Semen quality from patients affected by seminomatous and non-seminomatous testicular tumor

ABSTRACT Testicular cancer is considered a rare disease affecting approximately 1% to 2% of the male population. This neoplasm has a cure rate of over 95%; as a result, a major concern is the future of fertility of carriers from this disease. There are several histological subtypes of testicular tumors; however, the Testicular Germ Cell Tumors (TGCTs), comprising both seminoma and non-seminoma tumors, are considered the main subtypes of testicular neoplasms. TGCT are characterized by being a solid tumor that mostly affects young men aged between 15 and 40 years old. While TGCT subtypes may have an invasive potential, seminoma subtype does not affect other cells rather than germ cells, while non-seminomas have more invasive properties and can achieve somatic cells; thus, having a more aggressive nature. This research intends to review the literature regarding information about sperm parameters, correlating the data found in those studies to the subfertility and infertility of patients with TCGTs. Furthermore, it will also correlate the data to the non-seminoma and seminoma histological subtypes from pre- and post-cancer therapy. PubMed databases were used. Searched keywords included: seminoma AND non-seminoma; male infertility; germ cell tumor; chemotherapy AND radiotherapy. Only articles published in English were considered. Current studies demonstrate that both TGCT subtypes promote deleterious effects on semen quality resulting in decreased sperm concentration, declined sperm total motility and an increase in the morphology alterations. However, findings suggest that the non-seminoma subtype effects are more pronounced and deleterious. More studies will be necessary to clarify the behavior of seminoma and non-seminoma tumors implicating the reproductive health of male patients.

Effects of testicular dysgenesis syndrome components on testicular germ cell tumor prognosis and oncological outcomes

ABSTRACT Purpose: To evaluate whether components of Testicular Dysgenesis Syndrome (TDS) affect testicular germ cell tumor (TGCT) prognosis and oncological outcomes. According to the hypothesis called TDS; undescended testis, hypospadias, testicular cancer and spermatogenic disorders share the same risk factors and have a combined fetal origin. Materials and Methods: We retrospectively evaluated the stages and oncological outcomes of 69 patients who underwent radical orchiectomy between January 2010 and December 2014 due to TGCT in our department. The presence of undescended testis, hypospadias and semen parameters disorders were recorded according to anamnesis of patients. Results: Among 69 patients with TGCT, only 16 (23.1%) had TDS. Significantly higher rate of TDS (36.1% vs. 9.1%) was observed at the advanced stages of TGCT(p=0.008). In the TDS group, the rates of local recurrence (50% vs. 11.3%, p<0.001), distant metastasis (93.6% vs. 3.8%, p<0.001) and cancer-spesific mortality (87.5% vs. 3.8%, p<0.001) were found significantly higher than those without TDS. The predicted time for recurrence-free survival (13.70±5.13 vs. 100.96±2.83 months, p<0.001) metastasis-free survival (13.12±4.21 vs. 102.79±2.21 months, p <0.001) and cancer-specific survival (13.68±5.38 vs. 102.80±2.19 months, p<0.001) were also statistically lower in this group. Conclusions: According to our preliminary results, there is an apparent relationship between TDS and tumor prognosis. Even if the components of TDS alone did not contain poor prognostic features for TGCT, the presence of TDS was found as the most important independent predictive factor for oncological outcomes in both seminomas and nonseminomas as well as all patients with TGCT.

Testicular mixed germ cell tumor presenting with seizure as the initial symptom: a case report and literature review

Abstract Most patients with testicular germ cell tumor present with a painless scrotal mass. We report a 19-year-old patient who presented with neurological complains. Rapid clinical progression to coma was noted during the staging work up. A diagnosis of testicular mixed germ cell tumor with multiorgan metastasis (lymph node, lung, liver and brain) was made. Patients with brain metastasis should receive chemotherapy alone or combined with surgery or radiotherapy. Because the clinical symptoms deteriorated quickly, surgery was used upfront followed by chemotherapy and radiotherapy for the brain tumor. After the first stage of treatment, the clinical symptoms, tumor markers and imaging findings were improved. The residual brain tumor was eliminated by chemotherapy, and only sparse degenerated tumor cells were noted in the brain tissue. Longer follow up is required to assess the impact of our treatment strategy.

First - line, non - cryopreserved autologous stem cell transplant for poor - risk germ - cell tumors: Experience in a developing country

ABSTRACT Purpose: The current first - line treatment for non - seminomatous germ cell tumor (NSGCT) consists of four cycles of cisplatin, etoposide, and bleomycin (BEP), which results in 5 - year overall survival < 60% in patients with poor - risk features. Autologous hematopoietic stem cell transplantation (auto - HSCT) as a method for overcoming high toxicity after high dose chemotherapy (HDC) has been explored in different solid tumors, but has remained standard practice only for NSGCT. Our objective was to describe outcomes of patients with poor - risk NSGCT who underwent first - line autologous HSCT in a tertiary center in Mexico. Patients and Methods: Twenty nine consecutive patients with NSGCT who received first - line, non - cryopreserved autologous HSCT at the National Institute of Medical Sciences and Nutrition Salvador Zubiran in Mexico City, Mexico, from November 1998 to June 2016, were retrospectively analyzed. Results: The median age at transplantation was 23 (15 - 39) years. Most patients (n = 18, 62%) had testicular primary tumor, and 23 had metastases (79%). Complete response after auto - HSCT was observed in 45%. Non - relapse mortality was 0. Five - year relapse / progression free and overall survival were 67% and 69%, respectively. Conclusions: This small single limited - resource institution study demonstrated that patients with poor - risk NSGCT are curable by first - line HDC plus autologous HSCT and that this procedure is feasible and affordable to perform using non - cryopreserved hematopoietic stem cells.

Yolk sac primary tumor of mediastino: a rare case in a young adult / Tumor de saco vitelínico primário do mediastino: raro caso em um adulto jovem

ABSTRACT Germ cell tumors are rare neoplasms that mostly occur in the gonads, although they can also affect other body sites, especially the anterior mediastinum (50 to 70% of all extragonadal germ cell tumors). We report a case of a primary mediastinal yolk sac tumor, a rare and aggressive germ cell tumors subtype. This was a 38-year-old man who was admitted to Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", complaining about dyspnea and dry cough for 1 year. The computed tomography scan of his chest revealed a large mass in the anterior mediastinum with heterogeneous enhancement to the contrast associated with pleural effusion. There were also high serum levels of alpha-fetoprotein. After neoadjuvant chemotherapy, the patient underwent surgical resection of the mass, followed by pathological examination, which confirmed a primary mediastinal yolk sac tumor, a nonseminomatous subtype of germ cell tumors. Primary mediastinal yolk sac tumors have poor prognosis, despite advances in therapy with surgical resection and cisplatin-based chemotherapy. This poor prognosis is due to the degree of invasion and unresectability in most patients by the time of the diagnosis.

RESUMO Os tumores de células germinativas são neoplasias raras que acometem mais frequentemente as gônadas, embora possam também ocorrer em outras localizações do corpo, destacando-se o mediastino anterior (50 a 70% de todos os tumores de células germinativas extragonadais). No presente artigo, relatamos um caso de tumor de saco vitelínico mediastinal primário, de subtipo raro e agressivo de tumor de células germinativas. Tratava-se de um homem, 38 anos, admitido no Hospital do Servidor Público Estadual "Francisco Morato de Oliveira", com quadro de dispneia e tosse seca há 1 ano. Na investigação clínica, foi solicitada tomografia computadorizada de tórax, que mostrou volumosa massa no mediastino anterior com realce heterogêneo ao meio de contraste associada a derrame pleural. Havia ainda aumento dos níveis séricos da alfafetoproteína. Após quimioterapia neoadjuvante pré-operatória, o paciente foi submetido à ressecção cirúrgica, seguida de estudo anatomopatológico da peça, no qual demonstrou tratar-se de um tumor de saco vitelínico primário do mediastino. Os tumores de saco vitelínicos primários do mediastino têm prognóstico reservado, apesar do avanço na terapêutica com a ressecção cirúrgica e a quimioterapia à base de cisplatina. Isto se deve ao grau de invasão e de irressecabilidade na maioria dos pacientes no momento do diagnóstico.

Malignant extra-cranial germ cell tumors in children and adolescents: Results following the guidelines of SFOP/SFCE 95 Protocol

Between September 1995 and December 2010, 99 new consecutive assessable patients with extra-cranial MGCT were treated according to SFOP/SFCE TGM95 Protocol. A "watch and wait" strategy for completely resected stage I-II was observed in cases with preoperative high tumor markers levels. Metastatic disease or alpha fetoprotein levels > 15 000 ng/ml cases were treated by VIP chemotherapy (etoposide, ifosfamide and CDDP) 4-6-courses. All other cases were treated by VBP (vinblastine, bleomycin, and CDDP) 3-5 courses. Median age for the whole group was 11.1 (r: 0-17) years. Males: 49, females: 50. Stage I: 19 patients, stage II: 16, stage III: 31 and stage IV: 3. Gonadal disease occurred in 77 cases. Of 21 completely resected stage I-II patients with MGCT who did not receive chemotherapy after surgery, 6 presented disease progression and were successfully treated by chemotherapy and remained disease-free. There were no significant differences in outcome according to age, gender, initial site, staging, and histological variant or high levels of alpha-fetoprotein. Initial non-responsiveness to VIP chemotherapy was the only significant unfavorable prognostic feature. With a median follow-up of 64 (r: 5-204) months, at 10 years EFS and OS estimates for the whole group were 0.82 (SE = 0.05) and 0.90 (SE = 0.03) respectively. Therapy results of MGCT treated with the SFOP/SFCE 95 strategy were excellent. Initial non-response to front line chemotherapy was the only significant adverse prognostic feature. The "watch and wait" strategy for completely resected disease with initial positive markers proved to be safe with optimal outcome.

Entre septiembre de 1995 y diciembre 2010 se registraron 99 nuevos pacientes evaluables consecutivos con tumores germinales malignos (TGM) extra-cerebrales. Los pacientes fueron tratados prospectivamente según los lineamientos del Protocolo SFOP/SFCE TGM95. Se siguió una estrategia de watch and wait para la enfermedad estadio I-II completamente resecada. La enfermedad con metástasis y los casos con niveles de alfa fetoproteína > 15 000 ng/ml fueron tratados con etopósido, ifosfamida y CDDP, 4-6 cursos. El resto fue tratado con vinblastina, bleomicina y CDDP, 3-5 ciclos. La mediana de edad fue de 11.1 (r: 0-17) años. Varones: 49, niñas: 50. Estadio I: 19 casos; II: 16; III: 31y IV: 33. De 21 enfermos con estadios tumorales I y II con resección completa inicial que no tuvieron tratamiento adyuvante, seis progresaron, todos fueron exitosamente tratados con quimioterapia y permanecieron libres de enfermedad. No hubo diferencias significativas en los resultados de supervivencia según edad, género, sitio inicial, estadificación, variante histológica o niveles elevados de alfa-fetoproteína. La resistencia primaria a la quimioterapia VIP fue el único factor pronóstico desfavorable significativo. Con una mediana de seguimiento de 64 (r: 5-204) meses, a 10 años las probabilidades de supervivencia libre de eventos y supervivencia global para todo el grupo fueron respectivamente de 0.82 (EE = 0.05) y 0.90 (EE = 0.03). Los resultados con la estrategia SFOP/SFCE 95 fueron excelentes. La ausencia de respuesta a la quimioterapia de primera línea fue el único factor pronóstico adverso significativo. La estrategia de watch and wait probó ser segura y eficaz.

Tumores testiculares: alternativas a la orquidectomia radical / Testicular tumors: alternatives to radical orchidectomy

Los tumores testiculares de células germinales (TCG) son poco frecuentes, corresponden al 2 por ciento de todos los cánceres masculinos. La incidencia de cáncer contralateral oscila entre 1por ciento a 5 por ciento, siendo los tumores metacrónicos mucho más comunes que los sincrónicos bilaterales. El tratamiento estándar en estos casos es la orquidectomía bilateral. Se han propuesto diferentes enfoques que buscan preservar la función testicular. Dentro de estas alternativas se describen en la literatura la Orquidectomía Parcial (OP), el Ultrasonido Focalizado de Alta Intensidad (HIFU por su sigla en inglés) y la radioterapia primaria. Nuestro objetivo es realizar una revisión de este tema y describir las alternativas de tratamiento a la orquidectomía radical, con la idea de preservar la función androgénica. Para esto nos enfocaremos en el manejo del paciente con masa testicular palpable, no palpable y sus alternativas terapéuticas.

Testicular germ cell tumors (GCT) are rare, corresponding to 2 percent of all male cancers. Contralateral cancer incidence ranges from 1 percent to 5 percent, metachronous tumors being more common than bilateral synchronous. Standard treatment in these cases is bilateral orchiectomy. Diferent approaches have been proposed that seek to preserve testicular function. Among these alternatives the literature describes Partial orchiectomy (OP), High Intensity Focused Ultrasound (HIFU for its acronym in English) and primary radiotherapy. Our goal is to review this issue and describe treatment alternatives to radical orchiectomy, with the idea of preserving androgenic function. We focus on the management of patients with palpable testicular mass, not palpable mass and it therapeutic alternatives.

Struma ovarii maligno / Malignant Struma ovarii

O "Struma ovarii" é um tumor ginecológico raro, sendo de malignização e metástases incomuns. Constituído predominantemente por tecido tireoideano, apresenta maior incidência aos 50 anos. Apresentamos o caso de uma paciente de 41 anos com história prévia de teratoma tratado, que desenvolve dor pélvica e tumoração abdominal. Operada, concluiu-se tratar de "Struma ovarii" maligno com metástases. Após a radioablação com I-131, encontra-se sob controle clínico. Apesar de sua raridade, o "Struma ovarii" possui bom prognóstico, devendo ser lembrado no diagnóstico diferencial dos tumores ovarianos.

Conservative treatment of ovarian cancer, Safety, ovarian function preservation, reproductive ability, and emotional attitude of the patients in Saudi Arabia

To evaluate the safety, ovarian function preservation, reproductive ability, and the emotional attitude after a conservative surgery for ovarian cancer. This is a retrospective study of women conservatively treated for primary ovarian cancer between January 2000 and December 2010 at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. Patient's charts were reviewed for pathology, stage, requirement of adjuvant chemotherapy, and recurrent, as well as menstrual history, and pregnancy after treatment. During follow up the patients were asked 3 questions about their emotional attitude toward their disease. There were 39 patients identified [mean age 22 years]. Thirty-one [80%] patients were presented with stage I and 20 [52%] were Germ cell tumor. Fifteen [39%] patients received initial chemotherapy after primary surgery. Three [8%] patients had recurrent. Thirty-eight [98%] patients retuned to a regular menstruation after treatment. Eight patients [20%] had a normal pregnancy. Of the respondents to the given questions, 10 [44%] patients claimed that their disease did not have any impact on their desire to have children and 12 patients [52%] feared that their ovarian disease could have damage in their reproductive potential. Only 9 patients [39%] had no concerned about the effect of the treatment they received on the offspring. Fertility sparing surgery in ovarian cancer appears to be safe, and a practical treatment option in selected cases with ovarian cancer diagnosis. Most patients can have ovarian preservation after treatment and should not be discouraged from getting pregnant

Successful stem-cell mobilization and transplantation using plerixafor in a patient with a germ cell tumor

High-dose chemotherapy followed by autologous hematopoietic stem-cell transplantation is an important treatment option for a variety of malignancies. Peripheral blood stem cells [PBSCs] have replaced bone marrow-derived cells as source of stem cells in transplants, and the success of a transplant depends highly on the number of PBSCs mobilized, collected and eventually infused. Nevertheless, a good percentage of patients fail to mobilize stem cells when growth factors alone or in combination with chemotherapy are used. Recently, plerixafor has been approved as a novel agent to mobilize stem cells in multiple myeloma and lymphoma patients. Data on the efficacy and safety of plerixafor in solid tumors is lacking. We report the successful stem cell mobilization and transplantation for a patient with a germ cell tumor using plerixafor

Tumores de células germinativas primários do mediastino / Primary mediastinal germ cell tumors

Os tumores de células germinativas primários do mediastino podem corresponder de 10 por cento a 20 por cento das neoplasias mediastinais. Ocorrem devido à transformação maligna de elementos germinativos sem evidência de um foco gonadal primário. Podem ser classificados de acordo com suas características morfológicas em: teratomas, seminomas, não seminomas (tumores do saco vitelino, carcinomas embrionários e coriocarcicoma), e tumores de células germinativas combinados sem componentes teratomatosos. O objetivo dessa revisão é analisar os diferentes tipos de tumores de células germinativas primários do mediastino no que diz respeito aos seus aspectos clínicos bem como as suas diferentes formas de abordagens terapêuticas.

Tumores de células germinativas intracranianos na infância: avaliação de 14 casos / Primary intracranial germ cell tumors in children: evaluation of fourteen cases

This study evaluates the diagnosis, therapy and survival of 14 patients with primary intracranial germ cell tumors during the period from 1991 to 2001. There were 11 males and 3 females. Mean age was 12.2 years old (20 days-18 years). On admission, the most common symptoms were headache (10/14), vomiting (6/14) and visual (6/14). The tumor was in pineal and hypothalamic region in 10 cases, suprasellar in 3 cases, and in the cerebral parenchyma in 1 case. Histologically there were 1 embryonal carcinoma, 5 germinomas, 2 mature teratomas, 1 immature teratoma and 5 mixed germ cell tumors. Treatment differed among the patients according to the type of tumor. Three patients died after tumor progression or relapse and one patient died from another condition. The remaining patients are alive and without disease.

Este estudo avalia o diagnóstico, a terapia e a sobrevida de 14 pacientes com tumor de células germinativas intracraniano durante o período entre 1991 e 2001. Onze pacientes eram do sexo masculino e três do feminino. A média de idade do grupo foi 12,5 anos (20 dias-18 anos). Na admissão, os mais comuns sintomas foram cefaléia (10/14), vômitos (6/14) e visuais (6/14). Os tumores estavam localizados em região hipotalâmica/hipofisária em 10 casos, suprasselar em 3 casos e intraparenquimatosa em 1 caso. Histologicamente, havia 1 caso de carcinoma embrionário, 5 de germinomas, 2 de teratoma maduro, 1 de teratoma imaturo e 5 de tumores mistos. O tratamento foi variável, dependendo da histologia da lesão. Três pacientes morreram após a progressão tumoral ou recidiva e um paciente morreu devido causa não relacionada ao tumor. Os demais estão vivos e sem doença.

Cordomas de clivus. Presentación de tres casos / Clivus chordomas: presentation of three cases

los cordomas son neoplsias que se originan de remanentes de la notocorda. Su frecuencia es mayor en adultos y se ha informado de 13 casos en edades pediátricas hasta 1988, en la literatura internacional y ninguna en la nacional. Se presentan 3 casos tratados en nuestro hospital de 1984 a 1988, los tres casos corresponden a mujeres con edades de 11,7 y 16 años; el primero presentó el tumor localizado ventralmente al clivus con invasión a órbita y el segundo y tercer caso con localización dorsal al mismo

Tumor de la glandula pineal en niño escolar

Se presenta un caso de tumor de células germinales, presumiblemente un coriocarcinoma primario intracraneal de la glándula pineal, en un niño de 8 años de edad. El cuadro clínico fue el de un síndrome de hipertensión endocraneal y de precocidad isosexual. La tomografía axial computarizada del cráneo demonstró la presencia de una lesión tumoral esférica en la glándula pineal y una hidrocefalia obstructiva. La beta-hormona gonadotropina coriónica y la alfafetoproteína estaban elevadas en el plasma. El niño fue tratado con radioterapia (5000 rads dirigidas al cráneo y al tumor y 2500 al eje raquiespinal); y se prescribió, también, una quimioterapia combinada de cis-platinum, bleomicin, vinblastina y actinomicina. El resultado fue excelente. La eficiencia del tratamiento se confirmó con la curación clínica y tomográfica. La tomografía axial computarizada del cerebro es ahora normal, 4 años después del tratamiento