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1.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541948

RESUMO

In this manuscript, we describe a rare case of neuroendocrine tumour metastatic to the testicle, presenting with testicular mass as an isolated symptom. We describe the investigations and management leading us to this uncommon histological diagnosis and explore its significance and impact on further management.


Assuntos
Tumores Neuroendócrinos , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/cirurgia , Testículo/patologia , Colectomia , Humanos , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/secundário , Orquiectomia , Compostos Organometálicos , Tomografia por Emissão de Pósitrons , Neoplasias Testiculares/patologia , Ultrassonografia
2.
Urologe A ; 60(3): 337-343, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33427889

RESUMO

BACKGROUND: The prognostic classification system of the International Germ Cell Cancer Cooperative Group (IGCCCG) for testicular germ cell tumors is based on the histological subtype, location of the primary tumor, extent of metastatic spread and prechemotherapy tumor marker serum concentrations. OBJECTIVES: In this study, we aim to identify whether the use of preorchiectomy instead of prechemotherapy tumor marker serum concentration has an impact on IGCCCG risk group assignment. MATERIALS AND METHODS: We performed a retrospective analysis including 135 patients with metastasized testicular germ cell tumors. Analysis of the clinical information with a focus on the tumor marker serum concentration preorchiectomy and prechemotherapy was performed, thus leading to the grouping of patients according to IGCCCG risk group assignment. RESULTS: Using preorchiectomy instead of prechemotherapy tumor markers led to an incorrect IGCCCG risk group classification in 8% (11/135) of all patients, and consequently to a non-guideline concordant treatment. Up-staging was observed in 8 of 11 patients, representing 6% (8/135) of the total patient cohort. Three of the 11 misclassified patients showed a down-staging and thus describe 2% (3/135) of the total patient cohort. CONCLUSIONS: Using preorchiectomy tumor markers instead of prechemotherapy serum concentration might lead to an incorrect IGCCCG risk group assignment as well as non-guideline concordant treatment. Consequently, prechemotherapy tumor marker serum concentration should be applied for guideline concordant staging of patients.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Neoplasias Testiculares , Biomarcadores Tumorais , Consenso , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/cirurgia , Prognóstico , Estudos Retrospectivos , Neoplasias Testiculares/cirurgia
3.
J Thorac Cardiovasc Surg ; 161(3): 856-868.e1, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33478834

RESUMO

OBJECTIVE: Men with metastatic nonseminomatous germ cell tumors (NSGCTs) often present with residual chest tumors after chemotherapy. We examined the pathologic concordance of intrathoracic disease and outcomes based on the worst pathology of disease resected at first thoracic surgery. METHODS: A retrospective analysis was performed of consecutive patients undergoing thoracic resection for metastatic NSGCT in our institution between 2005 and 2018. RESULTS: Eighty-nine patients (all men) were included. The median age was 29 years (interquartile range [IQR], 23-35 years). Primary sites were testis (n = 84; 94.4%) and retroperitoneum (n = 5; 5.6%). Eighty-seven patients received chemotherapy before undergoing surgery. Nineteen patients (21.3%; group 1) had malignancy resected at first surgery (OR1), and the other 70 patients had benign disease at OR1 (78.7%; group 2). Concordant pathology between lungs was 85.2% in group 1 and 91% in group 2, and between lung and mediastinum was 50% in group 1 and 72.7% in group 2. Despite no teratoma at OR1, 3 patients (15.8%) in group 2 had resection of teratoma (n = 2) or malignancy (n = 1) at future surgery. After a mean follow-up of 65.5 months (IQR, 23.1-89.2 months) for group 1 and 47.7 months (IQR, 13.0-75.1 months) for group 2, overall survival was significantly worse for group 1 (68.4% vs 92.9%; P = .03). CONCLUSIONS: The wide range of pathology resected in patients with intrathoracic NSGCT metastases requires careful decision making regarding treatment. Pathologic concordance between lungs is better than that between lung and mediastinum in patients with intrathoracic NSGCT metastases. Aggressive surgical management should be considered for all residual disease due to the low concordance between sites and the potential for excellent long-term survival even in patients with chemotherapy-refractory disease.


Assuntos
Neoplasias Pulmonares/cirurgia , Neoplasias do Mediastino/cirurgia , Metastasectomia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Neoplasias Testiculares/cirurgia , Procedimentos Cirúrgicos Torácicos , Adulto , Biópsia , Quimioterapia Adjuvante , Tomada de Decisão Clínica , Humanos , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Masculino , Neoplasias do Mediastino/mortalidade , Neoplasias do Mediastino/secundário , Metastasectomia/efeitos adversos , Metastasectomia/mortalidade , Terapia Neoadjuvante , Neoplasia Residual , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/secundário , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/patologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Procedimentos Cirúrgicos Torácicos/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
5.
BMC Med Inform Decis Mak ; 20(1): 337, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33317510

RESUMO

BACKGROUND: Different from adult clinical stage I (CS1) testicular cancer, surveillance has been recommended for CS1 pediatric testicular cancer. However, among high-risk children, more than 50% suffer a relapse and progression during surveillance, and adjuvant chemotherapy needs to be administered. Risk-adapted treatment might reduce chemotherapy exposure among these children. METHODS: A decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as the relapse rates of different groups during surveillance or after chemotherapy were collected from the literature. A survey of urologists was conducted to evaluate the toxicity of first-line and second-line chemotherapy. Using the decision analysis model, chemotherapy exposure of the risk-adapted treatment and surveillance strategies were compared based on this series of clinical utilities. One-way and two-way tests were applied to check the feasibility. RESULTS: In the base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment resulted in a lower exposure to chemotherapy than surveillance (average: 0.7965 cycles verse 1.3419 cycles). The sensitivity analysis demonstrated that when the relapse rate after primary chemotherapy was ≤ 0.10 and the relapse rate of the high-risk group was ≥ 0.40, risk-adapted treatment would result in a lower exposure to chemotherapy, without any association with the proportion of low-risk patients, the relapse rate of the low-risk group, the relapse rate after salvage chemotherapy or the toxicity utility of second-line chemotherapy compared to first-line chemotherapy. CONCLUSIONS: Based on the decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients, and an evaluation after orchiectomy was critical to this process. Additional clinical studies are needed to validate this statement.


Assuntos
Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante/métodos , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Criança , Técnicas de Apoio para a Decisão , Humanos , Masculino , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia/efeitos adversos , Orquiectomia/métodos , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 99(36): e22085, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899084

RESUMO

RATIONALE: Testicular tumors represent 1% to 1.5% of all tumors in men. Those derived from Leydig cells are rare and account for 1% of testicular tumors. Leydig tumor cells can produce steroid hormones such as estrogen, progesterone and testosterone. The amount and type of hormones secreted by these tumors may produce complicated clinical characteristics in these patients. PATIENT CONCERNS: Here, we report a patient with azoospermia, a testicular Leydig cell tumor (LCT), and elevated plasma testosterone levels. We describe the diagnostic and therapeutic experience of this case, and our follow-up of the patient's clinical indicators and fertility status. DIAGNOSIS: The patient was diagnosed with azoospermia and a testicular LCT. INTERVENTIONS: The patient underwent testicular tumor removal and long-term follow-up. OUTCOMES: After 4 months of follow-up, the patient's semen examination index significantly improved and his wife became naturally pregnant. At 4 months of gestation, the fetus was delivered because of a ruptured amniotic cavity. Twenty-six months after tumor removal, the patient's sex hormone levels had completely returned to normal and spermatogenic function had partially recovered, but there was no natural pregnancy with his partner. CONCLUSION: For LCTs, testis sparing surgery may provide a safe and feasible option to restore spermatogenic function, although longer-term follow-up is required. Drug assistance may be required to maintain spermatogenic function and achieve fertility, and further research is required.


Assuntos
Azoospermia/complicações , Tumor de Células de Leydig/complicações , Neoplasias Testiculares/complicações , Adulto , Humanos , Tumor de Células de Leydig/patologia , Tumor de Células de Leydig/cirurgia , Masculino , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Testosterona/sangue
7.
Actas urol. esp ; 44(7): 469-476, sept. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-199424

RESUMO

INTRODUCCIÓN Y OBJETIVOS: La incidencia del cáncer testicular ha aumentado en los últimos años, pero gracias a las mejoras en el tratamiento las tasas de mortalidad han disminuido. Aunque las características primarias del tumor y los marcadores tumorales séricos son relevantes en términos de metástasis y recurrencia, su valor predictivo no es fiable. Por lo tanto, se requieren nuevos biomarcadores predictivos y pronósticos. El objetivo de nuestro estudio fue investigar el rol del valor preoperatorio de la relación albúmina/globulina (RAG) en la predicción de la propagación a los ganglios linfáticos retroperitoneales (GLRP) y la metástasis a distancia, así como en el pronóstico del cáncer testicular. MATERIAL Y MÉTODOS: Analizamos retrospectivamente los expedientes médicos de todos los pacientes que recibieron orquiectomía inguinal radical en nuestro hospital entre 2007 y 2018. La RAG se calculó mediante la ecuación: RAG = albúmina sérica/(proteína sérica total−albúmina sérica). El valor predictivo de la RAG para la propagación de los GLRP y la metástasis a distancia se evaluó mediante el análisis de las características operativas del receptor y su valor pronóstico se evaluó mediante el análisis de supervivencia de Kaplan-Meier. RESULTADOS: Un total de 115 pacientes fueron incluidos en el estudio, con una media de edad de 33,4±7,7 años. En el análisis multivariante se detectaron valores de la RAG inferiores a 1,47 y la presencia de invasión linfovascular como factores predictivos de la diseminación a los GLRP y la metástasis a distancia. El valor de la RAG de los pacientes fallecidos era significativamente menor que el de la RAG de los que seguían vivos: 1± 0,2 vs. 1,6± 0,3 (p = 0,001). En el análisis de supervivencia de Kaplan-Meier el tiempo medio de supervivencia de los pacientes con mayor RAG (> 1,47) fue mayor que el de los pacientes con menor RAG (< 1,47). CONCLUSIONES: El valor preoperatorio de la RAG puede usarse como biomarcador para predecir la propagación a los GLRP y la metástasis a distancia y para el pronóstico del cáncer testicular


INTRODUCTION AND OBJECTIVES: In recent years, the incidence of testicular cancer has increased, but mortality rates have decreased thanks to the improvements in treatment. Although primary tumor characteristics and serum tumor markers are associated with metastasis and relapse, their predictive value is not reliable. Therefore, there is a need for new biomarkers that predict prognosis. In this study, we aimed to investigate the role of preoperative albumin to globulin ratio (AGR) in predicting retroperitoneal lymph node (RPLN) involvement, distant metastasis and prognosis in testicular cancer. MATERIAL AND METHODS: We retrospectively analyzed the medical records of all patients that underwent radical inguinal orchiectomy at our hospital between 2007 and 2018. AGR was calculated using the equation: AGR=serum albumin/(serum total protein−serum albumin). The predictive value of AGR for RPLN involvement and distant metastasis was evaluated using receiver operating characteristic analysis and its prognostic value was evaluated using Kaplan-Meier survival analysis. RESULTS: A total of 115 patients with a mean age of 33.4± 7.7 years were included in the study. In multivariate analysis, AGR less than 1.47 and the presence of lymphovascular invasion were detected as the factors predicting RPLN involvement and distant metastasis. The AGR of patients who had died was significantly lower than AGR of those who were alive, 1± 0.2 versus 1.6± 0.3 (P = .001). In Kaplan-Meier survival analysis, the mean survival of patients with higher AGR (> 1.47) was found longer than patients with lower AGR (< 1.47). CONCLUSIONS: Preoperative AGR is a biomarker that may be used in predicting RPLN involvement, distant metastasis and prognosis in testicular cancer


Assuntos
Humanos , Masculino , Adulto , Albumina Sérica/análise , Soroglobulinas/análise , Neoplasias Testiculares/sangue , Neoplasias Testiculares/cirurgia , Metástase Linfática , Valor Preditivo dos Testes , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Neoplasias Testiculares/patologia
8.
Hinyokika Kiyo ; 66(6): 171-176, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32605355

RESUMO

A 49-year-old male visited our department of gastroenterology with chief complaints of blackish feces and ill complexion in February 1997. Computed tomography (CT) revealed a right retroperitoneal tumor, which was removed the same month. Histopathological examination showed teratoma and yolk sac tumor. He was diagnosed with primary retroperitoneal extragonadal germ cell tumor, and received three cycles of chemotherapy (bleomycin/etoposide/cisplatin ; BEP) starting in March 1997. Periodic imaging and determination of tumor markers (α fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase) showed no recurrence or metastasis for five years after treatment. After his visit in April 2002 he stopped visiting our outpatient ward. In November 2017, the patient visited our department with chief complaints of indolent right scrotum enlargement and a right inguinal mass. Past history showed that he had undergone hydrocele of the right testicle in August 1999. Contrast enhanced CT showed a 35-mm contrast effect with uneven contents in the right testis, and enlarged nodes that were suspicious of metastases in the right inguinal and right external iliac lymph nodes. All tumor markers were within the normal ranges. He underwent right high orchiectomy and resection of the right inguinal lymph nodes in the same month. Histopathological findings revealed seminoma (pT1, pN2, M0, S0, and clinical Stage IIA). He received postoperative chemotherapy starting in January 2018 ; one cycle of BEP therapy and three cycles of etoposide and cisplatin (EP) therapy. Post-chemotherapeutic CT confirmed clinical complete response at the right external iliac lymph nodes, and this response was confirmed 12 months later. Neither recurrence nor metastasis has occurred so far.


Assuntos
Neoplasias Embrionárias de Células Germinativas , Neoplasias Retroperitoneais , Neoplasias Testiculares/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica , Bleomicina , Cisplatino/uso terapêutico , Etoposídeo/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Orquiectomia
10.
Arch Esp Urol ; 73(5): 390-394, 2020 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-32538809

RESUMO

OBJECTIVES: To provide a priority algorithm for determinate diagnostic, therapeutic and follow-up procedures regarding at testicular cancer, adjusted by institutional requirements. Testicular cancer patient assessment during COVID-19 Pandemia. MATERIAL AND METHODS: Review of relevant manuscript published up to date, draft creation correctedt hough modified nominal group until final corrected manuscript. RESULTS: A lack of scientific evidence exists through a large amount of manuscripts. The authors support prioritizing diagnostic and therapeutic procedures. Once priorities have been established, that will facilitate providing each patients the limited resources. Initial diagnostic procedures for testicular cancer such as scrotal US, orchiectomy, staging CT and adjuvant treatment (if required) are priority. Reducing the usage of chemotherapy with respiratory toxicity and increasing the usage ofgrowth factors during chemotherapy treatment are the main stakeholders of treatment. Besides, providing active surveillance on non-risk factor clinical stage I is alsoa priority. In case of positive COVID-19, it is important to high light that the vast majority of patients are tentatively cured. CONCLUSIONS: During de-escalation phases, patients diagnosed with testicular cancer should receive priority care during initial assessment. The follow-ups of patients with low -risk and without recurrence for a long time, might be delayed.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Neoplasias Testiculares , Betacoronavirus , Quimioterapia Adjuvante , Infecções por Coronavirus/epidemiologia , Humanos , Excisão de Linfonodo , Masculino , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Orquiectomia , Pneumonia Viral/epidemiologia , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/cirurgia
12.
Crit Rev Oncol Hematol ; 150: 102946, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32353705

RESUMO

The presence of brain metastases (BMs) from germ cell tumor (GCT) remains a rare situation. BMs predominantly occur among patients with testis primary tumor site, and are almost exclusively associated with non-seminomatous (NS) histologies. Two situations must be distinguished, which differ in terms of clinical presentation, overall prognostic and management. At diagnosis, BMs are almost systematically associated with extra-cerebral metastases and the cornerstone of treatment is chemotherapy, while the role of local treatment remains controversial. In the metachronous setting, BMs more frequently constitute an isolated site of relapse, the outcome is poorer, and the role of local treatment is more consensual. However, all these data widely come from old reports, with outdated radiation techniques. The recent advances in radiation oncology, especially the rising use of stereotactic radiotherapy, could lead to the reconsideration of ancient dogmas regarding the "radiosensitivity" of (NS)GCT and the role of radiotherapy among patients with BMs.


Assuntos
Neoplasias Encefálicas/cirurgia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Radiocirurgia , Neoplasias Testiculares/cirurgia , Neoplasias Encefálicas/patologia , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Embrionárias de Células Germinativas/patologia , Estudos Retrospectivos , Neoplasias Testiculares/patologia , Resultado do Tratamento
14.
Eur J Cancer ; 132: 127-135, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32361383

RESUMO

BACKGROUND: The prognostic role of human chorionic gonadotropin (hCG) and lactate dehydrogenase (LDH) serum levels in seminoma patients remains uncertain. This observational study evaluates the prognostic impact of tumour marker levels, and other clinicopathological findings, in hCG-positive seminoma patients. METHODS: Seminoma patients with serum hCG levels above normal at first diagnosis were eligible for recruitment. Statistical analysis, including multivariate regression, was performed to identify risk factors. Primary end-points were overall survival (OS) and recurrence-free survival (RFS). RESULTS: We recruited 1031 hCG-positive patients (stage I: n = 586; stage II + III: n = 427) diagnosed between 1981 and 2018. In metastatic disease, LDH levels ≥3 above upper normal limit (UNL) pre- (n = 109) or post-orchiectomy (n = 73) and patients aged ≥40 years (n = 187) were associated with poor prognosis: 5-year OS rates of 84% (LDH ≥3 UNL pre-orchiectomy) versus 92% (<3 UNL pre-orchiectomy) (hazard ratio [HR]: 3.155, [95% confidence interval {CI}: 1.28-7.75], P = 0.012), 82% (≥3 UNL post-orchiectomy) versus 92% (<3 UNL post-orchiectomy) (HR: 6.877, [95% CI: 1.61-29.34]; P = 0.009) and 86% (≥40 years) versus 91% (<40 years) (HR: 6.870, [95% CI: 1.45-13.37], P = 0.009), respectively. A subset of patients with hCG levels ≥2000 IU/l pre-orchiectomy (n = 17) exhibited a poor prognosis, with 5-year OS rates of 73% (≥2000 IU/l) versus 94% (<2000 IU/l) (HR: 3.936, [95% CI: 1.02-12.61], P = 0.047). CONCLUSIONS: Age and LDH levels are significantly associated with poor prognosis in hCG-positive seminoma patients. A small number of patients, with levels of hCG ≥2000 IU/l, may represent a separate prognostic subgroup associated with impaired survival rates.


Assuntos
Gonadotropina Coriônica/metabolismo , Neoplasias Embrionárias de Células Germinativas/mortalidade , Orquiectomia/mortalidade , Sistema de Registros/estatística & dados numéricos , Seminoma/mortalidade , Neoplasias Testiculares/mortalidade , Adulto , Seguimentos , Humanos , Masculino , Neoplasias Embrionárias de Células Germinativas/metabolismo , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Prognóstico , Estudos Retrospectivos , Seminoma/metabolismo , Seminoma/patologia , Seminoma/cirurgia , Taxa de Sobrevida , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia
15.
Bull Cancer ; 107(6): 666-671, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32303361

RESUMO

Paratesticular Rhabdomyosarcoma accounts for 7 to 11% of pediatric rhabdomyosarcomas. Children older than 10 years have a worse event-free survival (69 to 80% vs. 87 to 92%) than children younger than 10 years. In this location, the relapses are essentially in the retroperitoneal lymph nodes and are often fatal. In European protocols, the assessment of the retroperitoneal lymph nodes at diagnosis is made by imaging whereas it is performed by retroperitoneal lymph node dissection in the American protocols. This method has been proved to improve event-free survival in the group of patient older than 10 years with a tumour bigger than 5cm. In the next European protocol, when nodes will be enlarged a surgical biopsy will be performed, this will be irrespective of age or size, and when no nodes will be enlarged in patients older than 10 years, retroperitoneal lymph node assessment will be performed. Other techniques of lymph nodes assessment will be tested like sentinel node biopsies or PET-scan.


Assuntos
Metástase Linfática/patologia , Rabdomiossarcoma/secundário , Neoplasias Testiculares/patologia , Criança , Intervalo Livre de Doença , Humanos , Excisão de Linfonodo , Masculino , Espaço Retroperitoneal , Rabdomiossarcoma/cirurgia , Neoplasias Testiculares/cirurgia
16.
Urologe A ; 59(9): 1092-1094, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32248276

RESUMO

We report about the rare occurrence of symptomatic testicular metastasis of an acinar adenocarcinoma of the prostate. Testicular metastases are usually incidentally detected in patients treated with bilateral orchiectomy or more often during autopsy. In the literature, there are only a few clinical cases describing symptomatic testicular metastases. However, the possibility of such metastases should be considered in patients diagnosed with advanced prostate cancer. Testicular examination should be performed regularly, even in patients with low prostate-specific antigen levels.


Assuntos
Adenocarcinoma/secundário , Carcinoma de Células Acinares/patologia , Neoplasias da Próstata/patologia , Neoplasias Testiculares/secundário , Células Acinares , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Carcinoma de Células Acinares/cirurgia , Humanos , Masculino , Orquiectomia , Neoplasias da Próstata/cirurgia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia
18.
Curr Opin Oncol ; 32(3): 250-255, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32168037

RESUMO

PURPOSE OF REVIEW: Although testicular cancer remains a highly curable malignancy, challenges and uncertainty still remain in certain aspects of management. Residual disease after chemotherapy in patients with germ cell tumors (GCT) remains one of these challenges. We aim to highlight the recent literature on the management of residual disease after chemotherapy in GCT and the emerging innovations that may provide further guidance into this area. RECENT FINDINGS: A subset of patients with GCT will have residual disease after chemotherapy, and management of these patients involves highly skilled multidisciplinary experts including medical oncologists, surgeons, radiologists, and pathologists. Management options depend on histologic subtype, either seminoma or nonseminoma, and involve size criteria, possible further imaging modalities, and tumor markers. Even with these tools at highly specialized expert centers, uncertainty in management remains, and recent literature has explored the use of newer biomarkers to aid in these cases. SUMMARY: Postchemotherapy residual masses in GCT can prove to be complicated cases to manage. Balancing survival with quality of life outcomes is important and requires a multidisciplinary team experienced in treating GCT.


Assuntos
Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Biomarcadores Tumorais/sangue , Humanos , Masculino , Neoplasia Residual/sangue , Neoplasia Residual/patologia , Neoplasia Residual/cirurgia , Neoplasias Embrionárias de Células Germinativas/sangue , Neoplasias Embrionárias de Células Germinativas/cirurgia , Seminoma/sangue , Seminoma/tratamento farmacológico , Seminoma/patologia , Seminoma/cirurgia , Neoplasias Testiculares/sangue , Neoplasias Testiculares/cirurgia
19.
J Robot Surg ; 14(6): 865-870, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32200542

RESUMO

The objective of this study is to determine recent trends in use of robotics and laparoscopy for pediatric retroperitoneal lymph-node dissection (RPLND) in pediatric and non-pediatric hospitals. We conducted a retrospective cohort study using data from 29 hospitals in the Pediatric Health Information System (PHIS), and data from 14 states in the State Inpatient Databases (SID), between 2008 and 2014. The study population was comprised of patients aged ≥ 10 years undergoing RPLND, with an inpatient diagnosis of testicular or paratesticular cancer, based on international classification of disease (ICD) codes. Robotic approach was identified by the presence of an ICD procedure code modifier. During the study period, a total of 90 RPLNDs were performed in pediatric hospitals (median patient age 16 years). Of these, 4 (4.4%) were performed robotically. A total of 3120 RPLNDs were performed in non-pediatric hospitals (median patient age: 32 years). Among these, 269 (8.6%) were performed robotically, with an increasing trend in the use of robotic RPLND (adjusted annual increase in probability of undergoing robotic vs. open procedure: 16%; 95% CI 8-24). Undergoing robotic RPLND was associated with a reduction in postoperative length of stay of 3.5 days (95% CI 2.9, 4.1). Open surgical approaches comprise the vast majority of RPLNDs performed at pediatric hospitals. This is in contrast with trends in non-pediatric hospitals where robotic RPLND is being increasingly utilized. Future research is necessary to investigate this discrepancy in adopting minimally invasive techniques for RPLND in pediatric centers.


Assuntos
Hospitais Pediátricos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Neoplasias Embrionárias de Células Germinativas/cirurgia , Espaço Retroperitoneal/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Testiculares/cirurgia , Adolescente , Adulto , Estudos de Coortes , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Urologe A ; 59(3): 278-283, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32020239

RESUMO

In prepubertal boys, testicular tumors are rare with an incidence between 2 and 5/million. In contrast to testicular tumors in adolescents and adults, more than 2/3 of these tumors are benign. Unfortunately, in Germany in most cases, only malignant tumors (usually yolk sac tumors) are reported to the study center (MAKEI IV and now V). Therefore, the incidence in Germany is unknown. Since the introduction of polychemotherapy in the 1970s, the prognosis of malignant testicular tumors has improved enormously and has become a curable disease, even in the case of recurrence. Today the orchiectomy, which was usually carried out in the past, appears to be no longer justified in most prepubertal boys due to the high incidence of benign tumors. It has been shown in various studies that organ-sparing surgery in germ cell tumors (epidermoid cysts, teratoma); gonadal stoma tumors (Sertoli, Leydig and granulosa cell tumors) and cystic lesions (intratesticular cysts and tubular ectasia of the rete testis) is reliable and safe. In cases with preoperative significantly increased AFP (caution: norm values not valid in the first year of life) and a clear testicular tumor in the ultrasound (yolk sac tumor) or if no testicular parenchyma is sonographically detectable, orchiectomy can still be carried out. Today orchiectomies in prepubertal boys should be an exception and the reasons for an orchiectomy must be well documented.


Assuntos
Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Preservação de Órgãos , Neoplasias Testiculares/cirurgia , Adolescente , Biomarcadores Tumorais , Alemanha , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Testiculares/patologia
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