Surveillance of postchemotherapy subcentimeter residual retroperitoneal mass in metastatic nonseminomatous germ cell tumor: Does how you measure matter?

BACKGROUND: Approximately 70% to 80% of patients with metastatic nonseminomatous germ cell tumor (NSGCT) treated with cisplatin-based chemotherapy achieve a complete response, defined as normalization of serum tumor markers and either no residual retroperitoneal mass (RRM) or an RRM <1.0 cm. While there is universal agreement that patients with an RRM ≥1.0 cm should undergo retroperitoneal lymph node dissection (RPLND), many institutions including ours recommend surveillance for patients who achieve a complete response. However, studies have not defined which axis of the RRM should be considered when deciding between surveillance and RPLND. PATIENTS AND METHODS: Good-risk metastatic NSGCT patients treated with cisplatin-based chemotherapy who achieved a complete response and underwent surveillance were identified using our institution's electronic medical records. A post-hoc review was performed by a blinded radiologist. The RRM dimensions in the transaxial short axis (TSA), transaxial long axis (TLA), and craniocaudal axis (CCA) were recorded. Differences in the frequency of recurrence between groups with an RRM <1.0 cm and ≥1.0 cm in the TLA and CCA were assessed using the Fisher exact test. RESULTS: Thirty-nine patients who met study criteria were included. At a median follow-up of 63.8 months, 2 patients (5.1%) recurred. Both were successfully treated with salvage chemotherapy and RPLND. Thirteen (33%) and 27 (69%) patients had an RRM ≥1.0 cm in the TLA and CCA, respectively. There were no statistically significant differences in the risk of recurrence between patients with an RRM <1.0 cm and ≥1.0 cm in the TLA (P = 0.54) or CCA (P = 0.53). CONCLUSIONS: Surveillance is an effective strategy in good-risk NSGCT patients with a postchemotherapy RRM <1.0 cm in the TSA. Our study suggests referencing the TSA and not the TLA or CCA may avoid unnecessary postchemotherapy RPLNDs.

Multiple myeloma with testicular involvement: a case report and review of the literature.

We report a case of a very unusual metastasis of multiple myeloma to the testis in a 53-year-old-patient, documented with images and anatomic-pathological exam. Our case report is of interest because it is one of the rarest forms ever reported of advanced multiple myeloma.

Metástasis testicular de cáncer renal de células claras: reporte de un caso y revisión de literatura / Testicular Metastasis of clear cell renal cancer: report of a case and review of literature

INTRODUCCIÓN: El carcinoma renal es la tercera neoplasia dentro de los tumores genitourinarios, correspondiendo a un 3 por ciento del total de tumores malignos primarios del adulto a nivel mundial. En Chile tiene una mortalidad de 2-3/100.000 habitantes, presentando un 30 por ciento metástasis al momento del diagnóstico, siendo las metástasis testiculares infrecuentes. CASO CLÍNICO: Hombre de 73 años, con antecedente de varicocele izquierdo sintomático sometido a nefrectomía radical laparoscópica izquierda en Mayo 2011 por tumor renal. Biopsia informa carcinoma de células claras tipo clásico, que invade cápsula renal y teiido adiposo perirrenal con área de carcinoma sarcomatoide. Etapificación: Pt2B NX. En Diciembre 2011 presenta aumento de volumen nodular, pétreo e indoloro en testículo izquierdo. Ecografía y ecodoppler evidencian lesión focal hipoecogénica, sólida. Marcadores tumorales negativos. Tras orquiectomía radical izquierda, biopsia indica metástasis de carcinoma de células claras renal. Tomografía computarizada de tórax abdomen y pelvis informa múltiples nódulos pulmonares de aspecto metastásico, clasificándosele en etapa IV, actualmente con cuidados paliativos DISCUSIÓN: Los metástasis testiculares son infrecuentes encontrándose como hallazgos en autopsias u orquiectomías, presentes simultáneamente con el tumor primario renal o precediendo a su diagnóstico. La mayoría son ipsilaterales izquierdas, asociadas a varicocele, y su baja incidencia podría deberse a su temperatura y localización anatómica distal. CONCLUSIÓN: El caso expuesto ilustra la infrecuente presentación de una metástasis de cáncer renal como masa testicular la cual debiese ser considerada frente a una masa sin antecedente de otro cáncer primario o con marcadores germinales negativos, aunque no ha sido descrita previamente en nuestro medio.

INTRODUCTION: Renal cell carcinoma is the third neoplasia in genitourinary tumors, corresponding to 3 percent of adult primary malignant tumors worldwide. In Chile it has a 2-3/100.000 mortality, 30 percent showing metastasis at diagnosis, testicular metastases being rare. CASE REPORT: 73 year old man with a history of symptomatic varicocele who underwent a left radical nephrectomy for renal tumor in May 2011. Biopsy reports clear cell carcinoma classic type that invades renal capsule and perirenal adipose teiido with sarcomatoid carcinoma area. Staging: Pt2B NX. In December 2011 he presents a painless nodular tumor in the left testicle. Doppler ultrasonography evidences a hypoechoic solid focal lesion. Tumor Markers are negative. After left radical orchiectomy, biopsy shows metastasis of renal clear cell carcinoma. Computed tomography of the chest, abdomen and pelvis reported multiple pulmonary metastatic nodules. He was classified as stage IV and currently recieves palliative care DISCUSSION: testicular metastases are an uncommon finding usually in autopsies or orchiectomy samples, present simultaneously or preceding the primary renal tumor. Most are ipsilateral left and are associated with varicocele. Its low incidence may be due to its anatomical distal location or temperature. CONCLUSION: This case illustrates an uncommon presentation of a metastatic renal cancer. It ought to be considered against a testicular mass with no history of another primary cancer or negative germ cell tumor markers, This uncommon finding has not been previously described in our media.

During twenty years of Cisplatin-based therapy the face of nonseminomatous testicular germ cell tumors is still changing: an evaluation of presentation, management, predictive factors and survival.

PURPOSE: To assess the changing presentation and treatment of nonseminomatous testicular germ cell tumors (NSGCT) and to investigate predictive factors for the status of metastasis at diagnosis and on relapse and death. MATERIALS AND METHODS: Retrospective record review of 147 patients that underwent inguinal orchiectomy from 1987-2007. Follow-up data was available for 102 patients (median follow-up: 80 months (0-243); 96 patients alive). RESULTS: Mean patients age increased (p = 0.015) and more patients were diagnosed in clinical stage I (CSI) (p = 0.040). The fraction of yolk sac (YS) elements inclined (p = 0.030) and pT2 tumors increased (p < 0.001). Retroperitoneal lymph node dissection (RPLND) declined whereas more patients were treated with chemotherapy (p < 0.001; p = 0.004). There was an increase in relapse free (RFS) and cancer specific survival (CSS) due to an improvement in patients with disseminated disease (p = 0.014; p < 0.001). The presence of YS and teratoma elements showed a reduction in the odds ratio (OR) for metastasis at diagnosis (p = 0.002, OR: 0.262; p = 0.009, OR: 0.428) whereas higher pT-stage was associated to their presence (p = 0.039). Patients with disseminated disease (CS > I) showed a declined CSS compared to CSI patients (p = 0.055). The presence of YS elements was associated to an improved RFS (p = 0.038). CONCLUSIONS: In our single institution study the face of NSGCT markedly changed over 20 years even after the introduction of Cisplatin-based chemotherapy. These changes were accompanied by an improvement in RFS and CSS. When dealing with NSGCT patients such observations now and in the future should be taken into account.

During twenty years of Cisplatin-based therapy the face of nonseminomatous testicular germ cell tumors is still changing: an evaluation of presentation, management, predictive factors and survival

Purpose: To assess the changing presentation and treatment of nonseminomatous testicular germ cell tumors (NSGCT) and to investigate predictive factors for the status of metastasis at diagnosis and on relapse and death. Materials and Methods: Retrospective record review of 147 patients that underwent inguinal orchiectomy from 1987-2007. Follow-up data was available for 102 patients (median follow-up: 80 months (0-243); 96 patients alive). Results: Mean patients age increased (p = 0.015) and more patients were diagnosed in clinical stage I (CSI) (p = 0.040). The fraction of yolk sac (YS) elements inclined (p = 0.030) and pT2 tumors increased (p < 0.001). Retroperitoneal lymph node dissection (RPLND) declined whereas more patients were treated with chemotherapy (p < 0.001; p = 0.004). There was an increase in relapse free (RFS) and cancer specific survival (CSS) due to an improvement in patients with disseminated disease (p = 0.014; p < 0.001). The presence of YS and teratoma elements showed a reduction in the odds ratio (OR) for metastasis at diagnosis (p = 0.002, OR: 0.262; p = 0.009, OR: 0.428) whereas higher pT-stage was associated to their presence (p = 0.039). Patients with disseminated disease (CS > I) showed a declined CSS compared to CSI patients (p = 0.055). The presence of YS elements was associated to an improved RFS (p = 0.038). Conclusions: In our single institution study the face of NSGCT markedly changed over 20 years even after the introduction of Cisplatin-based chemotherapy. These changes were accompanied by an improvement in RFS and CSS. When dealing with NSGCT patients such observations now and in the future should be taken into account. .

Testicular metastases: a poor prognostic factor in patients with advanced prostate cancer.

PURPOSE: Prostate cancer is the most frequently diagnosed neoplasm in men. In some patients, however, the disease pursues a clearly more aggressive course. Testicular metastases from prostate cancer are rare events that have been previously reported; however, its frequency and clinical meaning are not well established. The aim of the present study was, therefore, to evaluate its occurrence and clinical meaning. PATIENTS AND METHODS: A review of patients who underwent androgen deprivation orchidectomy for prostate cancer between 1995 and 2007 was undertaken. On the period evaluated, 1,693 orchidectomies were performed at our institution. Since, the population of patients treated at our institution does not have access to the expensive androgen-deprivation drugs, the vast majority is treated through surgical castration. In such context, evaluation of testicular parenchyma of patients with advanced prostate cancer could be assessed. Clinical and histological data were reviewed, and patients with testicular metastases were identified. RESULTS: Of the 1,693 orchidectomies performed during the period analysed, three cases of testicular metastases of prostate cancer (range 58-76 years) were diagnosed (0.18%). All patients had very atypical neoplasm's behaviour and poor prognosis, dying within the first year. CONCLUSION: In conclusion, testicular metastases from prostate cancer are a rare event, observed in 1.8 per 1,000 cases. As other visceral metastases, testicular metastases might also be considered as an unusual additional factor of poor prognosis.

Solitary metastasis in a nasal fossa as the first manifestation of a renal carcinoma.

Renal cell carcinoma is an uncommon tumor in adults. Metastasis in the nasal fossa is rare, and can become apparent as a result of repeated epistaxis. We report a patient with renal cell carcinoma presenting with epistaxis secondary to a metastasis in the right nasal fossa. The primary tumor was treated with nephrectomy and the nasal fossa metastasis was treated successfully with embolization, chemoimmunotherapy, surgery, and radiotherapy. The presence of repeated epistaxis may very occasionally be the first symptom of renal cell carcinoma, and systemic treatment combined with local treatment may enable adequate control of the disease.

Epididymal metastases as the first sign of a colon cancer recurrence.

Metastastic tumours involving the epididymis are rare and most often found in patients with disseminated disease. It is even more unusual when the metastasis of the epididymis is the first sign of tumour recurrence. We report a case of an asymptomatic recurrent colon carcinoma presenting as metastasis in the epididymis. Although metastatic cancer presenting as an intra-scrotal mass is extremely rare, it should be considered as a possibility in patients who present with a mass involving the testicle or epididymis.

Testicular metastasis 10 years after resection of appendiceal carcinoid.

Testicular carcinoids are very rare and account for less than 1% of all testicular neoplasms. They may present as primary testicular tumors or secondary tumors from extratesticular sources. We report a case of a secondary testicular carcinoid occurring 10 years after surgical treatment of an appendiceal carcinoid. The patient underwent radical orchiectomy and at 24 months of follow-up had no evidence of metastases elsewhere. Because secondary carcinoids have a worse clinical course and prognosis than primary tumors, metastatic disease should be excluded before the tumor is identified as a primary. Long-term follow-up is necessary for patients with carcinoid tumor owing to its indolent course and the risk of metastasis several years after treatment of the primary.

Single testicular metastasis mimicking primary testicular neoplasm: a rare manifestation of prostate cancer.

The incidence of secondary testicular tumors ranges from 0.02 to 2.5% among autopsies in general. With the exception of leukemias and lymphomas, prostate cancer is the most common primary site. It is diagnosed in autopsies or incidentally, following therapeutic orchiectomies in more advanced stages of the disease. In the present report, we show a case of testicular metastasis derived from prostate neoplasm whose clinical presentation as a single metastasis was similar to a primary testicular neoplasm. The diagnosis was evidenced after orchiectomy by histological examination and immunohistochemical tests.

Single testicular metastasis mimicking primary testicular neoplasm: a rare manifestation of prostate cancer

The incidence of secondary testicular tumors ranges from 0.02 to 2.5 percent among autopsies in general. With the exception of leukemias and lymphomas, prostate cancer is the most common primary site. It is diagnosed in autopsies or incidentally, following therapeutic orchiectomies in more advanced stages of the disease. In the present report, we show a case of testicular metastasis derived from prostate neoplasm whose clinical presentation as a single metastasis was similar to a primary testicular neoplasm. The diagnosis was evidenced after orchiectomy by histological examination and immunohistochemical tests.

Comparison of metastatic behavior of parental and metastatic pancreatic cancer cell lines in Syrian golden hamsters.

The major cause of death in patients with pancreatic cancer is metastatic disease. In fact, at the time of diagnosis, patients usually have locally advanced or metastatic disease involving lymph nodes, liver, lungs or peritoneum. Therefore, for a better understanding of the tumoral behavior to design prevention or treatment strategies, in vivo models are important. We report here the results of the metastatic behavior of parental and metastatic cell lines in a hamster pancreatic cancer model when implanted orthotopically (OIH,OIM) or into the liver (LIH,LIM). Metastatic sites and survival were studied. Survival ranged from 72 to 105 days. The OIH group showed spontaneous metastases to lymph nodes. The second target organ was the lung. Liver metastases appeared earlier in the OIM group than OIH. LIH showed only metastases to the pancreas while the LIM group showed metastases to pancreas, vas deferens and testis. This study suggests that the metastatic behavior of parental and metastatic cell lines is different. Thus, this should be considered in the planning of clinical or surgical treatment against pancreatic cancer.

Bilateral epididymal metastases from primary adenocarcinoma of the prostate.

A 65-year-old man diagnosed with adenocarcinoma of the prostate gland opted for hormonal manipulation and had bilateral orchiectomy. Histological evaluation showed tumour deposits in both epididymides. Despite the relatively common occurrence of adenocarcinoma of the prostate, epididymal metastasis is a rare occurrence. This case highlights the need for proper evaluation of the testes and para-testicular structures so that accurate staging of these tumours can be made.

Bilateral epididymal metastases from primary adenocarcinoma of the prostate

A 65-year-old man diagnosed with adenocarcinoma of the prostate gland opted for hormonal manipulation and had bilateral orchiectomy. Histological evaluation showed tumour deposits in both epididymides. Despite the relatively common occurrence of adenocarcinoma of the prostate, epididymal metastasis is a rare occurrence. This case highlights the need for proper evaluation of the testes and para-testicular structures so that accurate staging of these tumours can be made

Testicular metastases from carcinoma of the prostate

Secondary testicular tumours are uncommon and most originate from prostatic carcinoma. A retrospective study of the clinico-pathological features of prostatic carcinoma metastatic to the testes was conducted in the Department of Pathology, University of the West Indies, Jamaica, for the period June 1958 to January 1998. Metastatic prostatic carcinoma was seen in 1.4 percent of the 284 orchiectomy specimens examined. A brief review of the literature related to this entity was undertaken.(AU)

Testicular metastases from carcinoma of the prostate.

Secondary testicular tumours are uncommon and most originate from prostatic carcinoma. A retrospective study of the clinico-pathological features of prostatic carcinoma metastatic to the testes was conducted in the Department of Pathology, University of the West Indies, Jamaica, for the period June 1958 to January 1998. Metastatic prostatic carcinoma was seen in 1.4% of the 284 orchiectomy specimens examined. A brief review of the literature related to this entity was undertaken.

Metástasis secundarias en testículos / Secondary metastasis in testis

La presente publicación tiene la finalidad de presentar dos (2) nuevos casos de Metástasis Testicular del Carcinoma de la Próstata, dado su baja frecuencia, repasar bibliografía y recordar sus posibles vías de Metástasis. Según PUIGUERT la pulpa testicular extirpada se remite al laboratorio para su examen histológico, de acuerdo al estado de las células germinales y las células intersticiales de LEYDIG se podría decidir el tratamiento estrogénico complementario. Pero la Anatomía Patológica de los Testículos, también sirve como en estos dos casos para la detección de Metástasis de un Carcinoma Prostático y cambiar el M como ocurrió con nuestro primer paciente