Primary Germ Cell Tumors Research Articles

18F-FDG PET/CT Imaging for Mixed Germ Cell Tumor in the Pineal Region

Primary germ cell tumor (GCT) in the pineal region is very rare among all primary intracranial neoplasms. Here, we present the 18F-FDG PET/CT findings of a pineal mixed GCT in a 14-year-old boy. PET/CT showed little uptake of 18F-FDG in the mass in the pineal region, whereas MR imaging showed contra

Combination of paclitaxel, cisplatin, and gemcitabine (TPG) as third- to fourth-line therapy for male germ cell tumors (GCT).

341 Background: Rescue of patients (pts) who fail to be cured following 2–3 chemotherapy (CT) combinations ± high dose CT (HDCT) or who are cisplatin-refractory is still an unmet need. The identification of novel active agents/combinations is a priority. Methods: We reviewed the characteristics of consecutive pts who received TPG combination at our Institution for relapse/progression after 2 or 3 previous platinum-based CT lines. Treatment consisted of the administration of paclitaxel 80 mg/m2 IV, cisplatin 50 mg/m2 IV and gemcitabine 800 mg/m2 IV on days 1 and 8 q3w. Program provided up to 8 administrations of TPG followed by surgery of all resectable masses. Paraffin slides of all cases with residual viable cancer after TPG were retrieved: CD30 staining and somatic mutation analysis by Sequenom OncoCarta Panel v.1.0 were planned. Results: From 04/1999 to 07/2011, 74 pts have been treated with TPG, 64 in 3rd and 10 pts in 4th line. Median age was 32 (20–55), median number of prior CDDP cycles was 7 (4–10), 10 pts (13%) had already received HDCT, 4 pts had primary mediastinal GCT, 42 (57%) were CDDP-refractory/abs refractory, 25 pts (34%) had either liver, bone or brain metastases before TPG. 40% developed G3-4 hematologic and 2 pts G3 renal toxicity, none of them being dose-limiting. No treatment delays have been observed. Median number of administrations was 7 (1–10). 8 complete responses (CR), 28 partial responses with normal markers (PRm-) and 13 incomplete response/stable disease have been recorded, for a major response rate (CR+PRm-) of 49%. 34 pts (46%) underwent post-CT surgery which was radical in 15 cases (44%) and led to 7 pathologic CR. 3-, 6- and 12-month PFS was 68% (95% CI 55–76%), 31% (21–42) and 20% (12–30), respectively. 1-yr PFS after HDCT only was 24% (4–53). 12- and 24-month OS was 46% (34–57) and 26% (16–37), respectively. Median PFS and OS were 5 (1–104) and 12 mos (1–116). Conclusions: TPG combination rates first among salvage therapies for refractory GCT, even after failure of HDCT. Benchmark survival endpoints for trials on new agents/combinations have been set. Results of the biomarker analysis will be available in Feb 2012 and may help to corroborate a window of opportunity for targeted agents in GCT.

Attenuation of Spermatogonial Stem Cell Activity in Cryptorchid Testes

To elucidate the mechanism of infertility caused by cryptorchidism we focused on early stage spermatogenesis and spermatogonial stem cell activity in undifferentiated spermatogonia in cryptorchid testes. Histological findings and expression patterns of the stem cell marker undifferentiated embryonic cell transcription factor 1 were examined in a unilateral cryptorchid rat model. We removed unilateral descended testis and contralateral descended testis from cryptorchid and normal rats (control), respectively, 18 days postcoitum to 144 days postpartum. In descended testes gonocyte differentiation into early A spermatogonia occurred at 9 days postpartum. However, this transformation was altered in undescended testes. Furthermore, the undifferentiated embryonic cell transcription factor 1 negative early A spermatogonia-to-positive early A spermatogonia ratio was significantly higher in the undescended testis group (mean ± SD 0.69 ± 0.04) than in the control (0.46 ± 0.10, p = 0.037) and descended testis (0.44 ± 0.05, p = 0.022) groups, indicating decreased early A spermatogonia with spermatogonial stem cell activity in cryptorchid testes. In cryptorchid testes the differentiation from gonocytes into early A spermatogonia and the stem cell activity of early A spermatogonia were altered during the early stage of spermatogenesis, suggesting that the loss of spermatogonial stem cell activity in cryptorchid rats resulted in altered spermatogenesis, thus interfering with fertility.

Surgical outcomes in patients with primary mediastinal non-seminomatous germ cell tumours and elevated post-chemotherapy serum tumour markers

Platinum-based chemotherapy followed by surgical resection of residual masses has become the standard treatment of patients with primary mediastinal non-seminomatous germ cell tumours (NSGCTs). Persistent serum tumour marker (STM) elevation after chemotherapy usually indicates a poor prognosis. We retrospectively assessed surgical outcomes in patients with high STM levels after chemotherapy for primary mediastinal NSGCT. Between 1983 and 2010, residual tumour excision was performed in 21 patients, 20 men and one woman with a median age of 30 years (range: 19-49 years), with primary mediastinal NSGCTs and high STM levels after platinum-based chemotherapy, followed by second-line chemotherapy in 11 patients. Alpha-fetoprotein was elevated in all 21 patients and β-human chorionic gonadotropin in three patients. Permanent histology demonstrated viable germ cell tumour (n=13), teratoma (n=3) or necrosis (n=5). After surgery, the STM levels returned to normal in 11 patients. Eight patients are alive with a median follow-up of 98 months. The 5-year survival rate was 36% and was not significantly affected by the use of preoperative second-line chemotherapy. At univariate analysis, only postoperative STM elevation and residual viable tumour, indicating incomplete resection, were significantly associated with lower survival (P=0.018 and P=0.04, respectively). In patients with primary mediastinal NSGCTs and elevated post-chemotherapy STMs, surgery is warranted when complete resection is deemed feasible. In specialized oncology centres, this aggressive approach can provide a cure in some patients.

Mixed germ cell tumor with extensive yolk sac tumor elements in the frontal lobe of an adult.

Intracranial nongerminomatous germ cell tumors (NGGCTs) in unusual locations are extremely rare. Here, we report a case of a yolk sac tumor in the frontal lobe in a middle-aged patient. A 42-year-old man was admitted to our hospital for headache and nausea. Magnetic resonance imaging (MRI) showed an enhanced mass lesion with a marked cyst component. The serum alpha-fetoprotein (αFP) level was extremely high. Histological examination of specimens after subtotal removal revealed a primary mixed germ cell tumor with extensive yolk sac tumor elements, often referred to as an intracranial “yolk sac tumor.” The preoperative diagnosis of NGGCTs in unusual age and locations is extremely difficult. Clinicians should consider the possibility of NGGCTs, including yolk sac tumors, when intracranial tumors with unusual MRI findings are encountered.

Primary Embryonal Lung Carcinoma and Testicular Seminoma in the Same Patient Ten-Years Later: Case-Report and Literature Review

Primary germ cell tumors of lung are extremely rare. The prognosis is usually poor, with various symptoms seriously affecting quality of life. In this paper we describe the unique case of a patient affected by an embryonal carcinoma of lung and a testicular seminoma after ten years. We also report literature about pulmonary extragonadal germ cell tumors.

Extragonadal Tumor and Testicular Microlithiasis: “Burned-out” Tumors Are Represented by Macrocalcification

To the Editor: The recent case report 1 and subsequent correspondence 2,3 raise some important issues surrounding the presence of testicular microlithiasis and nontesticular microlithiasis (macrocalcification) in both the pediatric and adult testis. We note the opinion of Harris 2 with regard to the occurrence of macrocalcification as more likely to represent the presence of a “burned-out” tumor rather than the presence of microlithiasis as advocated by Meyer and Gilbertson-Dahdal. 1,3 It seems to us unlikely that testicular microlithiasis is representative of a burned-out tumor as advocated by Meyer and Gilbertson-Dahdal. 1 Unfortunately the description and depiction of intratesticular calcification in many of the older articles they cite would not stand up to modern-day scrutiny; vague sonographic methods and assessment are only too evident (eg, Figure 4 in the article by Grantham et al 4 depicts areas of macrocalcification described as bright echogenic foci), likely a manifestation of the less sophisticated transducers of that period. The histologic characteristics of testicular microlithiasis are very different from those of the necrosis, macrocalcification, and possible tumor cell remnants associated with a burned-out tumor 5 ; testicular microlithiasis clearly shows calcified intratubular bodies on histologic specimens. 6 The sonographic features of testicular microlithiasis as classically described are unique to this entity and are not mimicked by other forms of intratesticular calcification. However, the underlying association of testicular microlithiasis as well as burned-out tumors (manifested by macrocalcification) with intratubular germ cell neoplasia, a precursor of a germ cell tumor, indicates an increased risk of tumor development in both testicular microlithiasis and macrocalcification groups. Hence, testicular microlithiasis is associated with intratubular germ cell neoplasia and with that association an increased risk of developing a tumor. Thus, an area of macrocalcification may represent a burned-out tumor, but the remainder of the testis remains at risk if intratubular germ cell neoplasia is present, and it usually is present. We believe that the finding of testicular microlithiasis in the case of Meyer and Gilbertson-Dahdal 1 is more likely to indicate the simultaneous presence of intratubular germ cell neoplasia and not areas of a burned-out tumor. The finding of testicular microlithiasis is incidental and is a marker of the risk associated with intratubular germ cell neoplasia, with no manifestation in the testis of a focal tumor or macrocalcification to indicate the origin in the testis of the retroperitoneal germ cell tumor: a truly “silent” testis for the presence of the source of the retroperitoneal germ cell tumor. Harris was unable to identify any studies that address the prevalence of macrocalcification. We have addressed the prevalence of all types of calcification on scrotal sonography and related it to the presence of primary testicular tumors in 3447 patients, 7 having earlier described in detail the types of scrotal calcification that may be encountered. 8 Any intratesticular calcification not typical of the description of microlithiasis was termed “nontesticular microlithiasis calcification (macrocalcification),” and this is the type of calcification that may be shown when a burnedout tumor is diagnosed in the presence of an extragonadal germ cell tumor, as indicated by the experience of Harris. 2 The prevalence of testicular microlithiasis in our study population was 2.0% (95% confidence interval [CI], 1.6%– 2.6%), and that of nontesticular microlithiasis calcification was 1.7% (95% CI, 1.3%–2.3%). The association with a metachronous primary germ cell tumor was significant in both types of intratesticular calcification. 7 A small subset of pediatric patients (n = 198) was also analyzed, with the prevalence of testicular microlithiasis recorded as 2.0% (95% CI, 0.6%–5.1%) and that of nontesticular microlithiasis recorded as 0.5% (95% CI, 0.0%–2.8%). Our figures, although not significant in the pediatric group with the small cohort analyzed, warrant further evaluation. A possible scenario would advocate that testicular microlithiasis is present in the pediatric population at the same level as that seen in the adult population, but nontesticular microlithiasis increases in the adult patient. This scenario would support the theory that nontesticular microlithiasis is a manifestation of a burned-out tumor that puts the patient at risk of developing a further germ cell tumor of the testis or is responsible for an existing extra gonadal germ cell tumor. There are scarce data to support this theory; it is time we looked more closely at the prevalence of testicular calcification in the pediatric population. We would agree with Harris 2 that a burned-out tumor is represented by nontesticular microlithiasis macrocalcification, and testicular microlithiasis has associations with germ cell tumors and extragonadal tumors. However, areas of testicular microlithiasis, as classically described on sonography, do not represent tumor involution.

Treatment strategies and prognostic factors of patients with primary germ cell tumors in the mediastinum.

ObjectiveThe aim of this study was to evaluate the clinical characteristics and survival outcomes of patients with primary mediastinal germ cell tumor (PMGCT) by identifying the prognostic factors and efficacies of different treatment modalities.MethodsFifty-five patients with PMGCT who were treated consecutively at Cancer Center, Sun Yat-sen University, Guangzhou, from 1988 to 2010 were evaluated retrospectively.ResultsFifty-two men and 3 women with a median age of 25 years were identified, of whom 17 (30.9%) had pure seminomatous, 38 (69.1%) had nonseminomatous histology, 27 (49.1%) had tumor located at mediastinum, 20 (36.4%) had lung metastases and/or effusions, and 8 (14.5%) had distant metastases. Three treatments surgery, chemotherapy, and radiotherapy were performed in 11 (20%) patients, two treatments chemotherapy plus surgery or radiotherapy were performed in 25 (45.6%), and single treatment surgery or chemotherapy was performed in 17 (30.9%). The other two patients (3.6%) received no treatment. After a median follow-up time of 31.4 months, the 5-year survival rate was 52%. The median overall survival time was 87.9 months. Patients who received two treatments had the longest survival time of 118.3 months, P = 0.000. Those who had pure seminoma histology, whose tumor confined to the mediastinum and who achieved complete or partial remission at initial evaluation, who had complete resection and radiotherapy were considered to have better prognosis according to univariate analysis. On multivariate analysis, extension and response rate at initial evaluation were independently predictive of survival.ConclusionsPrimary mediastinal germ cell tumor is rare with a dominant frequency in young male patients. Chemotherapy combined with local therapy like surgery or radiotherapy is a reasonable treatment strategy recommended. Extension and initial remission rate are independent prognostic factors.

Resection of Primary Mediastinal Non-Seminomatous Germ Cell Tumors: A 28-Year Experience at Memorial Sloan-Kettering Cancer Center

Surgical resection of residual tumor mass in responders to platinum-based chemotherapy has evolved as the preferred treatment of primary mediastinal nonseminomatous germ cell tumors (PMNGCTs). We reviewed a single institution's operative experience with these rare tumors. We reviewed charts of patients resected for PMNGCT at Memorial Sloan-Kettering Cancer Center between July 1980 and April 2008. Analyses included Kaplan-Meier survival with univariate log-rank comparisons and Cox multivariate regression. Fifty-seven patients were identified and followed up for a median of 5.3 years. Fifty-four of them received platinum-based preoperative chemotherapy, and 28 (49%) had limited stage I/II disease. Preoperative tumor markers normalized or decreased in 79% of patients. The most common surgical approach was anterolateral thoracotomy with partial sternotomy ("hemiclamshell," 38.6%). An R0 resection was achieved in 91% of the patients with a major morbidity of 17.5% and no postoperative deaths. The median overall survival was 31.5 months. Factors correlating with better survival on univariate analyses were necrosis or teratoma versus residual cancer on final pathology (p = 0.001), R0 resection (p = 0.03), normalized or decreased postchemotherapy/preoperative tumor markers (p < 0.001), normalized postoperative tumor markers (p = 0.004), stage I/II disease (p = 0.03), and surgery after 2000 versus 1980-1999 (p = 0.01). An exploratory multivariate analysis suggests that normalized or decreased postchemotherapy/preoperative tumor markers is the strongest independent predictor of improved survival. In a cohort of PMNGCT patients in which 91% of the patients underwent complete posttherapy resection, response to chemotherapy, measured by normalized or decreased preoperative tumor markers, was the strongest predictor of improved survival.

The First Case of Primary Testicular Germ Cell Tumor Containing Nephroblastoma as the Only One Non-germ Cell Component

Adult extrarenal nephroblastomas (Wilms' tumor) are extremely rare tumors. They show a higher incidence of non-seminomatous elements and these so-called 'teratoid' Wilms' tumors are suggested to be of germ cell origin. To date, however, the number of reported cases with gonadal teratoma containing nephroblastoma is very low, and due to this reason, there are no standardized criteria for the categorization and treatment of these lesions. To our knowledge, the first case of nephroblastoma arising in a non-atrophic testis has been reported and it is associated with a teratoma as morphologically identifiable germ cell tumor and rhabdomyosarcoma as a second non-germ cell element. We report the second case of an adult nephroblastoma that arose within the primary testicular teratoma in a non-atrophic testis. Teratoma and nephroblastoma within the same testis may have an important point to clarify the developmental mechanism in nephroblastomatous differentiation of germ cell tumors.

MAGEC2 is a sensitive and novel marker for seminoma: a tissue microarray analysis of 325 testicular germ cell tumors

Melanoma-associated gene C2 (MAGEC2) is a recently identified cancer testis antigen expressed in normal testicular and placental tissue. It has been detected in some human carcinomas, but its expression in primary testicular germ cell tumors is unknown. Immunohistochemistry was used to study MAGEC2 protein in 325 primary testicular germ cell tumors, including 94 mixed germ cell tumors. Seminomatous and non-seminomatous components were separately arranged and evaluated on tissue microarrays. MAGEC2 expression was compared with POU5F1 (OCT3/4), SOX2, SOX17, KIT and TNFRSF8 (CD30). The mouse monoclonal anti-MAGEC2 antibody (clone LX-CT10.5) revealed a nuclear MAGEC2 expression with little or no background staining. MAGEC2 expression was found in 238 of 254 seminomas (94%), but not in embryonal carcinomas (n=89). POU5F1 (OCT3/4) was positive in 97% of seminomas and all embryonal carcinomas. In contrast, KIT was positive in 94% of seminoma but also in 8% of embryonal carcinomas. TNFRSF8 (CD30) and SOX2 were negative in seminoma and positive in embryonal carcinoma (96 and 90%, respectively). SOX17 was positive in 94% of seminoma and negative in embryonal carcinoma. We conclude that MAGEC2 allows a reliable distinction of seminoma from embryonal carcinomas. Therefore, MAGEC2 represents an additional tool for the differential diagnosis of testicular germ cell tumors.

Salvage therapy with high-dose chemotherapy (HDCT) and peripheral blood stem cell transplant (PBSCT) in patients with primary mediastinal nonseminomatous germ cell tumors (PMNSGCT).

e15119 Background: Salvage therapy with high dose chemotherapy (HDCT) and bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT) has curative potential in patients with recurrent germ cell tumor. Patients with primary mediastinal non-seminomatous germ cell tumors (PMNSGCT) have had poor results with any form of salvage chemotherapy including HDCT. From 1986 to 1996, we included 13 patients with PMNSGCT in our series treated with HDCT and BMT. All died from progressive cancer. Methods: We switched from BMT to PBSCT in 1996, allowing more rapid engraftment and earlier initiation of the second course of HDCT with tandem transplant. 116 of 184 (63%) patients with recurrent or refractory germ cell tumors treated from 1996 to 2004 were alive and continuously disease free (NEJM 357:340-348, 2007). PMNSGCT patients were excluded. In 2006, we resumed treating patients with recurrent PMNSGCT with salvage HDCT with PBSCT. Carboplatin 700mg/m2 x 3 plus etoposide 750mgs/m2 x3 were given with second course 3-4 weeks later. Results: 12 patients were treated, 11 as initial salvage chemotherapy and one as 4th line therapy. Eight patients had major thoracic resections prior to HDCT. 3 of the 12 achieved complete remission (52, 12 and 12 weeks duration) but all have relapsed. 10 of the 12 have died; one is lost to follow-up at 44 weeks, and one patient is currently disease free at 176 weeks from HDCT, treated with subsequent salvage surgery. However, he developed secondary acute myeloid leukemia and underwent allogeneic BMT. Median survival for the 12 patients was 41 weeks (range 14-176). Conclusions: In our experience with tandem transplant, recurrent PMNSGCT continues to have a low probability for cure.

Phase II clinical trial of oxaliplatin and bevacizumab in refractory metastatic germ cell tumors (GCT).

4579 Background: Salvage chemotherapy with Ifosfamide based regimen or high dose chemotherapy (HDCT) has curative potential in GCTs. We still need novel therapies for patients where cure is not possible. Oxaliplatin has single agent activity in refractory GCTs. Bevacizumab in combination with chemotherapy has activity in many solid tumors but has not been studied in GCTs. This is the first study of bevacizumab in refractory GCT patients. Methods: Patients with serologically or histologically proven metastatic GCT who have failed cisplatin based combination chemotherapy and progressed on salvage therapy were eligible. Prior HDCT and paclitaxel plus gemcitabine were required unless late relapse or primary mediastinal non-seminomatous GCT (NSGCT). Oxaliplatin was given 85 mg/m2 and bevacizumab 10 mg/kg every 2 weeks with a maximum of 14 cycles. Results: 25 total patients have been enrolled with 24 evaluable and 1 too early to evaluate. 9 were late relapses and 5 with primary mediastinal NSGCT. Median number of previous chemotherapies was 4 including 13 with prior HDCT. Median number of cycles administered was 5. There were 7 (29%) objective responders. Median duration of response was 6 months (range 4 to 22 months). Of these 7 patients 3 had normalization of HCG and/or AFP. One additional patient had serologic response (>1 log reduction in HCG) for 5 months with stable radiographic lesions. Median survival was 8 months (range 2 to 40 months). Four patients had Grade 3 adverse events (peripheral neuropathy, hypertension, seizures and DVT). Conclusions: Oxaliplatin plus bevacizumab has promising activity in heavily pretreated GCTs with manageable toxicity.

Protocol for the Examination of Specimens From Pediatric and Adult Patients With Extragonadal Germ Cell Tumors

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations. The College regards the reporting elements in the ‘‘Surgical Pathology Cancer Case Summary (Checklist)’’ portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice. The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the checklist elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of these documents.

A primary intrasellar mixed germ cell tumor with suprasellar extension

A primary intrasellar mixed germ cell tumor with suprasellar extension

Metastatic adenocarcinoma in a young male, 12 years after treatment of primary non seminomatous germ cell tumor

A man aged 32 years presented with metastatic adenocarcinomatous deposits, 12 years after his initial diagnosis and treatment of immature teratoma of the testis. He was treated for his metastasis with local radiotherapy, failing which he underwent excision of the tumor and palliative chemotherapy. This case is presented for its rarity of occurrence, unique presenting features and difficulty in management.

Mixed germ cell tumor and hemangioblastoma in the cerebellum: report of a rare coexistence

We report a case of a cerebellar tumor consisting of a mixed germ cell tumor (GCT) and a hemangioblastoma. A 22-year-old man presented with myoclonus and cerebellar ataxia. Magnetic resonance imaging showed a tumor mass in the left cerebellar hemisphere. The tumor was totally removed, and the histological diagnosis was an undetermined neoplasm. Ten months later, the patient returned with cerebellar hemorrhage at the site of the previous tumor. An emergency craniotomy was performed, and a tumor mass adjacent to the hematoma was resected. Microscopic examination revealed a mixed GCT consisting of a germinoma, choriocarcinoma, and mature teratomatous component. An area of hemangioblastoma was also found in the same tumor mass. A retrospective examination of the histological sample from the first operation indicated a germinoma. A primary GCT of the posterior fossa is very rare, and there are no other reports of the coexistence of a GCT and a hemangioblastoma. A metastatic GCT lesion of extracranial origin should be considered when the intracranial GCT is non-germinomatous and arises in an unusual site. The most probable hypothesis for the histogenesis of this case was a hemangioblastoma complicated by a "tumor-to-tumor" metastatic lesion of testicular GCT with "burnout" of the primary site.

587 BILATERAL TESTIS GERM CELL TUMORS: OBSERVATIONS FROM THE SEER DATABASE

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease1 Apr 2011587 BILATERAL TESTIS GERM CELL TUMORS: OBSERVATIONS FROM THE SEER DATABASE A. Ari Hakimi, Steve K. Williams, Reza Ghavamian, and Farhang Rabbani A. Ari HakimiA. Ari Hakimi Bronx, NY More articles by this author , Steve K. WilliamsSteve K. Williams Bronx, NY More articles by this author , Reza GhavamianReza Ghavamian Bronx, NY More articles by this author , and Farhang RabbaniFarhang Rabbani Bronx, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1419AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bilateral testis tumors are rare. We sought to use the population-based Surveillance, Epidemiology, and End Results (SEER) database to evaluate if there are differences between unilateral and bilateral tumors. METHODS From 1973–2006, 30330 men were identified in the SEER database as having a primary germ cell tumor of the testis, of which 29890 were unilateral, 163 bilateral synchronous and 277 bilateral metachronous. Median patient age was 33. Patient demographics and tumor characteristics were compared using the chi-squared test. RESULTS Patients with metachronous bilateral tumors were younger at the time of diagnosis of the first tumor (median age 28) vs. those with unilateral or bilateral synchronous tumors (median age 33 for each group). There was no statistically significant difference in laterality, histology, T stage, N stage, or incidence of AFP or LDH elevation at presentation. Patients with unilateral tumors had a higher incidence of metastases at presentation: 2897/26778 (10.8%) for unilateral, 11/229 (4.8%) for metachronous and 9/141 (6.4%) for synchronous tumors (p=0.0034). Patients with metachronous tumors had a higher incidence of BHCG elevation at diagnosis: 14/21 (67%) for metachronous, 3520/8523 (41%) for unilateral and 16/47 (34%) for synchronous tumors (p=0.037). The distribution of histology was similar in the three groups of patients with unilateral, synchronous and metachronous tumors: the histology was seminoma was in 17382, 94 and 163 cases, respectively; embryonal carcinoma/yolk sac tumor in 4271, 30 and 42 cases, respectively, teratoma/teratocarcinoma/mixed GCT in 7194, 35 and 66 cases, respectively; and choriocarcinoma in 1043, 4 and 6 cases, respectively (p=0.62). The correlation between the histology of the first and second tumor for those with metachronous tumors is shown in the table (p=0.030). Histology of Primary and Secondary Tumors Histology of Primary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Histology of Secondary Tumor Choriocarcinoma Embryonal/Yolk Sac Tumor Seminoma Teratoma/Teratocarcinoma/Mixed Total Choriocarcinoma 1 0 5 0 6 Embryonal/Yolk Sac Tumor 1 7 23 11 42 Seminoma 2 14 119 28 163 Teratoma/Teratocarcinoma/Mixed 5 10 38 13 66 Total 9 31 185 52 277 CONCLUSIONS Patients with metachronous tumors present at a younger age with a higher incidence of BHCG elevation. The lower incidence of metastases in these patients may be due to selection bias as these patients live to develop a second primary tumor. There is weak correlation between the histology of the first and second tumors in those with metachronous tumors. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e236-e237 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information A. Ari Hakimi Bronx, NY More articles by this author Steve K. Williams Bronx, NY More articles by this author Reza Ghavamian Bronx, NY More articles by this author Farhang Rabbani Bronx, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

CT findings of primary non-teratomatous germ cell tumors of the mediastinum—A report of 15 cases

To analyze computed tomography (CT) features of primary non-teratomatous germ cell tumors of the mediastinum and to improve the diagnostic efficacy of CT for such tumor. Fifteen patients with primary non-teratomatous germ cell tumors of the mediastinum, proven pathologically, were enrolled. All patients underwent non-enhanced and contrast-enhanced CT examinations. The CT features, including location, size, shape, edge, CT attenuation, involvement of adjacent structure and local or distant metastasis of each lesion were retrospectively analyzed. Each case showed single mass, a total of 15 masses. 11 masses arose within the left anterosuperior mediastinum and 4 masses arose within the right anterosuperior mediastinum. 10 masses appeared lobulated and ill-circumscribed, and 5 masses appeared rounded or oval and well-circumscribed. The maximal diameter of all the masses ranged from 5 cm to 16 cm (mean, 11 cm). 12 masses revealed heterogeneous attenuation on non-enhanced CT images with patchy low-attenuation foci and stippled calcification, and showed moderately heterogeneous enhancement after contrast administration. 3 masses of the patients with seminoma revealed homogeneous attenuation on non-enhanced CT images and showed lightly homogeneous enhancement after contrast administration. Pericardial effusion, pleural effusion and involvement of adjacent vascular structures were observed in 6, 5 and 10 cases, respectively. Pulmonary metastasis were observed in 3 cases. The characteristic CT findings of primary non-teratomatous germ cell tumors of the mediastinum include bulky, ill-circumscribed, lobulated masses, heterogeneous attenuation with low-attenuation foci and calcification on non-enhanced CT images and heterogeneous enhancement after contrast administration. Seminomas may show homogeneous attenuation and homogeneous enhancement after contrast administration. The tumor is apt to involve pericardium, pleura and adjacent vascular structure and develop distant metastasis. Primary non-teratomatous germ cell tumors should be considered when anterosuperior mediastinal masses are detected with these findings, especially in young males.

Primary retroperitoneal dysgerminoma presenting as an adrenal tumor: A case report and literature review

Primary extragonadal germ cell tumors are rare and mostly occur in young men with predominance of nonseminomatous histology. We report an undescribed case of primary retroperitoneal dysgerminoma presenting as an adrenal tumor in a 17-year-old girl. Surgery was performed on a 10 × 9.5 cm sized adrenal gland tumor and the resected tumor showed unequivocal histological features of dysgerminoma. The diagnosis was confirmed by the tumor's germ cell immunophenotype. Postoperative ultrasonography, CT and PET over a 6-month period revealed no evidence of ovarian lesion. The patient is stable, but with a suspicious residual tumor after adjuvant chemotherapy.