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3.
Zhonghua Bing Li Xue Za Zhi ; 52(4): 347-352, 2023 Apr 08.
Artigo em Chinês | MEDLINE | ID: mdl-36973194

RESUMO

Objective: To investigate the clinicopathological features and possible mechanisms of burned-out testicular germ cell tumors. Methods: The clinical and imaging data, histology and immunophenotypic characteristics of three cases of burned-out testicular germ cell tumors diagnosed at the Ruijin Hospital, Medical College of the Shanghai Jiaotong University, from 2016 to 2020 were retrospectively analyzed. The relevant literature was reviewed. Results: The mean age of the three patients was 32 years. Case 1 had an elevated preoperative alpha-fetoprotein level (810.18 µg/L) and underwent "radical pancreaticoduodenectomy and retroperitoneal lesion resection" for a retroperitoneal mass. Postoperative pathology showed embryonal carcinoma, which needed to exclude gonadal metastasis. Color Doppler ultrasound showed a solid mass of the right testis, with hypoechoic lesion and scattered calcification in some areas. Case 2 was a "right supraclavicular lymph node biopsy specimen." Chest X-ray showed multiple metastases in both lungs. The biopsy showed metastatic embryonic carcinoma and bilateral testicular color Doppler ultrasound revealed abnormal calcifications in the right testicle. Case 3 showed a cystic mass of the right testis with calcification and solid areas. All 3 patients underwent radical right orchiectomy. Grossly, borders of the testicular scar areas were well defined. Cross sectioning of the tumors showed a gray-brown cut surface and single focus or multiple foci of the tumor. The tumor maximum diameter was 0.6-1.5 cm. Microscopically, lymphocytes, plasma cells infiltration, tubular hyalinization, clustered vascular hyperplasia and hemosiderin laden macrophages were found in the scar. Atrophic and sclerotic seminiferous tubules, proliferation of clustered Leydig cells and small or coarse granular calcifications in seminiferous tubules were present around the scar. Seminoma and germ cell neoplasia in situ were seen in case 1, germ cell neoplasia in situ was seen in case 2 and germ cells with atypical hyperplasia were seen in case 3. Immunohistochemistry showed that embryonic carcinoma expressed SALL4, CKpan(AE1/AE3) and CD30, seminoma and germ cell tumor in situ expressed OCT3/4, SALL4 and CD117, and spermatogenic cells with atypical hyperplasia expressed CD99 and SALL4. The Ki-67 positive index was about 20%, while OCT3/4 and CD117 were both negative. Conclusions: Burned-out testicular germ cell tumors are rare. The possibility of gonad testicular metastasis should be considered first for extragonadal germ cell tumor. If fibrous scar is found in testis, it must be determined whether it is a burned-out testicular germ cell tumor. The burned-out mechanisms may be related to the microenvironment of tumor immune-mediated and local ischemic injury.


Assuntos
Calcinose , Carcinoma , Neoplasias Embrionárias de Células Germinativas , Seminoma , Neoplasias Testiculares , Masculino , Humanos , Adulto , Seminoma/diagnóstico , Seminoma/patologia , Seminoma/secundário , Cicatriz/patologia , Hiperplasia , Estudos Retrospectivos , China , Neoplasias Testiculares/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Microambiente Tumoral
5.
Chinese Journal of Pathology ; (12): 347-352, 2023.
Artigo em Chinês | WPRIM (Pacífico Ocidental) | ID: wpr-985678

RESUMO

Objective: To investigate the clinicopathological features and possible mechanisms of burned-out testicular germ cell tumors. Methods: The clinical and imaging data, histology and immunophenotypic characteristics of three cases of burned-out testicular germ cell tumors diagnosed at the Ruijin Hospital, Medical College of the Shanghai Jiaotong University, from 2016 to 2020 were retrospectively analyzed. The relevant literature was reviewed. Results: The mean age of the three patients was 32 years. Case 1 had an elevated preoperative alpha-fetoprotein level (810.18 μg/L) and underwent "radical pancreaticoduodenectomy and retroperitoneal lesion resection" for a retroperitoneal mass. Postoperative pathology showed embryonal carcinoma, which needed to exclude gonadal metastasis. Color Doppler ultrasound showed a solid mass of the right testis, with hypoechoic lesion and scattered calcification in some areas. Case 2 was a "right supraclavicular lymph node biopsy specimen." Chest X-ray showed multiple metastases in both lungs. The biopsy showed metastatic embryonic carcinoma and bilateral testicular color Doppler ultrasound revealed abnormal calcifications in the right testicle. Case 3 showed a cystic mass of the right testis with calcification and solid areas. All 3 patients underwent radical right orchiectomy. Grossly, borders of the testicular scar areas were well defined. Cross sectioning of the tumors showed a gray-brown cut surface and single focus or multiple foci of the tumor. The tumor maximum diameter was 0.6-1.5 cm. Microscopically, lymphocytes, plasma cells infiltration, tubular hyalinization, clustered vascular hyperplasia and hemosiderin laden macrophages were found in the scar. Atrophic and sclerotic seminiferous tubules, proliferation of clustered Leydig cells and small or coarse granular calcifications in seminiferous tubules were present around the scar. Seminoma and germ cell neoplasia in situ were seen in case 1, germ cell neoplasia in situ was seen in case 2 and germ cells with atypical hyperplasia were seen in case 3. Immunohistochemistry showed that embryonic carcinoma expressed SALL4, CKpan(AE1/AE3) and CD30, seminoma and germ cell tumor in situ expressed OCT3/4, SALL4 and CD117, and spermatogenic cells with atypical hyperplasia expressed CD99 and SALL4. The Ki-67 positive index was about 20%, while OCT3/4 and CD117 were both negative. Conclusions: Burned-out testicular germ cell tumors are rare. The possibility of gonad testicular metastasis should be considered first for extragonadal germ cell tumor. If fibrous scar is found in testis, it must be determined whether it is a burned-out testicular germ cell tumor. The burned-out mechanisms may be related to the microenvironment of tumor immune-mediated and local ischemic injury.


Assuntos
Masculino , Humanos , Adulto , Seminoma/secundário , Cicatriz/patologia , Hiperplasia , Estudos Retrospectivos , China , Neoplasias Testiculares/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Calcinose , Carcinoma , Microambiente Tumoral
6.
Eur Urol ; 82(2): 172-179, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35599187

RESUMO

BACKGROUND: In metastatic seminoma, a strategy is needed for selecting patients for less intensive chemotherapy, to limit toxicities. OBJECTIVE: To assess whether men with good-prognosis metastatic seminoma could be treated with two cycles of etoposide-cisplatin (EP) followed by only one cycle of carboplatin (CARBO) based on negative interim fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS: A nonrandomised, multicentre, phase 2 trial was conducted (NCT01887340). INTERVENTION: All patients with baseline-positive FDG-PET/CT received EP for two cycles. After completing the first two cycles, the patients underwent a second FDG-PET/CT to assess the response. Patients with positive FDG-PET/CT proceeded directly to two additional EP cycles; those who achieved FDG-PET/CT negativity received one cycle of CARBO. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The proportion of patients with negative interim FDG-PET/CT who received carboplatin was determined. RESULTS AND LIMITATIONS: Between 2013 and 2017, 102 patients were enrolled. After the first two EP cycles, FDG-PET/CT was available in 98 patients. Overall, 67 patients (68.4%; 95% confidence interval [CI]: 58.2-77.4) had negative FDG-PET/CT and proceeded to a single CARBO cycle. Twenty-seven patients (27.6%; 95% CI: 19.0-37.5) had positive FDG-PET/CT after two EP cycles. The 3-yr progression-free survival rate was 90.0% (95% CI: 74.4-96.5) in the EP group and 90.8% (95% CI: 81.4-95.7) in the CARBO group. The cumulative incidences of peripheral neuropathy and ototoxicity were significantly higher in the EP group. CONCLUSIONS: Omission of two cycles of EP based on negative FDG-PET/CT after two cycles of chemotherapy appears to be feasible. However, the absence of consensus criteria for FDG-PET/CT interpretation and the short follow-up need additional studies. This strategy does not warrant routine integration yet. PATIENT SUMMARY: Men with good-prognosis metastatic seminoma were treated with fewer cycles of chemotherapy based on interim fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT). Omission of two cycles of chemotherapy based on negative FDG-PET/CT after two initial cycles appears to be feasible, thereby limiting the burden of treatment and toxicity.


Assuntos
Seminoma , Neoplasias Testiculares , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/efeitos adversos , Fluordesoxiglucose F18 , Humanos , Masculino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Tomografia por Emissão de Pósitrons , Prognóstico , Compostos Radiofarmacêuticos/uso terapêutico , Seminoma/diagnóstico por imagem , Seminoma/tratamento farmacológico , Seminoma/secundário , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Resultado do Tratamento
7.
J Neuroophthalmol ; 41(2): 261-265, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33630775

RESUMO

ABSTRACT: A 45-year-old man with a history of testicular seminoma treated 8 years earlier presented with chronic progressive truncal and limb ataxia, progressive sensorineural hearing loss, and episodic vertigo. Eye movement and neuro-otology examinations showed localizing abnormalities to the bilateral cerebellar flocculus, vermis, and bilateral cerebellar hemispheres. Audiometric testing showed bilateral symmetric sensorineural hearing loss. There was a normal MRI of the brain. Cerebrospinal fluid (CSF) showed modest lymphocytic pleocytosis, and there was an elevated serum choriogonadotrophic hormone. An abdominal CT scan showed a solitary, large retroperitoneal lymph node, and histopathologic examination of the node biopsy showed granulomatous inflammation without microorganisms; eventually, immunohistochemical markers confirmed the diagnosis of metastatic seminoma. Although normal neuroimaging and inflammatory CSF reaction suggested a paraneoplastic etiology, the initial paraneoplastic antibody testing was negative. Subsequent investigation identified a positive kelch-11 protein antibody, thus confirming the paraneoplastic connection between the metastatic seminoma and the subacute neurologic-cochleovestibular syndrome.


Assuntos
Ataxia/etiologia , Autoanticorpos/sangue , Proteínas de Transporte/imunologia , Perda Auditiva Neurossensorial/etiologia , Nistagmo Patológico/etiologia , Seminoma/secundário , Neoplasias Testiculares/patologia , Ataxia/diagnóstico , Ataxia/fisiopatologia , Biomarcadores Tumorais/sangue , Biomarcadores Tumorais/imunologia , Proteínas de Transporte/sangue , Movimentos Oculares/fisiologia , Perda Auditiva Neurossensorial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/fisiopatologia , Síndromes Paraneoplásicas Oculares/sangue , Síndromes Paraneoplásicas Oculares/complicações , Síndromes Paraneoplásicas Oculares/diagnóstico , Seminoma/diagnóstico , Seminoma/imunologia , Neoplasias Testiculares/imunologia , Tomografia Computadorizada por Raios X
8.
Biomedica ; 40(Supl. 2): 27-33, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152185

RESUMO

COVID-19 is the viral infection caused by SARS-CoV-2 declared by the World Health Organization (WHO) as a pandemic. Patients with cancer have a higher risk to acquire the infection and worse prognosis as they have to attend more medical visits in healthcare institutions, receive medical and surgical treatments, and be subjected to diagnostic studies such as PET/CT in nuclear medicine services where the infection may be an incidental finding. We present here F18-FDG PET/CT (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose), images with findings of COVID-19 from patients with different oncological conditions but no respiratory symptoms.


La COVID-19 es la infección viral causada por el SARS-CoV-2 y declarada por la Organización Mundial de la Salud (OMS) como pandemia. Los pacientes con cáncer tienen un mayor riesgo de adquirir la infección y un peor pronóstico, ya que deben asistir a visitas médicas en diferentes centros hospitalarios, reciben tratamientos médicos y quirúrgicos y deben someterse a estudios diagnósticos como la PET/CT en servicios de medicina nuclear, lo que es ocasión para el hallazgo incidental de la infección. Se presentan las imágenes de tomografías computarizadas por emisión de positrones con 18-fluorodesoxiglucosa (F18) (Positron Emission Tomography and Computed Tomography with 2-deoxy-2-[fluorine-18]fluoro-D-glucose, PET/CT F18-FDG) en las que se evidenció la COVID-19 en pacientes con diversas enfermedades oncológicas, pero sin sintomatología respiratoria.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico por imagem , Achados Incidentais , Neoplasias/complicações , Pneumonia Viral/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Adulto , Idoso , Doenças Assintomáticas , COVID-19 , Teste para COVID-19 , Carcinoma de Células em Anel de Sinete/complicações , Carcinoma de Células em Anel de Sinete/diagnóstico por imagem , Carcinoma de Células em Anel de Sinete/secundário , Técnicas de Laboratório Clínico , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Metástase Linfática/diagnóstico por imagem , Linfoma não Hodgkin/complicações , Linfoma não Hodgkin/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Pandemias , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Compostos Radiofarmacêuticos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , SARS-CoV-2 , Seminoma/complicações , Seminoma/diagnóstico por imagem , Seminoma/secundário , Neoplasias Gástricas
10.
J Urol ; 204(6): 1242-1248, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32717162

RESUMO

PURPOSE: Robotic assisted retroperitoneal lymph node dissection in patients with testicular cancer is controversial. Lately, unusual recurrence patterns with adverse outcomes after robotic assisted retroperitoneal lymph node dissection have been published. In this report we determine the feasibility, safety and early oncologic outcome of robotic assisted retroperitoneal lymph node dissection in patients with small volume metastatic testicular cancer. MATERIALS AND METHODS: We retrospectively evaluated 27 consecutive patients with small volume metastatic testicular cancer (October 2010 to November 2019) who underwent robotic assisted retroperitoneal lymph node dissection (unilateral modified template). Intraoperative and postoperative complications as well as early oncologic outcomes are reported. Surgery was performed in the primary metastatic setting in 22 (81%), post-chemotherapy in 4 (15%) and for late relapse in 1 patient (4%). Initial clinical stage was IIA for 14 (52%), IIB for 12 (43%) and III for 1 (4%) patient. RESULTS: Median operative time, blood loss and length of hospital stay were 175 minutes, 50 ml and 4 days, respectively. Expectedly, viable tumor was found in 21/27 patients (78%) and 6 patients (22%) showed fibrosis, necrosis or no tumor. Overall 3 (11%) patients experienced intraoperative (Satava II) and 1 (4%) postoperative (Clavien-Dindo IIIb) complications, respectively. Median followup was 16.5 months (3-69), and 3 (11%) patients experienced relapse outside of the surgical field after 12, 22 and 36 months. CONCLUSIONS: In highly selected patients with low volume metastatic testicular cancer robotic assisted retroperitoneal lymph node dissection may be indicated, and appears to be technically feasible and comparable with open surgery in terms of complications and early oncologic safety. Prospective data collection in larger series is necessary to clarify the role and specific indications of this approach.


Assuntos
Excisão de Linfonodo/efeitos adversos , Metástase Linfática/terapia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Seminoma/terapia , Neoplasias Testiculares/terapia , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Quimioterapia Adjuvante , Estudos de Viabilidade , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Seminoma/epidemiologia , Seminoma/secundário , Neoplasias Testiculares/epidemiologia , Neoplasias Testiculares/patologia , Resultado do Tratamento , Adulto Jovem
11.
Andrology ; 8(6): 1687-1698, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32530514

RESUMO

BACKGROUND: Seminomatous germ cell tumours (SGCT) are the most frequent malignancy in young men. Reliable prognostic biomarkers for the prediction of metastasis at diagnosis and the risk of relapse in clinical stage I (CSI) are lacking. Adjuvant therapies carry a risk of overtreatment, whereas salvage therapies have a risk of high toxicities. Thus, the identification of reliable prognostic biomarkers is highly desirable to identify patients who will benefit from early adjuvant treatment. MicroRNAs (miRNAs) regulate tumour development and progression, and their potential as biomarkers has already been proven in a variety of malignancies. OBJECTIVES: The aim of our study was to define a specific miRNA expression pattern that discriminates metastatic from non-metastatic primary SGCT. MATERIALS AND METHODS: Total RNA was isolated from 24 formalin-fixed paraffin-embedded (FFPE) primary SGCT tumours (10 non-metastatic, five metachronously and nine synchronously metastatic) and from 10 normal testicular tissue samples. Microarray analysis was performed for global miRNA expression profiling. The results were validated by quantitative real-time polymerase chain reaction (qRT-PCR). Statistical analysis was performed using SPSS. RESULTS: Microarray analyses revealed a specific miRNA pattern that distinguishes metastatic from non-metastatic SGCT. Sixty-three miRNAs were differentially expressed in metastatic compared to non-metastatic tumours (P < .01). Microarray results were confirmed by qRT-PCR for three out of five selected miRNAs (miR-29c-5p, miR-506-3p and miR-371a-5p; P < .05). All five miRNAs (miR-29c-5p, miR-506-3p, miR-1307-5p, miR-371a-5p and miR-371a-3p) showed differential expression between tumour and normal tissues (P < .05). CONCLUSION: Metastatic primary SGCTs are characterized by a specific miRNA expression pattern. Therefore, specific miRNAs could represent a new tool to predict the metastatic potential in SGCT patients.


Assuntos
Biomarcadores Tumorais/genética , Perfilação da Expressão Gênica , MicroRNAs/genética , Neoplasias Embrionárias de Células Germinativas/genética , Seminoma/genética , Neoplasias Testiculares/genética , Transcriptoma , Adulto , Biomarcadores Tumorais/metabolismo , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , MicroRNAs/metabolismo , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/metabolismo , Neoplasias Embrionárias de Células Germinativas/secundário , Análise de Sequência com Séries de Oligonucleotídeos , Valor Preditivo dos Testes , Seminoma/metabolismo , Seminoma/secundário , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/patologia
12.
Urol Int ; 104(5-6): 489-496, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32241010

RESUMO

BACKGROUND: The aim of this study was to examine clinical/pathological characteristics, prognosis and tendency to metastasis of mixed germ cell tumours (MGCTs) that contain a seminoma component. METHODS: A total of 111 MGCT cases between 2008 and 2018 were retrospectively enrolled. The patients were divided into 2 groups according to the absence (group 1) or presence (group 2) of seminoma component in MGCTs. Patients' age, complaints at admission to our clinic, primary tumour localization, primary tumour size, preoperative testicular tumour markers, MGCT histopathological components and percentages, lymphovascular invasion, pathological tumour stage, postoperative testicular tumour markers, presence of lymph node involvement in abdominal tomography, lung metastasis based on thorax tomography, clinical tumour stage, adjunctive therapies performed, state of recurrence and survival were compared in 2 groups. RESULTS: The mean age of the patients was 24.51 ± 4.79 years. The mean age, initial complaint rates, primary tumour size, postoperative testicular tumour markers, presence of lymphovascular invasion, presence of lymph node involvement and lung metastasis were found to be higher in group 2 than in group 1, although these differences were not statistically significant. Especially, it was found that a seminoma component rate of 30% and higher had a higher tendency for a poor prognosis. CONCLUSION: Although the word "seminoma" may be initially interpreted as an indication of good prognosis, a seminoma component in MGCTs is actually not a good prognostic factor. MGCTs that contain a seminoma component (especially 30% and higher) can have a higher tendency for occult metastatic disease.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Primárias Múltiplas/patologia , Seminoma/patologia , Neoplasias Testiculares/patologia , Adulto , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/secundário , Prognóstico , Estudos Retrospectivos , Seminoma/secundário , Adulto Jovem
13.
BMJ Case Rep ; 13(4)2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32327457

RESUMO

Two male patients, aged 55 and 75 years, were referred to the ENT and haematology team respectively, with an asymptomatic left supraclavicular neck mass. Investigations revealed metastatic primary testicular seminoma. CT contrast study of the thorax, abdomen and pelvis demonstrated an additional left para-aortic nodal mass in both cases. The initial presentation of a solitary left neck lump from a metastatic testicular seminoma is extremely unusual, especially in an older age group. The pattern of metastatic spread to the supraclavicular neck nodes from a single para-aortic lymph node is also an interesting finding. Although the majority of seminomas present in younger patients in the early stages when confined to the testis, seminoma can also occur in older patients and can present in an atypical manner. The ability to recognise an atypical presentation in an older patient is invaluable for prompt diagnosis, treatment and follow-up of disease. This case also highlights the importance of a multisystematic structured and an open-minded approach to investigating and diagnosing a neck mass.


Assuntos
Neoplasias de Cabeça e Pescoço/secundário , Seminoma/secundário , Neoplasias Testiculares/patologia , Idoso , Biópsia com Agulha de Grande Calibre , Meios de Contraste , Diagnóstico Diferencial , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Seminoma/diagnóstico por imagem , Seminoma/terapia , Tomografia Computadorizada por Raios X , Ultrassonografia
14.
Asian Pac J Cancer Prev ; 21(2): 511-515, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32102532

RESUMO

OBJECTIVES: The present study aims to evaluate the role of Positron emission tomography (PET) -computed tomography (CT) with 18F-fluorodeoxyglucose (18F-FDG) in the restaging of high-risk testicular cancer. METHODS: Forty-five patients (mean age of 38.1±11.3 years and range 23-81 years) with testicular carcinoma, underwent 18F-FDG PET-CT during their clinical course were prospectively selected. PET positivity was defined as a site of abnormal 18F-FDG uptake in tissue histologically proven or clinically or radiographically suspected to represent tissue involvement. The sites of disease were characterized as either nodal or extranodal. All patients were followed-up for at least 12 months with a diagnostic and/or functional imaging modality. RESULTS: Of the 45 patients 38 (84%) patient presented with seminoma and 7 (16%) were Non-seminomatous germ cell tumors. Analysis of secondary disease spectrum showed nodal involvement in 65%, osseous involvement in 23% and mixed visceral/soft tissue lesions in 12% of patients. Nineteen (42%) were negative for any metastatic disease. All negative patients remain disease free in the follow-up of one year. Out of the positive 26/45 patients, PET-CT showed progressive disease in 3/26, stable disease 1/26 and partial response in 2/26 and complete metabolic resolution in 20/26 patients. 18F-FDG PET-CT was able to characterize all patients leading to significant change of primary decision of wait and watch to go for treatment and vice versa. CONCLUSION: 18F-FDG PET-CT scan is potentially an excellent tool for characterization of equivocal lesions on CT scan in the restaging settings and follow up of high-risk testicular cancer patients.


Assuntos
Linfonodos/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Seminoma/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Fluordesoxiglucose F18 , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/secundário , Compostos Radiofarmacêuticos , Seminoma/secundário , Neoplasias Testiculares/patologia , Neoplasias Testiculares/secundário , Adulto Jovem
15.
World J Urol ; 38(6): 1535-1544, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31463562

RESUMO

BACKGROUND: The International Germ Cell Consensus Classification (IGCCC) is the recommended stratification scheme for newly diagnosed metastatic seminoma (mSGCT) and non-seminoma germ cell tumor (mNSGCT) patients. However, a contemporary North-American population-based validation has never been completed and represented our focus. MATERIALS AND METHODS: We identified mSGCT and mNSGCT patients within the SEER database (2004-2015). The IGCCC criteria were used for stratification into prognostic groups. Kaplan-Meier (KM) derived actuarial 5-year overall survival (OS) rates were calculated. In addition, cumulative incidence plots tested cancer-specific (CSM) and other-cause mortality (OCM) rates. RESULTS: Of 321 mSGCT patients, 190 (59.2%) and 131 (40.8%), respectively, fulfilled good and intermediate prognosis criteria. Of 803 mNSGCT patients, 209 (26.1%), 100 (12.4%), and 494 (61.5%), respectively, fulfilled good, intermediate, and poor prognosis criteria. In mSGCT patients, actuarial KM derived 5-year OS was 87% and 78% for, respectively, good and intermediate prognosis groups (p = 0.02). In cumulative incidence analyses, statistically significant differences were recorded for CSM but not for OCM between good versus intermediate prognosis groups. In mNSGCT patients, actuarial KM derived 5-year OS was 89%, 75% and 60% for, respectively, good, intermediate, and poor prognosis groups (p < 0.001). In cumulative incidence analyses, statistically significant differences were recorded for both CSM and OCM between good, intermediate, and poor prognosis groups. CONCLUSIONS: Our findings represent the first population-based validation of the IGCCC in contemporary North-American mSGCT and mNSGCT patients. The recorded OM rates closely replicate those of the original publication, except for better survival of poor prognosis mNSGCT patients.


Assuntos
Neoplasias Embrionárias de Células Germinativas/classificação , Neoplasias Embrionárias de Células Germinativas/secundário , Seminoma/classificação , Seminoma/secundário , Neoplasias Testiculares/patologia , Adulto , Conferências de Consenso como Assunto , Humanos , Cooperação Internacional , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/mortalidade , Prognóstico , Estudos Retrospectivos , Seminoma/mortalidade , Taxa de Sobrevida , Neoplasias Testiculares/classificação , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/secundário
16.
Hum Pathol ; 94: 16-22, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31666197

RESUMO

Management of clinical stage (CS) 1 testicular seminoma is controversial. Treatment choice is based on a number of pathological risk factors. However, they have been inconsistently associated with risk of metastatic disease. The eighth edition of the American Joint Committee on Cancer Tumor-Node-Metastasis staging system has separated pT1a and pT1b tumors according to a 3-cm size cutoff and upstaged invasion of hilar soft tissue and epididymis as pT2. We investigated pathological predictors of metastatic disease at presentation in 332 testicular seminomas. Age, tumor size, invasion of vessels, hilar soft tissue, rete testis, epididymis, spermatic cord, tunica vaginalis and tumor at spermatic cord margin were assessed and correlated with CS at presentation. A total of 290 (87%) tumors were CS 1; 42 (13%) were CS 2/3. Median patient age of CS 1 was 36 years (20-81); that of CS 2/3 was 36 years (26-63). Mean tumor size of CS 1 was 38 mm (5-95 mm); that of CS 2/3 was 54 mm (8-95 mm). On univariate analysis, lymphovascular invasion (P = .044), epididymal invasion (P = .009) and tumor size (P = .0001) were associated with higher CS. On multivariate analysis, tumor size (P = .0001) and epididymis invasion (P = .023) remained significant. Optimal tumor size cutoff was 4.25 cm. We conclude that tumor size and epididymal invasion are the strongest predictors of metastatic disease at presentation. The results validate changes in American Joint Committee on Cancer Tumor-Node-Metastasis staging eighth edition but suggest a tumor size of 4 cm as better cutoff value.


Assuntos
Estadiamento de Neoplasias , Seminoma/secundário , Neoplasias Testiculares/patologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Epididimo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Seminoma/terapia , Neoplasias Testiculares/terapia , Carga Tumoral , Adulto Jovem
17.
Eur J Cancer ; 115: 128-135, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31136925

RESUMO

INTRODUCTION: Carboplatin monotherapy for metastatic seminoma at a dose of AUC-10 has shown promising activity. Three or four cycles have been given with most haematological side-effects seen with the 4th cycle. An early response might allow de-escalation of therapy. METHODS: Forty-eight patients with metastatic seminoma (International Germ Cell Cancer Collaborative Group good prognosis) were recruited. Positron emission tomography (PET) scanning was performed before and after one cycle of carboplatin. Those with a Deauville score of 3 or less were given a total of three cycles of carboplatin, the rest received four. RESULTS: PET scanning allowed 44% to receive three cycles of carboplatin. With a median follow-up of 31.2 months, 95.6% (95% confidence interval: 83.5%-98.9%) were progression free. The overall survival at 2-years was 100%. Lower stage (2A and 2B) disease was significantly (P = 0.001) associated with the better metabolic response, but the association was not strong (correlation coefficient = -0.48). Over a third of the blood products given were used to support the 4th cycle. The regimen was well tolerated with a low incidence of grade III neutropenic sepsis or nausea and vomiting (<3% cycles). CONCLUSION: Carboplatin AUC-10 monotherapy is effective with low toxicity. Early changes during PET scanning may allow de-escalation of therapy in high volume disease-comparison against combination therapy is warranted. CLINICALTRIALS. GOV IDENTIFIER: NCT02272816. EUDRACT NUMBER: 2009-009882-33.


Assuntos
Antineoplásicos/administração & dosagem , Carboplatina/administração & dosagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Seminoma/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adulto , Idoso , Antineoplásicos/efeitos adversos , Carboplatina/efeitos adversos , Tomada de Decisão Clínica , Progressão da Doença , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Intervalo Livre de Progressão , Medição de Risco , Fatores de Risco , Seminoma/diagnóstico por imagem , Seminoma/metabolismo , Seminoma/secundário , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/patologia , Fatores de Tempo , Adulto Jovem
18.
Future Oncol ; 15(12): 1347-1352, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30880465

RESUMO

Germ cell tumors represent 11% of the cancers diagnosed in adolescent males and are the most common solid tumors in adult men between the ages of 20 and 35. Pure seminoma accounts for around 50% of all testicular germ cell tumors. The prognostic classification of the International Germ Cell Cancer Collaborative Group for good-prognosis seminoma includes both nodal disease and pulmonary visceral metastases. In this article, we analyzed recent data on prognosis and outcome of good-prognosis seminoma to revise the traditional classification of the disease and improve tailored treatment.


Assuntos
Biomarcadores Tumorais/análise , Neoplasias Pulmonares/mortalidade , Seminoma/classificação , Neoplasias Testiculares/classificação , Intervalo Livre de Doença , Humanos , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Masculino , Estadiamento de Neoplasias , Prognóstico , Medição de Risco , Seminoma/mortalidade , Seminoma/secundário , Seminoma/terapia , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/secundário , Neoplasias Testiculares/terapia , Testículo/patologia
20.
Arch Soc Esp Oftalmol (Engl Ed) ; 93(9): 417-422, 2018 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29907347

RESUMO

INTRODUCTION: The curing of a testicular tumour is currently feasible in more than 95% of patients, and in 80% of those with metastases. Until now, there has been no study or series of cases that describe the ocular changes of the posterior segment associated with testicular cancer. OBJECTIVE: To evaluate patients with a diagnosis of testicular cancer in order to determine the presence of changes in the posterior segment and the relationship to the stage. MATERIAL AND METHOD: An observational, cross-sectional, and descriptive study was conducted on 21 male patients (42 eyes) with a diagnosis of testicular cancer. Age, histological type, time of evolution, stage, treatment, and comorbidities were recorded, as well as visual acuity measurement (LogMAR), biomicroscopy of the anterior segment, and photographic records of the posterior pole and peripheral retina. RESULTS: The mean age was 29 years (18-43 years). All (100%) of the patients were treated surgically. The most frequent histological type was classic seminoma (42.8%), followed by the mixed germinal tumour (38.0%). At the time of evaluation, 42.8% of patients had a stage II, and 23.8% had distant metastasis. The changes in the posterior segment were: vascular tortuosity (14.2%), retinopathy associated with cancer (9.5%), choroidal metastasis (9.5%), pigmentary changes of the retinal pigment epithelium (9.5%), and retinal metastasis (4.7%). CONCLUSIONS: It is possible to find changes at the level of retinal pigment epithelium, as well as vascular tortuosity, retinopathy associated with cancer, and choroidal and/or retina metastases.


Assuntos
Neoplasias da Coroide/secundário , Neoplasias Embrionárias de Células Germinativas/secundário , Segmento Posterior do Olho/patologia , Neoplasias da Retina/secundário , Neoplasias Testiculares/complicações , Adolescente , Adulto , Neoplasias da Coroide/diagnóstico , Estudos Transversais , Detecção Precoce de Câncer , Etnicidade , Hospitais Gerais , Humanos , Masculino , México , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/terapia , Neoplasias da Retina/diagnóstico , Epitélio Pigmentado da Retina/patologia , Vasos Retinianos/patologia , Seminoma/diagnóstico , Seminoma/secundário , Seminoma/terapia , Neoplasias Testiculares/terapia , Acuidade Visual , Adulto Jovem
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