RESUMEN
Germ cell tumors are the most frequent neoplasia in young males. The aims of this study is to describe a case in which a postpuberal teratoma suffers a transformation to choriocarcinoma and metastasize to stomach. We have made a systematic review in PubMed and consensus documents to study this mismatch between the tumour, metastasis and the exception of gastric metastatic affectation. We describe three options to explain this discordance: a mixed germ cells tumour, a burned out tumour or a germ cells tumour derived from a malignant germ cell tumour precursor or different clonal strains. After made a thorough investigation we conclude that the most truly option is the last one as we extensive explain below. Once the gastric metastatic lesions are extremely rare and reach to <5%, but there are not conclusive assessments.
Asunto(s)
Coriocarcinoma , Neoplasias de Células Germinales y Embrionarias , Teratoma , Coriocarcinoma/patología , Femenino , Humanos , Masculino , Embarazo , Estómago/patología , Teratoma/patología , Teratoma/secundarioAsunto(s)
Neoplasias de Células Germinales y Embrionarias , Neoplasias Primarias Secundarias , Teratoma , Fluorodesoxiglucosa F18 , Humanos , Masculino , Neoplasias de Células Germinales y Embrionarias/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Teratoma/diagnóstico por imagen , Teratoma/patología , Teratoma/secundario , Neoplasias TesticularesRESUMEN
OBJECTIVE/HYPOTHESIS: Testicular cancer is the most common malignancy of young males. Limited reports describe perioperative and long-term outcomes after surgical resection of metastatic, cervical, non-seminomatous germ cell tumors (NSGCT). The objective of this study was to investigate the effectiveness and safety of cervical lymphadenectomy in the management of metastatic NSGCT. STUDY DESIGN: Retrospective case series. METHODS: A single institution, retrospective review from 1998 to 2020 of patients with metastatic NSGCT who underwent cervical lymphadenectomy was conducted. Clinicopathological, surgical, and postoperative data were collected and analyzed. RESULTS: Sixty-eight predominantly white (91.0%) male patients with mean age 33.0 ± 11.3 years were included. Most (82.2%) presented with stage III disease at initial diagnosis. All patients had undergone primary platinum-based chemotherapy 1.0 to 22.7 months prior to selective ND. Surgery mainly involved nodal levels III (67.6%), IV (92.6%) and/or Vb (77.9%) and was frequently performed with concomitant thoracoabdominal NSGCT resections (63.2%). Cervical specimens predominantly revealed mature teratoma (83.8%) as solitary (69.1%) or component of mixed (14.7%) NSGCT. Ten (14.7%) perioperative complications occurred as vocal cord paresis (n = 6) from thoracic surgery and chyle leakage (n = 4). All resolved conservatively except two vocal cord paralyzes that required surgical repair due to tumor involvement of vagus nerve. Six instances of cervical recurrence occurred at median 12.5 (range, 5.8-38.6) months from ND, all re-demonstrating purely mature teratoma. The two-year cervical, non-cervical, and overall recurrence-free survivals were 83%, 55%, and 55%, respectively. Two-year disease-free and overall survivals were both 93%. CONCLUSIONS: Selective neck dissection is a safe, effective method for managing cervical NSGCT metastases. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:1528-1534, 2021.
Asunto(s)
Metástasis Linfática/terapia , Disección del Cuello , Recurrencia Local de Neoplasia/epidemiología , Neoplasias de Células Germinales y Embrionarias/terapia , Teratoma/terapia , Neoplasias Testiculares/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Quimioterapia Adyuvante/métodos , Supervivencia sin Enfermedad , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Masculino , Terapia Neoadyuvante/métodos , Recurrencia Local de Neoplasia/prevención & control , Estadificación de Neoplasias , Neoplasias de Células Germinales y Embrionarias/mortalidad , Neoplasias de Células Germinales y Embrionarias/patología , Orquiectomía , Estudios Retrospectivos , Teratoma/mortalidad , Teratoma/secundario , Neoplasias Testiculares/mortalidad , Neoplasias Testiculares/patología , Testículo/patología , Testículo/cirugía , Adulto JovenRESUMEN
PURPOSE: To describe a rare presentation of a case of intraocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes. CASE DESCRIPTION: A 9-year-old male child with previous history of ciliary body non-teratoid medulloepithelioma presented with a swelling in the right pre-auricular region for 1 month. Magnetic resonance imaging and positron emission tomography-computed tomography showed a right intraparotid mass with enlarged ipsilateral cervical lymph nodes. A core biopsy was taken from the lesion, which on microscopy showed a tumor composed of small round cells arranged in cords, tubules lined by multilayered cells, and in cribriform pattern. These cells were embedded in a hypocellular, loose myxoid matrix. Based on the histopathological characteristics and previous history, a diagnosis of medulloepithelioma metastastic to ipsilateral parotid gland was made. The patient underwent right total conservative parotidectomy and bilateral neck dissection. Histopathological examination revealed metastatic medulloepithelioma in five out of eight intraparotid lymph nodes, with extranodal extension into the adjacent parotid parenchyma. Foci of hyaline cartilage were identified within the tumor, leading to a diagnosis of metastatic teratoid medulloepithelioma. CONCLUSION: Intraparotid lymph node metastases from intraocular medulloepithelioma is a rare possibility and we recommend that the parotid should be evaluated in cases of intraocular medulloepithelioma at initial presentation as well as during the follow-up period. Also, metastasis should be considered in all pediatric patients with solitary mass lesions showing unconventional histology for a primary parotid neoplasm.
Asunto(s)
Cuerpo Ciliar/patología , Metástasis Linfática , Tumores Neuroectodérmicos Primitivos/secundario , Neoplasias de la Parótida/secundario , Teratoma/secundario , Neoplasias de la Úvea/patología , Niño , Enucleación del Ojo , Humanos , Ganglios Linfáticos/patología , Imagen por Resonancia Magnética , Masculino , Cuello , Disección del Cuello , Tumores Neuroectodérmicos Primitivos/diagnóstico por imagen , Tumores Neuroectodérmicos Primitivos/cirugía , Neoplasias de la Parótida/diagnóstico por imagen , Neoplasias de la Parótida/cirugía , Tomografía Computarizada por Tomografía de Emisión de Positrones , Teratoma/diagnóstico por imagen , Teratoma/cirugía , Neoplasias de la Úvea/diagnóstico por imagen , Neoplasias de la Úvea/cirugíaRESUMEN
BACKGROUND: Metastatic atypical teratoid/rhabdoid tumors (AT/RTs) are aggressive central nervous system tumors that present during infancy and are associated with dismal outcomes. Patients receive multimodal treatment including surgical resection, systemic chemotherapy, and one or more of intrathecal chemotherapy (IT), marrow-ablative chemotherapy with autologous hematopoietic cell rescue (AuHCR) and radiation therapy (XRT). While data regarding treatment modalities for AT/RT patients exist, no comprehensive data have been published regarding the metastatic patients. METHODS: We performed a meta-analysis of 1578 articles published through September 2018, including 44 studies with a total of 123 subjects. In addition, seven patients were included through chart review of patients treated at Nationwide Children's Hospital. RESULTS: Analysis of 130 patients revealed a 3-year overall survival (OS) of 25%. Age at diagnosis had a significant effect on survival (P = 0.0355); 3-year OS for infants less than 18 months was 21%, 18 to 36 months was 26%, and greater than 36 months was 36%. Location of the primary tumor, metastatic stage, and extent of surgical resection did not have a significant impact on OS. On univariate analysis, XRT (P < 0.0001), IT (P = 0.01), and AuHCR (P < 0.0001) were found to significantly improve survival. The most substantial effect was noted in patients who received AuHCR (3-year OS of 60% vs 9% in those who did not). On multivariable analysis, XRT (P = 0.0006), IT (P = 0.0124), and AuHCR (P < 0.0001) were independently associated with reduced risk of death. CONCLUSIONS: Although more research is warranted to make generalizable conclusions, these results suggest that treatment regimens for patients with metastatic AT/RTs should include AuHCR, XRT, and IT.
Asunto(s)
Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/terapia , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Radioterapia/estadística & datos numéricos , Tumor Rabdoide/terapia , Teratoma/terapia , Neoplasias Encefálicas/mortalidad , Neoplasias Encefálicas/secundario , Preescolar , Terapia Combinada , Femenino , Humanos , Lactante , Masculino , Tumor Rabdoide/mortalidad , Tumor Rabdoide/secundario , Teratoma/mortalidad , Teratoma/secundarioRESUMEN
Atypical teratoid/rhabdoid tumors (AT/RT) are highly aggressive malignant primitive neoplasms that commonly occur in children younger than 2 years of age. The prognosis is generally dismal with a median survival time of <1 year. The majority of AT/RT occur in the posterior fossa and less frequently the supratentorium. Primary pediatric spinal AT/RT are exceedingly rare and only 15 cases have been reported to date. Here we report a very unusual case of primary spinal AT/RT extensively involving the spinal cord from T11 down to the cauda equina. In this patient, the tumor was highly aggressive and resulted in extensive dissemination into the nerve roots and paraspinal soft tissue rapidly resulting in the patient's death 1 month after diagnosis. to the best of our knowledge, this degree of involvement of the spine by a primary AT/RT has not been described before.
Asunto(s)
Cauda Equina/patología , Tumor Rabdoide/fisiopatología , Neoplasias de la Médula Espinal/fisiopatología , Teratoma/fisiopatología , Biopsia , Cauda Equina/diagnóstico por imagen , Femenino , Humanos , Lactante , Imagen por Resonancia Magnética , Pronóstico , Tumor Rabdoide/diagnóstico por imagen , Tumor Rabdoide/mortalidad , Tumor Rabdoide/secundario , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/mortalidad , Neoplasias de la Médula Espinal/patología , Teratoma/diagnóstico por imagen , Teratoma/mortalidad , Teratoma/secundarioAsunto(s)
Quistes/diagnóstico por imagen , Imagen por Resonancia Magnética , Neoplasias Pélvicas/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Complicaciones Posoperatorias/diagnóstico por imagen , Teratoma/diagnóstico por imagen , Terapia Combinada , Quistes/patología , Quistes/terapia , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Lactante , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/terapia , Neoplasias Pélvicas/patología , Neoplasias Pélvicas/terapia , Complicaciones Posoperatorias/patología , Complicaciones Posoperatorias/terapia , Recto/diagnóstico por imagen , Recto/patología , Teratoma/patología , Teratoma/secundario , Teratoma/terapiaRESUMEN
Introduction: We report a rare case of testicular teratoma combined with a neuroendocrine tumour, emphasizing the difficulty of the following aspects: the clinical and laboratory diagnosis, the treatment options and the evolution of patients suffering from this disease. Case presentation: The patients with testicular neuroendocrine tumours represent a rarity, considering that as of 2017, only 22 cases had been reported in the literature. The case operated on in our clinic presents an association between a testicular teratoma and a neuroendocrine tumour. A 39-year-old patient was admitted in our Department for a non-painful abdominal tumour and concomitant testicular tumour. The serum tumour markers (-human chorionic gonadotropin, -phetoprotein and lactate dehydrogenase) were within normal limits. Lung and bone metastases were diagnosed CT scan. The histopathological diagnosis consisted of immunohistochemical study of the orchidectomy specimen as well as of the bioptic material from bone marrow puncture. Conclusions: The diagnosis of testicular carcinoids is based on immunohistochemistry study. Radical orchidectomy is the only potentially curative treatment for this type of malignancy. Adjuvant chemotherapy determined size reduction of the lung and bone metastases and the disappearance of the lymph node metastases.
Asunto(s)
Tumores Neuroendocrinos/terapia , Neoplasias Retroperitoneales/terapia , Teratoma/terapia , Neoplasias Testiculares/terapia , Adulto , Antineoplásicos/administración & dosificación , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/secundario , Neoplasias Óseas/terapia , Quimioterapia Adyuvante , Humanos , Inmunohistoquímica , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/terapia , Metástasis Linfática , Masculino , Tumores Neuroendocrinos/diagnóstico por imagen , Tumores Neuroendocrinos/secundario , Orquiectomía , Radioterapia , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/secundario , Teratoma/diagnóstico por imagen , Teratoma/secundario , Neoplasias Testiculares/diagnóstico por imagen , Neoplasias Testiculares/patología , Resultado del TratamientoAsunto(s)
Neoplasias de Cabeza y Cuello/secundario , Cuello/diagnóstico por imagen , Teratoma/diagnóstico , Adulto , Cuidados Posteriores , Desfibriladores Implantables , Diagnóstico Diferencial , Edema/etiología , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Dolor de Cuello/etiología , Radiografía Torácica , Teratoma/complicaciones , Teratoma/patología , Teratoma/secundario , Neoplasias Testiculares/terapia , Tomografía Computarizada por Rayos X , Ultrasonografía , Espera VigilanteRESUMEN
A 23-year-old man presented with difficulty walking and leg pain and numbness. MRI revealed a cystic mass at Th11-12 and a pineal-region tumour. The patient underwent surgery to resect the thoracic-level mass. The tumour adhered strongly to the neural tissue and could only be partially resected. On pathological examination, the resected tumour was diagnosed as a mature teratoma. The tumour regrew and disseminated within 3 months after resection. Both the spinal cord tumour and the tumour in the pineal region shrank significantly after chemotherapy and radiotherapy. Although the tumour was pathologically diagnosed as a mature teratoma, we suspect that the residual tumour contained an immature or malignant component. Thus, careful follow-up observation is mandatory after partial resection of a mature teratoma. In addition, because teratomas can disseminate in the central nervous system, the presence of teratoma should prompt an examination of both the spinal cord and brain.
Asunto(s)
Neoplasias Encefálicas/terapia , Vértebras Lumbares , Recurrencia Local de Neoplasia/terapia , Neoplasias de la Médula Espinal/cirugía , Teratoma/cirugía , Vértebras Torácicas , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/diagnóstico por imagen , Neoplasias Encefálicas/secundario , Terapia Combinada , Diagnóstico Diferencial , Humanos , Imagen por Resonancia Magnética , Masculino , Metástasis de la Neoplasia , Recurrencia Local de Neoplasia/complicaciones , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/patología , Dolor/etiología , Neoplasias de la Médula Espinal/complicaciones , Neoplasias de la Médula Espinal/diagnóstico por imagen , Neoplasias de la Médula Espinal/patología , Teratoma/complicaciones , Teratoma/diagnóstico por imagen , Teratoma/secundario , Adulto JovenRESUMEN
PURPOSE OF REVIEW: The purpose of this review is to examine the historical context alongside contemporary studies in order to provide the most current recommendations for the management of patients with metastatic teratoma with malignant somatic transformation (MST). RECENT FINDINGS: The main themes in the recent literature covered herein include prognostic features, the management of early-stage disease, recommended chemotherapeutic and surgical strategies as well as recognized patterns of late relapse. SUMMARY: Recent literature, combined with a significant contribution from historical studies, suggests that while MST is uncommon, its aggressive nature coupled with its resistance with traditional germ cell tumor chemotherapies makes it very difficult to manage. The key message is that surgery is recommended in all resectable MST from primary retroperitoneal lymph node dissection for clinical stage I, to radical removal of disease after chemotherapy and when chemotherapy fails. In advanced cases with documented spread of the transformed histologic subtype, systemic therapies targeted to the identified tumor type should be considered.
Asunto(s)
Adenocarcinoma/terapia , Transformación Celular Neoplásica , Tumores Neuroectodérmicos Periféricos Primitivos/terapia , Rabdomiosarcoma/terapia , Teratoma/terapia , Neoplasias Testiculares/terapia , Adenocarcinoma/secundario , Quimioterapia Adyuvante , Humanos , Escisión del Ganglio Linfático , Masculino , Metastasectomía , Recurrencia Local de Neoplasia , Tumores Neuroectodérmicos Periféricos Primitivos/secundario , Pronóstico , Espacio Retroperitoneal , Rabdomiosarcoma/secundario , Sarcoma/terapia , Teratoma/secundario , Neoplasias Testiculares/patologíaRESUMEN
Growing teratoma syndrome (GTS) of the lung is extremely rare, and there are very few reports on this condition. This is a case report of GTS of the lung that was successfully treated by resection. A 19-year-old man, who had been diagnosed with a testicular tumor, lung metastases and left hilar lymph node metastasis, underwent surgical resection for left testicular cancer. After orchiectomy and chemotherapy, the patient was successfully treated with wedge resection of the right upper lobe and left upper lobectomy. In conclusion, the current case suggests that some patients with GTS might be successfully treated by surgical resection.
Asunto(s)
Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Neoplasias de Células Germinales y Embrionarias/patología , Teratoma/secundario , Teratoma/cirugía , Neoplasias Testiculares/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Masculino , Neoplasias de Células Germinales y Embrionarias/tratamiento farmacológico , Neoplasias de Células Germinales y Embrionarias/cirugía , Orquiectomía , Neumonectomía , Síndrome , Teratoma/tratamiento farmacológico , Neoplasias Testiculares/tratamiento farmacológico , Neoplasias Testiculares/cirugía , Adulto JovenRESUMEN
PURPOSE: Ovarian cancer is the most common deadly cancer of gynecologic origin. Patients often are diagnosed at advanced stage with peritoneal metastasis. There are many rare histologies of ovarian cancer; some have outcomes worse than serous ovarian cancer. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can be considered for patients with recurrence. This study was designed to assess the impact of CRS and HIPEC on survival of patient with peritoneal metastasis from rare ovarian malignancy. METHODS: A prospective, multicentric, international database was retrospectively searched to identify all patients with rare ovarian tumor (mucinous, clear cells, endometrioid, small cell hypercalcemic, and other) and peritoneal metastasis who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI) and BIG-RENAPE working group. The postoperative complications, long-term results, and principal prognostic factors were analyzed. RESULTS: The analysis included 210 patients with a median follow-up of 43.5 months. Median overall survival (OS) was 69.3 months, and the 5-year OS was 57.7%. For mucinous tumors, median OS and DFS were not reached at 5 years. For granulosa tumors, median overall survival was not reached at 5 years, and median DFS was 34.6 months. Teratoma or germinal tumor showed median overall survival and DFS that were not reached at 5 years. Differences in OS were not statistically significant between histologies (p = 0.383), whereas differences in DFS were (p < 0.001). CONCLUSIONS: CRS and HIPEC may increases long-term survival in selected patients with peritoneal metastasis from rare ovarian tumors especially in mucinous, granulosa, or teratoma histological subtypes.
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Carcinoma Endometrioide/terapia , Procedimientos Quirúrgicos de Citorreducción , Tumor de Células de la Granulosa/terapia , Hipertermia Inducida , Neoplasias Quísticas, Mucinosas y Serosas/terapia , Neoplasias de Células Germinales y Embrionarias/terapia , Neoplasias Ováricas/patología , Neoplasias Peritoneales/terapia , Teratoma/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Endometrioide/secundario , Procedimientos Quirúrgicos de Citorreducción/efectos adversos , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Tumor de Células de la Granulosa/secundario , Humanos , Metástasis Linfática , Persona de Mediana Edad , Neoplasias Quísticas, Mucinosas y Serosas/secundario , Neoplasias de Células Germinales y Embrionarias/secundario , Neoplasias Peritoneales/secundario , Enfermedades Raras/patología , Enfermedades Raras/terapia , Estudios Retrospectivos , Tasa de Supervivencia , Teratoma/secundario , Resultado del Tratamiento , Adulto JovenRESUMEN
Malignant transformation of mediastinal mature teratoma is extremely rare and worsens the prognosis of the disease. Transformation can appear synchronously to or several years after the initial diagnosis. Clinical and radiological signs can orientate the clinician but the definitive diagnosis is obtained thanks to histology. An 11 year-old boy presented with a mediastinal mature teratoma and bone and pulmonary metastases. He received six cycles of chemotherapy combining etoposide, ifosfamide, cisplatin, followed by resection of a 16×14×9cm mediastinal mass. Karyotype analysis revealed the presence of an additional sex chromosome X (47 XXY) pathognomonic of Klinefelter's syndrome. Ten years later, sciatalgia revealed malignant transformation of a pre-existing sacral bone metastasis into gastrointestinal adenocarcinoma. The patient received four cycles of chemotherapy combining oxaliplatin, 5-fluorouracil and cetuximab. This treatment was followed by a complete resection of the sacral metastasis and completed with adjuvant irradiation of 54Gy in 30 daily fractions. Twelve months after the diagnosis of relapse, the patient remained alive without disease. To our knowledge, this is the first case of adenocarcinoma developed in bone metastases of a mediastinal mature teratoma in a boy with a Klinefelter's syndrome. We propose a review of the literature and an analysis of 20 others published cases of mediastinal teratoma with malignant transformation into adenocarcinoma.
Asunto(s)
Adenocarcinoma/patología , Neoplasias Óseas/patología , Neoplasias Gastrointestinales/patología , Neoplasias del Mediastino/patología , Teratoma/patología , Adenocarcinoma/complicaciones , Neoplasias Óseas/complicaciones , Neoplasias Óseas/secundario , Transformación Celular Neoplásica , Niño , Neoplasias Gastrointestinales/complicaciones , Humanos , Síndrome de Klinefelter/complicaciones , Masculino , Neoplasias del Mediastino/complicaciones , Teratoma/complicaciones , Teratoma/secundario , Adulto JovenRESUMEN
OBJECTIVE: To determine the pathologic findings and clinical outcome of patients with pure embryonal carcinoma (EC) of the testis who were diagnosed with testis cancer from January 1989 to January 2013 who underwent an orchiectomy, cisplatin-based chemotherapy and a postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). METHODS: We compared those patients with 100% EC with those with mixed nonseminomatous germ cell tumor pathology who underwent a PC-RPLND. RESULTS: Of 1105 patients who underwent a PC-RPLND, 145 had pure EC. Twenty-six percent of patients presented with metastatic disease outside the retroperitoneum. Patients with mixed histologies tended to have worse International Germ Cell Cancer Collaborative Group risk compared to those with EC at orchiectomy (P = .037). Histology at PC-RPLND revealed fibrosis or necrosis in 76%, mature teratoma in 19% and viable cancer in 4%. Over one-third of the patients had a residual mass of <1 cm prior to RPLND; of whom 15% harbored mature teratoma in PC-RPLND histology. The Kaplan-Meier estimated probability of recurrence at 5 years of follow-up was 3.1% (95% CI 1.2%, 8.0%) for EC histology, 7.3% lower than mixed histology. For cancer-specific mortality, the Kaplan-Meier estimated probability at 5 years was 4.6% (95% CI 3.3%, 6.3%) and 1.7% (95% CI 0.4%, 6.8%) for mixed and pure EC histologies, respectively. CONCLUSION: Approximately 20% of patients with pure EC had teratoma at PC-RPLND. We have shown that those with a maximum node size of <1 cm should not be precluded from RPLND.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma Embrionario/terapia , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Neoplasias Complejas y Mixtas/terapia , Neoplasias de Células Germinales y Embrionarias/terapia , Teratoma/terapia , Neoplasias Testiculares/terapia , Adulto , Carcinoma Embrionario/secundario , Quimioterapia Adyuvante , Cisplatino/administración & dosificación , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Fibrosis , Humanos , Estimación de Kaplan-Meier , Metástasis Linfática , Masculino , Persona de Mediana Edad , Necrosis , Neoplasia Residual , Neoplasias Complejas y Mixtas/secundario , Neoplasias de Células Germinales y Embrionarias/secundario , Orquiectomía , Espacio Retroperitoneal , Estudios Retrospectivos , Tasa de Supervivencia , Teratoma/secundario , Neoplasias Testiculares/patología , Neoplasias Testiculares/secundarioAsunto(s)
Cromosomas Humanos Par 12 , Quistes/diagnóstico , Neoplasias de Cabeza y Cuello/secundario , Mucosa Respiratoria/patología , Teratoma/genética , Teratoma/secundario , Adulto , Quistes/patología , Diagnóstico Diferencial , Neoplasias de Cabeza y Cuello/diagnóstico , Neoplasias de Cabeza y Cuello/genética , Neoplasias de Cabeza y Cuello/patología , Humanos , Masculino , Metástasis de la Neoplasia , Teratoma/diagnóstico , Teratoma/patologíaRESUMEN
Thoracoscopy can be safely used for dissection of masses in the visceral mediastinum. We report the case of a 31-year-old man affected by metastatic germ cell tumour and successfully treated with a 3-port posterior approach video-assisted thoracic surgery.
Asunto(s)
Neoplasias del Mediastino/cirugía , Metastasectomía/métodos , Teratoma/cirugía , Neoplasias Testiculares/patología , Cirugía Torácica Asistida por Video/métodos , Adulto , Humanos , Masculino , Neoplasias del Mediastino/diagnóstico , Neoplasias del Mediastino/secundario , Metástasis de la Neoplasia , Teratoma/diagnóstico , Teratoma/secundario , Tomografía Computarizada por Rayos XRESUMEN
A 41-year-old patient, with a medical history of embryonal carcinoma treated by orchidectomy at the age of 27, presented with abdominal pain. Serum alphafetoprotein, ß-HCG and CEA levels were normal. MRI showed a cystic retroperitoneal lesion with septation, measuring 20cm. He underwent a surgical resection. Histology revealed an adenocarcinoma arising on a mature multitissular teratoma.
Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/secundario , Transformación Celular Neoplásica/patología , Neoplasias Retroperitoneales/secundario , Teratoma/patología , Teratoma/secundario , Neoplasias Testiculares/patología , Adulto , Humanos , MasculinoRESUMEN
BACKGROUND: Germ cell tumors are tumors composed of tissues derived from more than one of the three germinal layers. They are more common in the testes and ovaries, but can present in many different regions in the midline, including the sacral region, retroperitoneum, mediastinum, and brain. Testicular germ cell tumors generally metastasize to the retroperitoneum, lungs, and brain; metastases to soft tissue are very rare. CASE PRESENTATION: Here we describe a case of a single soft-tissue mass in the thigh of a 27-year-old man, with histology showing areas of mature teratoma tissues derived from the ectodermal and mesodermal lineages, and areas of immature teratoma tissue composed of small undifferentiated cells, with primitive neuroectodermal differentiation foci forming neuroepithelial elements - thus classified as immature teratoma. The patient had no other clinical or radiological evidence of involvement, besides the lymph nodes. CONCLUSION: The case presented suggests a rare and unexpected primary immature teratoma of the thigh.
Asunto(s)
Neoplasias de los Tejidos Blandos/patología , Teratoma/patología , Adulto , Biomarcadores de Tumor/análisis , Biopsia , Diferenciación Celular , Linaje de la Célula , Resultado Fatal , Humanos , Inmunohistoquímica , Masculino , Recurrencia Local de Neoplasia , Neoplasias de los Tejidos Blandos/química , Neoplasias de los Tejidos Blandos/cirugía , Teratoma/química , Teratoma/secundario , Teratoma/cirugía , Muslo , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: Pseudomyxoma peritonei (PMP) usually originates from appendiceal neoplasms and, less commonly, from extra-appendiceal lesions. To date, the clinical and therapeutic implications of extra-appendiceal origin are largely unknown. METHODS: A prospective database of 225 PMP patients uniformly treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was reviewed to identify cases with extra-appendiceal primaries. Histologically, negative appendix defined extra-appendiceal origin. Clinical, pathological, and immunohistochemical features (cytokeratin [CK]-20, CK-7, CDX-2, MUC-2, MUC-5A) were correlated with the site of origin. PMP was categorized into low or high grade, according to the 2010 World Health Organization (WHO) classification. The main independent variable for survival analysis was appendiceal versus extra-appendiceal primary. RESULTS: In 19 patients (8.4 %), PMP origin was the ovary (n = 9), uterine cervix (n = 1), mature cystic teratomas (n = 4), and unknown (n = 5). Appendiceal and extra-appendiceal PMP groups were comparable for all characteristics, except for a prevalence of females in the latter. Median follow-up was 64.1 months (95 % confidence interval [CI] 53.9-80.1), and 10-year overall survival was 63.4 % (median 148.2 months; 95 % CI 131.2-165.2) for appendiceal PMP, and 62.0 % (median not reached) for extra-appendiceal PMP. The difference was not significant at univariate ( p = 0.297) and multivariate analysis (hazard ratio 1.51, 95 % CI 0.78-3.14; p = 0.278). High-grade peritoneal histology (p = 0.007), prior systemic chemotherapy (p = 0.003), more than four visceral resections (p = 0.011), and incomplete cytoreduction (p = 0.021) independently correlated with poorer survival. CONCLUSIONS: Clinical-pathological features of PMP, and outcome after CRS/HIPEC, did not differ according to the primary site, thus suggesting that PMP is a relatively homogeneous disease that can be produced by a range of histopathologic entities. Extra-appendiceal origin does not contraindicate CRS/HIPEC.