Normal Tumor Marker Levels Research Articles

Chemotherapy in stage II nonseminomatous germ cell tumors of the testis: The institut Gustave roussy experience

To assess the role of chemotherapy in the treatment of stage II nonseminomatous germ-cell tumors of the testis, the outcomes of 154 patients who were included in prospective trials and standard treatment programs at Institut Gustave Roussy between 1984 and 1993 were reviewed. The median follow-up is 5.5 years. Cisplatin-based primary chemotherapy was the treatment regimen for 108 patients. Elevated serum tumor marker levels were found in 27 patients only while 81 had radiologic evidence of retroperitoneal disease. Primary chemotherapy was followed by retroperitoneal lymph node dissection (RPLND) in 41 % of cases. Long-term nonevolutive disease (NED) was diagnosed in 101 (93%) patients. Primary RPLND and adjuvant chemotherapy was the treatment regimen for 46 patients, 100% of whom are long-term NED. Patients with normal serum tumor marker levels following orchiectomy and radiologic evidence of low volume retroperitoneal disease should undergo primary RPLND. Patients with persistently elevated serum tumor marker levels without retroperitoneal involvement should be treated by primary chemotherapy, as should patients with large volume retroperitoneal disease. In patients with elevated serum tumor marker levels and low volume retroperitoneal disease who may benefit equally from up-front chemotherapy or primary RPLND, assessment of risk-benefit, cost-benefit, and quality of life is warranted in future trials.

Adult mesenchymal hamartoma of the liver mimicking bile duct cystadenoma

We report a rare case of mesenchymal hamartoma in the cirrhotic liver of a 52-year-old Japanese male. The tumor, 3.5 cm in diameter, contained a cystic lesion and was located in the lateral segment. Bile duct cystadenoma was considered most likely preoperatively because of the patient's age and the normal levels of tumor markers. However, since malignancy of the lesion could not be ruled out by preoperative imaging diagnosis, lateral segmentectomy was performed. Histological examination led to a diagnosis of mesenchymal hamartoma, since the lesion consisted of a multilocular abnormal bile duct accompanied by abundant myxomatous or loose collagen.

A CASE OF AORTODUODENAL FISUTULA AFTER RETROPERITONEAL LYMPH NODE DISSECTION IN TESTICULAR TUMOR

A 19-year-old male underwent right orchiectomy for testicular tumor on December 25, 1986, Histopathological examination revealed teratocarcinoma and embryonal carcinoma. Three courses of salvage chemotherapy with cisplatin, VP-16 and bleomycin (PEB) were preformed for multiple lung and abdominal retroperitoneal lymph node metastases. Re-elevation after chemotherapy showed clearing of the chest lesions, normal tumor marker levels and decreasing size of the abdominal mass. Residual retroperitoneal lymph node metastasis was resected. A potion of aorta denuded by tumor dissection was reconstructed from a patch of a knitted graft. After salvage surgery, the patient experienced abdominal and back pain, subfebrile temperature, and upper gastrointestinal bleeding. Aortoduodenal fistula was diagnosed intraoperatively.