Recurrence Of Germ Cell Tumor Research Articles

Surgery in Chinese children affected by 45,X/46,XY disorders of sex development: A 20-year experience in a single center

Background: Children affected by 45,X/46,XY mosaicism have a wide spectrum in their phenotypes. Although surgery has a role in management, there is no universally agreed strategy.Methods: We conducted a retrospective review in a tertiary center on the surgical management and its long-term outcomes in children with the karyotype 45,X/46,XY or its variants over a 20-year study period. Patients were divided into 4 groups based on their phenotypes.Results: 22 children(female=13, male=9) were included in the study, and were grouped as I)female phenotype(n = 11), II)ambiguous external genitalia(n = 2), III)undervirilized male with hypospadias(n = 6), and IV)normal male phenotype(n = 3). 19/22(86%) underwent gonadal surgeries(bilateral gonadectomy=15; unilateral gonadectomy=1; testicular biopsy=3) and 8/22(36%) underwent genitalia reconstructive surgeries(hypospadias repair=6; feminizing surgery=2). Gonadal germ cell tumors were detected in 55%, 50% and 50% of Group I, II and III respectively. 3/6 patients required reoperations for complications after hypospadias repairs. None of the patients had recurrence of germ cell tumors after gonadectomy. All the patients who had reached late adolescence or adulthood maintained their genders as their sex of rearing.Conclusions: Majority of 45,X/46,XY children benefit from timely gonadal surgery while genitalia reconstructive surgery can be considered in selected patients. Surgical management can be strategized by patients’ phenotypes.

18F-FDG-PET/CT in a patient with suspected recurrence of germ cell tumor

At present, the available clinical practice guidelines for the management of patients with germ cell tumor (GCT) assign to Positron Emission Tomography (PET) scan a role in the evaluation of the residual mass at the end of the treatment of advanced seminoma, while a possible role of this tool in the strategy of follow-up has not been defined yet. We are presenting a case of a patient treated for a GCT with an increase of the marker levels during the follow-up where a PET/CT with 18F-FDG was the only noninvasive examination able to correctly identify the site of disease recurrence. This case shows how this tool could have a role, in addition to morphological examinations, in the management of patients with GCT during the follow-up.

UNDULANT COURSE OF AFP: A Sign of Tumor Activation or Not?

Objective: To assess the predictive value of undulant alpha fetoprotein (AFP) course in recurrence of germ cell tumors (GCT). Patients/method: A retrospective file search of 491 patients with GCT was performed and 18 patients who had an undulant course of AFP levels (increased and spontaneously decreased) without any demonstrable tumor on radiological images were selected for the study. Results: The median age of the 10 boys and 8 girls was 2 years (1.1–16 years). All the patients were disease-free for a median of 16.2 months (8.4–132 months). At follow-up, radiologically proven tumor recurrences were diagnosed in 8 patients in median 12.2 ± 3.2 months from the initial diagnosis (8.4–18.2 months) and 7.4 ± 2.2 months from the last normal level of AFP (5.0–11.2 months). The mean peak AFP values within the first 90 days were 24 ± 38.1 ng/mL and 11.1 ± 10.9 ng/mL in patients who did and did not have recurrent disease, respectively (p =. 0051). The patients whose AFP levels were higher than 10 ng/mL were likely to have recurrent disease (p =. 02). Conclusion: Without a demonstrable tumor, the small amplitude undulations may only require careful follow-up. However, it should be kept in mind that despite the decrease in AFP levels, there still might be a risk of recurrence, especially in patients who have greater amplitude undulations.

Recommendations of follow-up after treatment of germ cell tumors

Patients diagnosed with germ cell tumors (GCT) are relatively young, and most are rendered disease-free by primary treatment. Also, second-line therapies in nearly all instances are potentially curative. Therefore, the schedule and modalities of follow-up testing are important issues in detecting recurrence of GCT and for detecting secondary malignancies and complications of therapy. Follow-up is usually based on the pattern and probability of recurrence following primary therapy according to stage and histology. The National Comprehensive Cancer Network has outlined guidelines (www.nccn.org/physician_gls/index.html). There is a paucity of randomized data regarding the follow-up regimens most effective in identifying relapsed disease. Optimal means of imaging and frequency of physician visits and serum marker level measurements need to be further addressed.

Recurrence of germ cell tumor after orchiectomy

Objectives. To assess the characteristics of patients with recurrent disease by a retrospective analysis. Methods. Between 1982 and 1998, 488 patients were treated in Nijmegen for testicular cancer. All patients underwent orchiectomy and adjuvant treatment when indicated. Patients were routinely followed up. Results. In 36 patients (7.4%), disease recurrence was found during follow-up; 12 had contralateral disease and 24 systemic recurrence. Contralateral testicular cancer occurred a median of 63.8 months (range 43.2 to 165.2) after orchiectomy and systemic recurrence at a median of 6.1 months (range 1.5 to 94.4). Contralateral testicular cancer was more frequent in patients with pure seminoma (odds ratio 4.3, 95% confidence interval 1.4 to 13.1); 8 of 9 patients with contralateral cancer received adjuvant radiotherapy. The best predictor of systemic recurrence after nonseminoma germ cell tumor was the presence of teratoma and embryonal cell components in the primary tumor. In the entire population, 19 patients (3.9%) died of the disease. None of the patients with contralateral testicular recurrence or systemic recurrence after Stage I seminoma died of the disease. One of 10 patients died of recurrent Stage I nonseminoma germ cell tumor. The chance of dying of recurrence after metastatic nonseminoma germ cell tumor was 36%. Conclusions. Recurrence after an initially complete response is rare in testicular cancer. Contralateral testicular cancer is associated with the presence of seminoma components in the primary tumor and occurs almost 10 times later than systemic recurrence. The prognosis after contralateral testicular cancer and after recurrence in Stage I seminoma is good.

Primary mediastinal nonseminomatous germ cell tumors. A modern single institution experience

Between 1976 and 1988, 31 patients with mediastinal nonseminomatous germ cell tumors (MNGCT) received initial cisplatin-based chemotherapy of uniform intensity. Eighteen of these patients (58%) obtained disease-free status; 11 with chemotherapy alone and seven with adjunctive surgery. Eleven have remained continuously free of disease. Two have had recurrence of teratoma and are disease-free after resection of teratoma at 12+ and 68+ months. Three patients developed recurrence of germ cell tumor. Three patients developed a hematologic malignancy. Of the 18 patients who obtained disease-free status, 15 remain alive and disease-free. Overall, 13 of the 31 patients and 24 other patients received salvage chemotherapy at Indiana University, Indianapolis, Indiana. Of these 37 patients, six obtained a disease-free status and four (11%) remain alive at 13+, 56+, 78+, and 122+ months, respectively. This series represents the largest series of patients with MNGCT ever reported. Analysis of these data and results from other recent series suggest that approximately 50% of patients with MNGCT will be cured with modern, intense cisplatin-based chemotherapy coupled with adjunctive surgery if needed.