You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disaese (I)1 Apr 2013711 MANAGEMENT OF MALIGNANT TRANSFORMATION DIAGNOSED EARLY IN THE TREATMENT OF GERM CELL TUMORS Kevin Rice, Stephen Beck, Martin Magers, Lawrence Einhorn, Thomas Ulbright, and Richard Foster Kevin RiceKevin Rice Indianapolis, IN More articles by this author , Stephen BeckStephen Beck Indianapolis, IN More articles by this author , Martin MagersMartin Magers Indianapolis, IN More articles by this author , Lawrence EinhornLawrence Einhorn Indianapolis, IN More articles by this author , Thomas UlbrightThomas Ulbright Indianapolis, IN More articles by this author , and Richard FosterRichard Foster Indianapolis, IN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.269AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Malignant transformation (MT) of germ cell tumors (GCT) is a rare and poorly understood phenomenon. The goal of this study was to examine outcomes in patients found to have MT early in management. METHODS We queried the Indiana University (IU) Testis Cancer database for all patients who presented with non-germ cell histology at orchiectomy, biopsy of metastatic site, or primary retroperitoneal lymph node dissection (RPLND). Chart review and survival analysis were performed. Patients with MT to primitive neuroectodermal tumor (PNET) only were excluded since PNET is managed differently. RESULTS 43 patients met inclusion criteria for this study. MT was discovered at orchiectomy in 30. Clinical stage (CS) was I, II, and III, in 13, 9, and 8 patients, respectively. Of these 30, 12 patients underwent primary RPLND of whom 1 had MT in the retroperitoneum. After induction chemotherapy 18 patients (including 3 that relapsed on surveillance) underwent postchemotherapy (PC) RPLND. In addition, 6 patients were found to have MT at biopsy of a metastatic site; all received chemotherapy and underwent PC RPLND. Another 7 patients were serendipitously found to have MT in the retroperitoneum at primary RPLND. Pathology for all 43 patients is seen in table 1. The most common transformed histology was sarcoma, being present alone in 20 patients and in combination with other MT histologies in 3. Overall, 19 patients underwent primary RPLND with MT in the retroperitoneum revealed in 8. The 2-year CSS for these 8 was 100%. The 2-year CSS for the 13 patients with MT in the retroperitoneum at PC RPLND was 74%. For the entire cohort of 43 patients at a median follow-up of 71 months, the 2- and 5-year cancer specific survival rates were 85% and 77%, respectively. The only statistically significant predictor of poorer CSS was number of resections (p = 0.016). CONCLUSIONS Low volume non-PNET MT is curable with surgery. MT found at PC PRLND has a lower cure rate. Hence, patients with MT found at orchiectomy with clinical stage I or low volume stage II should undergo primary RPLND. Table 1. Retroperitoneal Pathology in Patients with Malignant Transformation of Germ Cell Tumors Diagnosis and Management Retroperitoneal Pathology MT GCT Teratoma Benign/Necrosis At Orchiectomy RPLND (n = 12) 1 3 0 8 PC RPLND (n = 18) 8 0 7 3 Extragonadal Biopsy PC RPLND (n=6) 5 0 1 0 RPLND (n = 7) 7 0 0 0 Total 21 3 8 11 © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e292 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Rice Indianapolis, IN More articles by this author Stephen Beck Indianapolis, IN More articles by this author Martin Magers Indianapolis, IN More articles by this author Lawrence Einhorn Indianapolis, IN More articles by this author Thomas Ulbright Indianapolis, IN More articles by this author Richard Foster Indianapolis, IN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...