND) in patients with advanced non-seminomatous germ cell testicular tumors (NSGCT) and incomplete serological and radiological response to chemotherapy (CT).Materials and methods: The study included 96 patients with advanced NSGCT who underwent RPLND in N.N. Blokhin Russian Cancer Research Center in 1983-2020. The median age was 27 (15-57) years. All patients (n = 96, 100,0 %) received first-line cisplatin-based CT. Fifty-eight patients (60,4%) received second-line CT. After completion of CT, all patients presented with elevated levels of AFP and/or hCG and detectable tumor lesions (retroperitoneal metastases only in 77 cases (80,2 %), metastases in the retroperitoneal space and other sites in 19 cases (19,8%)). All patients underwent the follow-up surgery after CT completion: RPLND in 96 cases (100,0%) and resection of extra-retroperitoneal lesions in addition to RPLND in 8 cases (8,3%). In total, 29 (30,2%) of 96 patients received CT following surgery. The median follow-up was 39,4 (1-284) months.Results: Postoperative complications were reported in 10 (10,6%) patients, including grade 3-4 in 3 patients (3,1%). The mortality rate was 1,1%. The complete resection of retroperitoneal tumor lesions was performed in 80 cases (83,3 %), resection of all detectable tumor lesions in 69 cases (71,9%). None of the patients achieved complete response to postoperative CT. Pathological examination of retroperitoneal lesions revealed necrosis and fibrosis, teratomas, and malignant non-seminomatous tumors in 25 (26,0 %), 29 (30,2 %), and 42 (43,8 %) cases, respectively. The long-term overall survival (OS) and cancer-specific survival rates were 60,9 % and 61,7 %, respectively. The relapse-free survival rate in patients who underwent complete resection reached 65,2 %, the progression-free survival rate in patients who underwent incomplete resection was 35,9 %. A multivariate analysis revealed the following independent predictors of unfavorable OS: RPLND after second-line CT (odds ratio [OR] 4,667 (95% confidence interval [CI]: 1,987-10,961)), presence of a residual retroperitoneal mass of a malignant non-seminomatous tumor (OR 3,081 (95% CI: 1,178-8,055), and incomplete removal of residual lesions after CT (OR 4,445 (95% CI: 1,813-10,899)).Conclusion: Post-CT RPLND may be considered a viable option in the selected group of advanced NSGCT patients with an incomplete serological response to CT eligible for complete resection of all detectable tumor lesions.

Semen quality from patients affected by seminomatous and non-seminomatous testicular tumor.

ABSTRACTTesticular cancer is considered a rare disease affecting approximately 1% to 2% of the male population. This neoplasm has a cure rate of over 95%; as a result, a major concern is the future of fertility of carriers from this disease. There are several histological subtypes of testicular tumors; however, the Testicular Germ Cell Tumors (TGCTs), comprising both seminoma and non-seminoma tumors, are considered the main subtypes of testicular neoplasms. TGCT are characterized by being a solid tumor that mostly affects young men aged between 15 and 40 years old. While TGCT subtypes may have an invasive potential, seminoma subtype does not affect other cells rather than germ cells, while non-seminomas have more invasive properties and can achieve somatic cells; thus, having a more aggressive nature. This research intends to review the literature regarding information about sperm parameters, correlating the data found in those studies to the subfertility and infertility of patients with TCGTs. Furthermore, it will also correlate the data to the non-seminoma and seminoma histological subtypes from pre- and post-cancer therapy. PubMed databases were used. Searched keywords included: seminoma AND non-seminoma; male infertility; germ cell tumor; chemotherapy AND radiotherapy. Only articles published in English were considered. Current studies demonstrate that both TGCT subtypes promote deleterious effects on semen quality resulting in decreased sperm concentration, declined sperm total motility and an increase in the morphology alterations. However, findings suggest that the non-seminoma subtype effects are more pronounced and deleterious. More studies will be necessary to clarify the behavior of seminoma and non-seminoma tumors implicating the reproductive health of male patients.

Is there still a place for retroperitoneal lymph node dissection in clinical stage 1 nonseminomatous testicular germ-cell tumours? A retrospective clinical study

BackgroundPrimary retroperitoneal lymph node dissection (RPLND) ultimately lost its role as the standard management of clinical stage (CS) 1 nonseminomatous (NS) testicular germ cell tumours (GCTs) in Europe when the European Germ Cell Cancer Consensus Group released their recommendations in 2008. Current guide-lines recommend surgery only for selected patients but reasons for selection remain rather ill-defined. We evaluated the practice patterns of the management of CS1 patients and looked specifically to the role of RPLND among other standard treatment options.MethodsWe retrospectively evaluated the treatment modalities of 75 consecutive patients treated for CS1 NS at one centre during 2008–2017. The patients undergoing RPLND were selected for a closer review. Particular reasons for surgery, clinical features of patients, and therapeutic outcome were analyzed using descriptive statistical methods.ResultsTwelve patients (16%) underwent nerve-sparing RPLND, nine surveillance, 54 had various regimens of adjuvant chemotherapy. Particular reasons for surgery involved illnesses precluding chemotherapy (n = 2), patients´ choice (n = 4), and teratomatous histology of the primary associated with equivocal radiologic findings (n = 6). Five patients had lymph node metastases, two received additional chemotherapy. Antegrade ejaculation was preserved in all cases. One patient had a grade 2 complication that was managed conservatively. All RPLND-patients remained disease-free.ConclusionsPrimary RPLND is a useful option in distinct CS1 patients, notably those with concurrent health problems precluding chemotherapy, and those with high proportions of teratoma in the primary associated with equivocal radiological findings. Informed patient’s preference represents another acceptable reason for the procedure. RPLND properly suits the needs of well-selected patients with CS1 nonseminoma and deserves consideration upon clinical decision-making.

Retroperitoneal surgery in the treatment of germ-cell tumors of the testis: retroperitoneal lymph node dissection (RPLND)

Germ-cell tumors of the testis (GCTT) are rare, but have a high social impact. In fact they represent no more than 1% of male tumors (about 700 new cases per year in Italy), but electively occur in young patients, 20 to 40 years old, during their fully mature social and working life. More than 80% of patients are cured and return to a normal social, sexual, and working life. Improvements achieved both in diagnosis, with the use of scans (CT, MRI, US and recently PET) and of serum tumor markers alpha-fetoprotein (AFP), beta-fraction of human chorionic gonadotropin (b-HCG) and lactate dehydrogenase (LDH), and mainly in treatment, through the amelioration of radiotherapy and surgical techniques and, especially, with the introduction of Cisplatin, Etoposide and Ifosfamide in chemotherapic regimens, have made germ-cell tumor a model of "curable disease". Retroperitoneal lymph node dissection (RPLND) has indications in patients with clinical stage I (CS1) as well as in advanced disease, where it is integrated in the multimodality treatment. Anatomical studies, as well as a long-term experience, have gradually but consistently modified the surgical techniques of RPLND. Currently, "nerve sparing" RPLND represents a safe management of CS1 nonseminomatous germ cell testicular tumor with minimal morbidity and excellent outcomes. Nonetheless, surveillance and adjuvant chemotherapy are as effective as RPLND, but, in our opinion, associated with some discomforts for the patients. Laparoscopic retroperitoneal lymph node dissection (Lap-RPLND) is gaining popularity as a minimally invasive staging procedure for clinical stage I nonseminomatous testicular carcinoma, but its therapeutic role is still under investigation.

Non-seminomatous germ cell testicular tumor with poor prognosis

Non-seminomatous germ cell testicular tumor with poor prognosis

Laparoscopic retroperitoneal lymph node dissection (L-RPLND) as therapeutic in stage I nonseminomatous germ cell testicular tumors: Findings from a referral center.

411 Background: Active surveillance or one course of BEP are the usual policies in stage I NSGTT. RPLND has been progressively abandoned due to morbidity and, mostly, to its low reproducibility. L-RPLND was introduced aiming at reducing morbidity, but few systematic data are available concerning its therapeutic efficacy. A long-term accrual in a referral center is presented. Methods: Analysis includes patients undergoing primary L-RPLND between 2000 and 2014, performed by 4 different surgeons. Patients underwent unilateral dissection according to a template in use since 1980. Adjuvant chemotherapy was provided in cases with a positive nodal ratio ≥ 25%. Regular follow-up was provided. Performance, safety and effectiveness measures have been analyzed. Results: Out of 225 patients, full data including clinico-pathologic variables and follow-up are available in 188 cases. Mean age is 31 yrs, vascular invasion is present in 37.2%. Left dissections are 52%. Fifteen (8%) cases have been converted to open RPLND. Median duration of RPLND is 200 min. Median number of removed nodes is 15 (IQR: 11-20). Complications of Clavien Dindo grade ≥ 3 are 9. Twenty-six patients have metastatic nodes (pN+) and 6 received adjuvant chemotherapy. After a median follow-up of 40 months (range: 24, 71), 11 relapses occurred: 6 (3.7%) of 162 pN0 and 5 of 20 pN+ not undergoing adjuvant chemotherapy. Infield recurrences are not reported. All relapsed patients have been rescued by first line chemotherapy. Presence of vascular invasion (p .073) and node ratio as continuous variable (p .097) are not associated with recurrence considering all cases, while conversion to open RPLND is significant (p .019), considering patients operated by the two surgeons with homogeneous variables. Conclusions: L-RPLND in a referral centre is a safe procedure and is apparently effective as open surgery, as there is no an excess of relapses in pN0 cases (3.6%), and the proportion of relapses in pN1 (25%) compares with the traditional figures of open surgery. Conversion to open surgery may be a marker predicting recurrence in a mature phase of experience.

Survival outcomes of adolescent and adult patients with non-seminomatous testicular germ-cell tumors: A population-based study

In adolescents, approximately 90% of testicular germ cell tumors (T-GCTs) are non-seminomas (NS T-GCTs). Few studies have evaluated the impact of age, specifically in adolescence, on outcomes of NS T-GCTs. The purpose of this study was to review all patients diagnosed with NS T-GCTs in the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the association between age (adolescents vs. adults) and survival outcomes. The SEER database was queried for individuals ≥13 years old diagnosed with NS T-GCTs from 1995 to 2012. Patients were categorized into adolescent (13-19 years) and adult (≥20 years) cohorts. A Cox proportional hazards model was used for multivariate analysis (MVA). A total of 13,963 patients (1496 adolescents, 12,467 adults) was included. Median follow-up was 71 months (range 1-215). Five-year overall survival (OS) for adolescent and adult patients was 94% and 92%, respectively (p=0.007); 5-year cancer-specific survival (CSS) was 95% and 94%, respectively (p=0.139). Under MVA, adolescent patients had improved OS (HR 0.61; 95% CI 0.50-0.75; p<0.001) and CSS (HR 0.65; 95% CI 0.51-0.82; p<0.001), when compared with adults (Table). In a logistic regression analysis adjusting for demographics, adolescent patients were more likely to present with regional or distant metastatic disease (OR 1.16; 95% CI 1.01-1.35; p=0.039), undergo an orchiectomy (OR 2.44; 95% CI 1.50-4.00; p<0.001) or tumor excision (OR 2.43; 95% CI 1.57-3.77; p<0.001), and receive other adjuvant surgery (OR 5.87; 95% CI 2.25-15.30; p<0.001). To our knowledge, this is the largest population-based comparative analysis in NS T-GCTs comparing outcomes between these two age groups. Adolescent patients with NS T-GCTs had slightly improved survival compared with adults, despite presenting with more advanced disease. While adolescent patients present at more advanced stage, they achieve excellent survival outcomes possibly at the cost of a greater therapeutic burden.

Additional Surgical Procedures During Postchemotherapy Retroperitoneal Lymph Node Dissection in Patients with Nonseminomatous Testicular Tumor

Additional Surgical Procedures During Postchemotherapy Retroperitoneal Lymph Node Dissection in Patients with Nonseminomatous Testicular Tumor

Risk stratification of clinical stage I (CSI) non-seminomatous germ cell testicular tumors (NSGCT): A retrospective analysis of experience at Indiana University (IU).

e16052Risk Stratification of Clinical Stage I (CSI) Non-Seminomatous Germ Cell Testicular Tumors (NSGCT): A Retrospective Analysis of Experience at Indiana University (IU) Background: Nearly 50% of...

Outcomes of surveillance VS. adjuvant chemotherapy for patients with STAGE IA and IB NON-seminomatous testicular germ-cell tumors.

e16051Background: Approximately 50-60% of nonseminomatous germ-cell tumors (NSGCT) present with clinical stage I (CS I). Initial active surveillance, adjuvant chemotherapy and retroperitoneal lymph...

Predictive models for lymph node metastases in patients with testicular germ cell tumors.

To develop predictive models for lymph node (LN) metastasis in testicular germ cell tumors. 291 patients with testicular germ cell tumors were included, which were divided into seminomatous and nonseminomatous groups. For screening the risk factors for LN metastasis, the tumor-related characteristics (including histopathological information and tumor markers) alpha fetoprotein and the lymph node-related features on CT were compared between metastatic cases and nonmetastatic cases. Two logistic regression models were built for each histological group, one depending on all tumor- and lymph node-related risk factors (Model 1) and another only on tumor-related factors (Model 2). Receivers operating characteristic curves were used to evaluate the predictive abilities of these models. 117 positive nodes/regions were identified in 68 patients, including 51 metastases and 17 occult metastases. Based on the selected independent risk factors, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Models 1 and 2 in seminomatous and nonseminomatous groups were (95.5%, 95.3%, 95.3%, 77.8%, and 99.2%), (63.6%, 83.6%, 80.7%, 40.0%, and 93.0%), (93.5%, 94.7%, 94.3%, 89.6%, and 96.8%), and (89.1%, 44.2%, 58.9%, 43.6%, and 89.4%), respectively. Two predictive models for each seminomatous and nonseminomatous testicular tumor were established based on lymph node- and tumor-related risk factors. In patients with tumor and lymph node-related risk factors, regular CT surveillance is likely sufficient for predicting LN status, while in the patients without any tumor and lymph node-related risk factors a long interval-time CT follow-up should be considered. Additionally, right side tumors tend to involve contralateral LNs compared to left side ones. Positive inguinal LNs more frequently occur in patients with a history of groin surgery.

Efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer

Objective To evaluate of efficacy and safety of nerve sparing laparoscopic retroperitoneal lymph node dissection for early stage testicular cancer. Methods From January 2001 to September 2014, 83 patients with primary testicular nonseminomatous germ cell tumors (NSGCT) received nerve sparing LRPLND at 1-4 week after orchiectomy.Their age ranged from 18 to 44 years old, mean 25 years old.Serum AFP was abnormally elevated in 51 patients, ranged from 15to 1432μg/L (mean 874 μg/L). beta-HCG were abnormally elevated in 46 patients, ranged from 5-70 IU/L(mean 56 IU/L). All of their clinical stage was stage Ⅰ and did not suffer from ejaculatory dysfunction.The operating time, intraoperative blood loss, postoperative intestinal function recovery time, drainage removal time, hospital stay, intra - and post - operative complications were recorded. Results The nerve sparing laparoscopic retroperitoneal lymph was successfully performed in all patients.The mean operating time was 218 min, (range 158-285 min). The mean intraoperative blood loss was 368ml (range 255-587ml). The postoperative intestinal function recovery time ranged from 24 to 48 hours (mean 31 hours). And the hospital stay ranged from 5 to 9 days (mean 7days). The inferior vena cava was injured during operation and was sutured laparoscopically in 1 patient.Mild chylous retroperitoneal drainage was seen in 3 patients, which was cured within 1 week after operation by restriction of high - fat diet.22 cases were noticed ejaculation dysfunction postoperatively, which recovered spontaneously within 8 to 12 weeks.Within the 3 to 76 months follow - up, 73 patients revealed no evidence of recurrence or distant metastasis. Conclusions Nerve sparing LRPLND is technically feasible, mini invasive, the morbidity and complication were significantly lower.It can be performed with satisfactory results in young patients with early stage NSGCT. Key words: Testicle; Nonseminomatous germ cell tumors; Nerve sparing retroperitoneal lymph node dissection; Laparoscopy; Ejaculation

Volumetric assessment of lymph node metastases in patients with non-seminomatous germ cell tumors treated with chemotherapy

We evaluate volumetry and RECIST (Response Evaluation Criteria In Solid Tumors) as methodologies for response after chemotherapy for non-seminomatous germ cell tumour with retroperitoneal lymph node metastases. We performed a retrospective analysis of non-seminomatous testicular tumours and concurrent retroperitoneal lymph node metastases, which received chemotherapy and had computed tomography scans before and after treatment. Volumetric analysis and RECIST criteria were used to calculate response rates. We included a new category (favourable response) for patients with response rates between <100% and >70%. We calculated the correlation between volumetric and RECIST criteria with histological and clinical variables. In total, 18 patients met the inclusion criteria. Histopathologic analysis of orchiectomy showed teratoma in 55.5% of patients, and those without teratoma had predominantly embryonal carcinoma. The mean baseline volume of retroperitoneal metastases was 447 cc, the mean post-chemotherapy volume was 33.6 cc, and the response rate was 62.6%. According to RECIST criteria, the mean baseline diameter was 4.93 cm, the mean post-chemotherapy diameter was 2.39 cm, and the response rate was 42.4%. Large post-chemotherapy residual masses correlated in both classifications with teratoma. The response rate was associated with the need for surgical treatment and the volumetric classification correlated with the need for lymphadenectomy. This study evaluated volumetry as a way to measure clinical response in lymph node metastases of non-seminomatous germ cell tumours. Volumetric analysis is the next step in the evaluation of response rate; its accuracy remains to be determined. Teratoma had greater residual masses and our classification correlated with the need for lymphadenectomy.

Can we predict the presence of teratoma in the retroperitoneum before post-chemotherapy retroperitoneal lymphadenectomy?

The biological potential of teratoma remains unpredictable, therefore identifying its presence in the retroperitoneum remains important. We evaluated patients undergoing post-chemothe rapy retroperitoneal lymphadenectomy (PC-RPLA) for nonseminomatous testicular tumors (NSTT), to determine predictors of teratomatous elements in the retroperitoneum. We identified 161 patients from 1982 to 2005 who underwent PC-RPLA for metastatic NSTT. Multiple clinical and pathological variables were reviewed from out RPLA database. Of the 161 patients in our series, 112 (70%) received only induction chemotherapy and 49 (30%) required 2nd line chemotherapy. Studies of retroperitoneal pathology demonstrated the presence of fibrosis in 44 (27%), teratoma in 82 (51%) and vital carcinoma in 35(22%).Among 82 patients (51%) with finding of teratomatous elements at PC-RPLA, we revealed the presence of mature teratoma in 85%, immature teratoma in 12% and teratoma with malignant transformation in 3%. Of the 99 patients (61%) with teratomatous elements in the primary NSTT, 61 (62%) had teratoma at PC-RPLA. Even in the absence of teratoma in the primary NSTT, teratoma was present in the retroperitoneum in 21 of 62 patients (32%) (p 5 cm in diameter occured in 30%, 52% and 55%, respectively. By multivariate analysis, teratoma in the orchiectomy specimen (p<0.005), relative change in nodal size before and after chemotherapy (p<0.005), and no requirement for 2nd line chemotherapy (p=0.33) were independent predictors for the presence of the teratoma in the retroperitoneum. Teratoma remains a common histologic finding in the retroperitoneal lymph nodes following chemotherapy. We have identified several pre-RPLA variables that predict the finding of teratoma in the retroperitoneum for men treated with chemotherapy for metastatic NSTT.

S258: Long-term follow-up of cisplatin combination Chemotherapy (C) in patients (pts) with disseminated Nonseminomatous Testicular Tumors (NSTT): Is a Post-Chemotherapy Retroperitoneal Lymphadenectomy (PC-RPLA) needed after Complete Remission (CR)?

S258: Long-term follow-up of cisplatin combination Chemotherapy (C) in patients (pts) with disseminated Nonseminomatous Testicular Tumors (NSTT): Is a Post-Chemotherapy Retroperitoneal Lymphadenectomy (PC-RPLA) needed after Complete Remission (CR)?

1116 Is template laparoscopic retroperitoneal lymph-node disection (Lap-RPLND) an advisable option for adequately selected patients with a residual mass of non-seminomatous germ-cell testicular tumours (NSGCTT)?

1116 Is template laparoscopic retroperitoneal lymph-node disection (Lap-RPLND) an advisable option for adequately selected patients with a residual mass of non-seminomatous germ-cell testicular tumours (NSGCTT)?

Metástasis óseas y sección medular secundaria a tumor testicular no seminomatoso

Testicular cancer is the most frequent solid tumor in men between 15 and 35 years of age. Bone metastases associated with spinal cord injury are rare.We present the case of a 28-year-old man whose disease began 4 years prior with enlargement of the right testis. Physical examination revealed a hardened right testis measuring 20cm. An ultrasound study showed a heterogeneous image and the patient had elevated preoperative levels of the tumor markers, lactate dehydrogenase (LDH) and alpha-fetoprotein (AFP), and bilateral pulmonary and retroperitoneal metastases. Radical orchiectomy revealed a mixed germ cell tumor made up of 70 % immature teratoma and 30 % endodermal sinuses. In the postoperative period, the patient presented with paraplegia and urinary retention. Tumor activity was documented in the cervical and lumbar spine with complete spinal cord injury. He was managed with steroid treatment and radiotherapy and then with 4 cycles of bleomycin-etoposide-cisplatin (BEP), but had disease progression. One month later he presented with intense pain and was unable to move his left shoulder due to tumor activity in that area, which was managed with radiotherapy. Second-line chemotherapy was not administered and the patient died.Vertebral metastases derived from testicular tumors can cause epidural compression. Management is based on steroid treatment and radiotherapy and emergency decompression surgery is required to prevent functional loss. The neurologic deficit tends to persist. These tumors are accompanied by bulky metastatic disease and require chemotherapy. Their outcome is poor. Bone metastases of nonseminomatous testicular tumors can manifest as bone pain or as spinal cord compression symptoms. No cases have been reported in the Mexican medical literature.

1060 Thoracic metastectomy for nonseminomatous testicular tumors (NSTT): Long term survival and prognostic factors

1060 Thoracic metastectomy for nonseminomatous testicular tumors (NSTT): Long term survival and prognostic factors