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1.
Medicine (Baltimore) ; 99(40): e22530, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019456

RESUMO

RATIONALE: Ovotesticular disorder of sex development (DSD), previously known as true hermaphroditism, is a disorder in which individuals have both testicular and ovarian tissues. Instances of tumors arising in the gonads of individuals with 46,XX ovotesticular DSD are uncommon. PATIENT CONCERNS: We report a case of a 36-year-old phenotypical male with a chief complaint of an abdominal mass for 3 months. He reported normal erections and regular menses. Computerized tomography showed a large tumor measuring 15 × 10 cm in size, a uterus, and a cystic ovary. DIAGNOSIS: 46, XX ovotesticular DSD with seminoma. INTERVENTIONS: The patient was treated with neochemotherapy (etoposide and cisplatin), surgery, chemotherapy, and testosterone replacement. OUTCOMES: At the 13-month follow-up, the patient reported satisfactory erections, and no evidence of disease was found. CONCLUSION: Cases of 46,XX ovotesticular DSD with seminoma are uncommon. Our case reveals the importance of surgery combined with neochemotherapy, chemotherapy, and testosterone replacement in these patients to improve the prognosis.


Assuntos
Transtornos Ovotesticulares do Desenvolvimento Sexual/complicações , Seminoma/complicações , Neoplasias Testiculares/complicações , Adulto , Humanos , Masculino , Transtornos Ovotesticulares do Desenvolvimento Sexual/diagnóstico , Transtornos Ovotesticulares do Desenvolvimento Sexual/patologia , Seminoma/patologia , Seminoma/terapia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia
2.
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
3.
Rev. clín. med. fam ; 13(1): 76-80, feb. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-193917

RESUMO

Los tumores de células de Leydig son raros y suponen una pequeña proporción de neoplasias testiculares (1-3 %). La forma más frecuente de presentación es una masa indolora testicular o un hallazgo ecográfico incidental acompañado en más del 80 % de los casos de desórdenes hormonales. Los marcadores tumorales séricos son negativos y aproximadamente el 30 % de los casos presentan ginecomastia. El tratamiento de elección es la cirugía (orquiectomía ingui-nal) y el seguimiento postoperatorio será prolongado. El diagnóstico definitivo es histológico y se realizará durante o tras la cirugía. Entre los marcadores inmunohistológicos de tumores de células de Leydig se incluyen alfa inhibina, calretinina y melan A. La presencia de la subunidad alfa de inhibina mediante técnica de inmunohistoquímica, destaca la intensa positividad de las células tumorales en comparación con la del tejido sano circundante. La calretinina es más sensible pero menos específica que la inhibina. Melan A es un marcador moderadamente sensible y específico en la diferenciación de tumores del estroma del cordón sexual y como tal es un valor complementario a otros marcadores inmunohistoquímicos en la valoración de tumores de difícil diagnóstico. El interés de este caso es mostrar la complejidad de alteraciones clínicas asociadas a estos tumores, así como establecer un diagnóstico diferencial con otros tumores histológicos


Leydig cell tumors are rare and account for a small proportion of testicular neoplasms (1-3%). They most frequently present as a painless testicular mass or as an incidental ultrasound finding, accompanied by hormonal disorders in more than 80% of cases. Serum tumor markers are negative and approximately 30% of cases present gynecomastia. The treatment of choice is surgery (inguinal orchiectomy) with a long post-operative follow-up. The definitive diagnosis is histological, which will be carried out during or after surgery. The immunohistochemical markers of Leydig cell tumors include inhibin alpha, calretinin, and melan-A. The presence of the inhibin alpha subunit in immunohistochemical analysis shows intense positivity of tumor cells compared with the surrounding healthy tissue. Calretinin is more sensitive but less specific than inhibin. Melan-A is a moderately sensitive and specific marker of sex cord-stromal tumors, and, as such, complements other immunohistochemical markers in the assessment of tumors which are difficult to diagnose. The interest of this case is to show the complex pattern of clinical presentation of these tumors, and to establish a differential diagnosis with other testicular tumors


Assuntos
Humanos , Masculino , Adulto Jovem , Ginecomastia/diagnóstico , Hipoadrenocorticismo Familiar/diagnóstico , Hipogonadismo/diagnóstico , Neoplasias Testiculares/patologia , Tumor de Células de Leydig/patologia , Diagnóstico Diferencial , Varicocele/diagnóstico , Seminoma/patologia
4.
J Urol ; 204(1): 96-103, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32003612

RESUMO

PURPOSE: We analyzed the oncologic outcomes of men undergoing primary retroperitoneal lymph node dissection and characterized the use of adjuvant chemotherapy and template dissections. MATERIALS AND METHODS: Retrospective review of the Indiana University testis cancer database identified patients who underwent primary retroperitoneal lymph node dissection between January 2007 and December 2017. Patients and providers were contacted to obtain information regarding adjuvant therapy, recurrence and survival. The primary outcome was recurrence-free survival. Kaplan-Meier curves assessed survival differences stratified by pathological stage, template of dissection and use of adjuvant chemotherapy. RESULTS: A total of 274 patients were included in the study. Most men presented with clinical stage I disease (214, 78%). A modified unilateral template was performed in 257 (94%) and bilateral template in 17 (6%). Overall 148 (54%) and 126 (46%) men had pathological stage (PS) I and PS-II disease, respectively. Thirteen patients (10%) with PS-II disease were treated with adjuvant chemotherapy. With a median followup of 55 months only 33 (12%) patients had recurrence. Of the 113 patients with PS-II disease who did not receive chemotherapy 21 (19%) had disease relapse and 81% were cured with surgery alone and never had recurrence. No difference in recurrence-free survival was noted between modified and bilateral template dissections. CONCLUSIONS: The use of adjuvant chemotherapy has been minimal during the last decade. The majority (81%) of men with PS-II disease were cured with retroperitoneal lymph node dissection alone and were able to avoid chemotherapy. Modified unilateral template dissection provided excellent oncologic control while minimizing morbidity.


Assuntos
Quimioterapia Adjuvante/estatística & dados numéricos , Excisão de Linfonodo , Espaço Retroperitoneal/cirurgia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Adulto , Seguimentos , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/terapia , Espaço Retroperitoneal/patologia , Estudos Retrospectivos , Seminoma/mortalidade , Seminoma/patologia , Seminoma/terapia , Teratoma/mortalidade , Teratoma/patologia , Teratoma/terapia , Neoplasias Testiculares/mortalidade
6.
Int J Cancer ; 146(6): 1592-1605, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31583686

RESUMO

Embryonal carcinomas (ECs) and seminomas are testicular germ cell tumors. ECs display expression of SOX2, while seminomas display expression of SOX17. In somatic differentiation, SOX17 drives endodermal cell fate. However, seminomas lack expression of endoderm markers, but show features of pluripotency. Here, we use chromatin immunoprecipitation sequencing to report and compare the binding pattern of SOX17 in seminoma-like TCam-2 cells to SOX17 in somatic cells and SOX2 in EC-like 2102EP cells. In seminoma-like cells, SOX17 was detected at canonical (SOX2/OCT4), compressed (SOX17/OCT4) and noncomposite SOX motifs. SOX17 regulates TFAP2C, PRDM1 and PRDM14, thereby maintaining latent pluripotency and suppressing somatic differentiation. In contrast, in somatic cells canonical motifs are rarely bound by SOX17. In sum, only 12% of SOX17-binding sites overlap in seminoma-like and somatic cells. This illustrates that binding site choice is highly dynamic and cell type specific. Deletion of SOX17 in seminoma-like cells resulted in loss of pluripotency, marked by a reduction of OCT4 protein level and loss of alkaline phosphatase activity. Furthermore, we found that in EC-like cells SOX2 regulates pluripotency-associated genes, most likely by partnering with OCT4. In conclusion, SOX17 (in seminomas) functionally replaces SOX2 (in ECs) to maintain expression of the pluripotency cluster.


Assuntos
Carcinoma Embrionário/genética , Neoplasias Embrionárias de Células Germinativas/genética , Fatores de Transcrição SOXB1/metabolismo , Fatores de Transcrição SOXF/metabolismo , Seminoma/genética , Neoplasias Testiculares/genética , Animais , Carcinoma Embrionário/patologia , Diferenciação Celular/genética , Linhagem Celular Tumoral , Sequenciamento de Cromatina por Imunoprecipitação , Proteínas de Ligação a DNA/genética , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Camundongos , Neoplasias Embrionárias de Células Germinativas/patologia , Fator 1 de Ligação ao Domínio I Regulador Positivo/genética , Proteínas de Ligação a RNA/genética , Seminoma/patologia , Neoplasias Testiculares/patologia , Fator de Transcrição AP-2/genética , Fatores de Transcrição/genética , Ativação Transcricional/genética , Ensaios Antitumorais Modelo de Xenoenxerto
7.
Int J Mol Sci ; 21(1)2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31877678

RESUMO

In this study, we describe the identification of a novel splice variant of TERF1/PIN2, one of the main components of the telomeric shelterin complex. This new splice variant is identical to TERF1, apart from a 30 amino acid internal insertion near to the C-terminus of TERF1. Based on genome comparison analyses and RNA expression data, we show that this splice variant is conserved among hominidae but absent from all other species. RNA expression and histological analyses show specific expression in human spermatogonial and hematopoietic stem cells (HSCs), while all other analyzed tissues lack the expression of this TERF1-isoform, hence the name TERF1-tsi (TERF1-tissue-specific-isoform). In addition, we could not detect any expression in primary human cells and established cancer cell lines. Immunohistochemistry results involving two new rabbit polyclonal antibodies, generated against TERF1-tsi specific peptides, indicate nuclear localization of TERF1-tsi in a subset of spermatogonial stem cells. In line with this observation, immunofluorescence analyzes in various cell lines consistently revealed that ectopic TERF1-tsi localizes to the cell nucleus, mainly but not exclusively at telomeres. In a first attempt to evaluate the impact of TERF1-tsi in the testis, we have tested its expression in normal testis samples versus matched tumor samples from the same patients. Both RT-PCR and IHC show a specific downregulation of TERF1-tsi in tumor samples while the expression of TERF1 and PIN2 remains unchanged.


Assuntos
Regulação para Baixo , Seminoma/genética , Proteínas de Ligação a Telômeros/genética , Neoplasias Testiculares/genética , Animais , Linhagem Celular Tumoral , Regulação Neoplásica da Expressão Gênica , Células HEK293 , Humanos , Masculino , Camundongos , Isoformas de Proteínas/análise , Isoformas de Proteínas/genética , Seminoma/patologia , Telômero/genética , Telômero/patologia , Proteínas de Ligação a Telômeros/análise , Neoplasias Testiculares/patologia , Testículo/metabolismo , Testículo/patologia
8.
Medicine (Baltimore) ; 98(45): e17937, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702681

RESUMO

Magnetic resonance imaging (MRI) has excellent soft tissue resolution, as well as multidirectional and multisequence scanning technology, making it an important supplementary method in the diagnosis of testicular tumor.To explore the utility of preoperative MRI for the differential diagnosis of testicular seminoma and nonseminomatous germ cell tumors (NSGCTs).The medical records from 39 patients with testicular tumors that were examined preoperatively with MRI and treated with urologic surgery at our institution between January 2015 and March 2019 were retrospectively reviewed. Testicular tumors were confirmed by pathology and classified as seminoma (n = 20) or NSGCT (n = 19). Two radiologists analyzed the testicular tumors on preoperative MRI for morphology: multiple nodules or a single mass; presence/absence of a capsule; signal compared to the normal contralateral testicle (isointense, hypointense, hyperintense, or mixed); enhancement; septa; and hemorrhagic or cystic degeneration. Characteristics of seminomas and NSGCT were compared using the Chi-square or Fischer exact test.MRI showed that the majority (95%; 19/20) of seminomas were nodular. There were significant differences in the presence/absence of a capsule (P = .001), T1-weighted imaging (T1WI) signal intensity (P = .047), T2-weighted imaging (T2WI) signal intensity (P < .001), septa (P < .001), and hemorrhagic or cystic degeneration (P < .001) between seminomas and NSGCT.Seminomas were more likely to have no capsule, isointensity on T1WI, hypointensity on T2WI, and had narrow obviously enhanced fibrovascular septa without hemorrhagic or cystic degeneration; NSGCT was more likely to have a capsule, a mainly mixed signal on T1WI and T2WI, most of them had no fibrovascular septa, and hemorrhagic or cystic degeneration was common in malignant NSGCT.This study suggests that preoperative MRI can distinguish seminoma from NSGCT. We propose that preoperative MRI of the scrotum is an effective technique that should be widely adopted for the management of scrotal disease.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Seminoma/patologia , Neoplasias Testiculares/patologia , Adolescente , Adulto , Criança , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Período Pré-Operatório , Estudos Retrospectivos , Seminoma/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Adulto Jovem
9.
Crit Rev Oncol Hematol ; 143: 130-138, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31634730

RESUMO

Germ cell tumors (GCTs) are the most common type of solid tumor amongst patients between 15 and 35 years of age. They are also one of the types of tumor with the highest cure rate, due to their high sensitivity to cisplatin based chemotherapy. Nonetheless, around 15-20% of metastatic patients will not have curative options after a relapse on the first and second line. This proves that new therapeutic options for these refractory GCTs patients need to be developed. This article offers a bibliographic review of all studies using targeted treatment or immunotherapy for refractory GCTs patients.


Assuntos
Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adolescente , Adulto , Animais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Cisplatino/administração & dosagem , Humanos , Masculino , Terapia de Alvo Molecular , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Seminoma/tratamento farmacológico , Seminoma/patologia , Teratoma/tratamento farmacológico , Teratoma/patologia , Neoplasias Testiculares/patologia , Adulto Jovem
10.
Acta Histochem ; 121(8): 151442, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31540712

RESUMO

Telocytes (TCs), also known as CD34+ stromal/interstitial cells, have recently been identified within the connective tissue of a variety of organs including the normal human testis. Testicular TCs appear to constitute a widespread reticular network distributed either in the peritubular or in the intertubular stromal spaces where they have been suggested to play different roles, such as participation to testis morphogenesis, postnatal preservation of the normal tissue/organ three-dimensional structure, and regulation of spermatogenesis and androgen hormone secretion and release. Although increasing evidence indicates that TCs may be involved in the pathophysiology of various diseases, no study has yet reported possible changes in these cells within the stromal compartment of seminoma, one of the most frequent malignant testicular cancers in humans. Therefore, here we carried out the first investigation of the presence and tissue distribution of TCs/CD34+ stromal cells in human testicular seminoma in comparison with normal human testis using either CD34 immunohistochemistry or CD34/CD31 and CD34/α-smooth muscle actin (α-SMA) double immunofluorescence analyses. In seminoma tissue sections, we observed an overall loss of TCs (CD34+/CD31- stromal cells) accompanying a severe degeneration of the normal architecture of seminiferous tubules and stromal tissue associated with dense cellularity increase and presence of interstitial fibrosis. Noteworthy, in the seminoma tissue the disappearance of TCs was paralleled by an expansion of α-SMA+ myoid cells. Moreover, the CD34+/CD31+ blood vessel network was greatly expanded, while steroidogenic Leydig cells were undetectable in seminoma specimens. Since TCs are emerging as important regulators of tissue and organ homeostasis, collectively the present findings indicate that the possible pathophysiologic implications of the loss of TCs in human testicular seminoma should not be further overlooked.


Assuntos
Actinas/metabolismo , Antígenos CD34/metabolismo , Células Mieloides , Proteínas de Neoplasias/metabolismo , Seminoma , Telócitos , Neoplasias Testiculares , Adulto , Humanos , Masculino , Células Mieloides/metabolismo , Células Mieloides/patologia , Seminoma/metabolismo , Seminoma/patologia , Telócitos/metabolismo , Telócitos/patologia , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/patologia
12.
Folia Histochem Cytobiol ; 57(3): 139-145, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513277

RESUMO

INTRODUCTION: Testicular tumors are heterogeneous group of neoplasms divided mainly into two types: seminomas and non-seminomas. Nucleolin (NCL) and nucleophosmin (NPM) are abundant nucleolar proteins involved in many physiologic and pathologic processes including cancer. Their overexpression was found in many tumors but it was not studied in testicular cancer. MATERIAL AND METHODS: The study was performed on tissue microarrays of 19 seminomas, 21 embryonal carcinomas and 11 yolk sac tumors. The expression of NCL and NPM was detected with monoclonal antibodies and visualized with EnVision FLEX/HRP technique. Immunohistochemical reactions were measured with Aperio ImageScope Software and analyzed as means of percentages of all immunopositive cells in three groups of reaction intensity, i.e. 3+, 2+, and 1+ as well as of H-score. RESULTS: Seminomas showed higher expression of nucleolin indicated by higher H-score and higher percentage of positive cells than non-seminomas. The differences in subpopulations of NCL-positive cells were also found. Embryonal carcinomas and yolk sac tumors showed lower expression of NCL than seminomas indicated by H-score. The percentage of NCL-positive cells did not differ between embryonal carcinomas and seminomas while there were significant differences in subpopulations of cells. The percentage of NCL-positive cells in yolk sac tumors was lower than in seminomas. The results show different heterogeneity of subpopulations of NCL-positive cells in embryonal carcinomas and yolk sac tumors compared to seminomas. The analysis of nucleolin expression in embryonal carcinomas and yolk sac tumors showed no differences between these two tumor types. No differences in nucleophosmin expression between seminomas and non-seminomas were found. CONCLUSIONS: The differences in the expression of nucleolin between two groups of germ cell testicular tumors found in the current study indicate a new aspect of biology of these neoplasms and require further studies on the role of nucleolin in germ cell tumorigenesis.


Assuntos
Neoplasias Embrionárias de Células Germinativas/metabolismo , Proteínas Nucleares/metabolismo , Fosfoproteínas/metabolismo , Proteínas de Ligação a RNA/metabolismo , Seminoma/metabolismo , Neoplasias Testiculares/metabolismo , Adulto , Núcleo Celular/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/patologia , Seminoma/patologia , Neoplasias Testiculares/patologia , Testículo/metabolismo , Testículo/patologia , Adulto Jovem
13.
Clin Genitourin Cancer ; 17(5): e1026-e1035, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378580

RESUMO

BACKGROUND: We comprehensively tested contemporary incidence and mortality rates in patients with germ cell tumor of the testis (GCTT). MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2004-2015), statistical analyses included estimated annual percentage changes, multivariable logistic regression (MLR) models, Kaplan-Meier curves, and multivariable Cox regression (MCR) models. RESULTS: Of 13,114 GCTT patients, 7954 (60.6%) harbored seminoma germ cell tumors of the testis (SGCTT) and 5160 (39.4%) non-SGCTT (NSGCTT). Relative to SGCTT, NSGCTT patients harbored more advanced stage (for stage III 824 [16.0%] vs. 279 patients [3.5%]; P < .001). In MLR, higher rates of stage II/III affected those with never-married status (odds ratio [OR], 1.6; P < .001) and African American ethnicity (OR, 1.5; P = .005) for SGCTT and never-married (OR, 1.3; P = .002) and Hispanic ethnicity (OR, 1.3; P < .001) for NSGCTT. Significant differences in 5-year cancer-specific mortality (CSM) distinguished SGCTT (stage I: 0.4; stage II: 3.4; stage III: 11.4%; P < .001) from NSGCTT (stage I: 1.6; stage II: 2.5; stage III: 22.2%; P < .001). In MCR, unmarried status independently predicted higher CSM for SGCTT (hazard ratio [HR], 2.1; P = .007) and NSGCTT (HR, 1.9; P < .001). CONCLUSION: Stage I and stage III NSGCTT survival is worse, than for SGCTT. Never-married, Hispanic, and African American individuals are at higher risk of more advanced stage and/or CSM in SGCTT and NSGCTT.


Assuntos
Neoplasias Embrionárias de Células Germinativas/epidemiologia , Neoplasias Embrionárias de Células Germinativas/patologia , Seminoma/epidemiologia , Seminoma/patologia , Neoplasias Testiculares/epidemiologia , Neoplasias Testiculares/patologia , Adulto , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estadiamento de Neoplasias , Neoplasias Embrionárias de Células Germinativas/mortalidade , Programa de SEER , Seminoma/mortalidade , Fatores Socioeconômicos , Análise de Sobrevida , Neoplasias Testiculares/mortalidade , Estados Unidos/epidemiologia
14.
J Cancer Res Clin Oncol ; 145(9): 2335-2342, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31286241

RESUMO

PURPOSE: Clinical stage (CS) 1 testicular seminoma is cured in almost 100% of cases following either retroperitoneal radiotherapy, carboplatin monotherapy, or surveillance strategies. Little is known about potential long-term effects of carboplatin. We, therefore, examined late sequelae of this drug in seminoma patients. PATIENTS AND METHODS: We retrospectively identified 451 patients with CS1 testicular seminoma treated between 1994 and 2014, of whom 243 underwent carboplatin therapy [median follow-up (F/U) 96 months], 81 received radiotherapy (median F/U 142 months), and 127 underwent surveillance (median F/U 40 months). Satisfaction regarding management, as well as the following events during F/U, were analysed by questionnaire: subsequent malignant neoplasms (SMNs), cardiovascular events, arterial hypertension, peptic ulcer, tinnitus, peripheral neuropathy, hypogonadism, and infertility. The relative frequencies of the events were analysed using descriptive statistics. The frequency of observed SMNs was compared with the expected number. RESULTS: Patients receiving carboplatin tolerated the treatment less well (71.2%) than those under surveillance (81.9%). After carboplatin, 12 SMNs (5.0%) were noted vis-a-vis 5.0 expected. There were three cases of prostatic cancer and 3 melanomas among the SMNs. Half of these SMNs occurred early after treatment. Among the other health events, only reported hypogonadism (13.2%) appeared to be marginally increased in frequency. CONCLUSIONS: This study found a 2.4-fold higher than expected rate of SMN-and a slightly increased rate of hypogonadism-in the long-term period following carboplatin treatment. Although further studies are needed to confirm these preliminary findings, these results are probably informative for clinicians caring for seminoma patients.


Assuntos
Carboplatina/administração & dosagem , Seminoma/tratamento farmacológico , Seminoma/radioterapia , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/radioterapia , Adolescente , Adulto , Idoso , Carboplatina/efeitos adversos , Quimioterapia Adjuvante , Terapia Combinada , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Transtornos de Início Tardio/induzido quimicamente , Transtornos de Início Tardio/epidemiologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Segunda Neoplasia Primária/epidemiologia , Radioterapia Adjuvante , Estudos Retrospectivos , Seminoma/patologia , Neoplasias Testiculares/patologia , Resultado do Tratamento , Conduta Expectante , Adulto Jovem
15.
Urol Clin North Am ; 46(3): 399-407, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31277734

RESUMO

Seminoma is commonly diagnosed in young men, and it has therefore become a disease of long-term survivors. As the late toxic effects of radiation and chemotherapy are better understood, it is becoming imperative to focus management advancements on reducing exposure to toxic agents. Retroperitoneal lymph node dissection (RPLND) currently is indicated as a salvage procedure in postchemotherapy patients with residual masses. Primary RPLND currently is being further explored in patients with clinical stage IA and clinical stage IB disease in 2 prospective studies.


Assuntos
Neoplasia Residual/cirurgia , Seminoma/cirurgia , Neoplasias Testiculares/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Estadiamento de Neoplasias , Neoplasia Residual/patologia , Terapia de Salvação , Seminoma/patologia , Neoplasias Testiculares/patologia
16.
Scott Med J ; 64(4): 133-137, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31237804

RESUMO

Gastric metastases are a rare occurrence in patients with malignancy. In case reports of these arising from germ cell tumours, the majority were non-seminomatous germ cell tumours and had evidence of retroperitoneal involvement. We present a unique case of a 67-year-old man with metastatic testicular pure seminoma. He presented with dyspepsia and investigation found isolated metastases to the gastric mucosa and sub-mucosa from a right testicular primary. No lymph node involvement was identified. The patient was managed with curative intent with total gastrectomy and inguinal orchidectomy. To date, there is no evidence of disease recurrence.


Assuntos
Seminoma/patologia , Neoplasias Gástricas/secundário , Neoplasias Testiculares/patologia , Idoso , Gastrectomia , Humanos , Masculino , Orquiectomia , Seminoma/cirurgia , Neoplasias Gástricas/cirurgia , Neoplasias Testiculares/cirurgia
17.
Clin Genitourin Cancer ; 17(4): e793-e801, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31182339

RESUMO

BACKGROUND: We tested contemporary surveillance and active treatment (AT) that included chemotherapy (CHT) and radiotherapy (RT) rates for stage I testicular seminoma patients, as well as cancer-specific mortality (CSM) and other-cause mortality (OCM) rates. PATIENTS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (1988-2015) we identified 11,206 stage I testicular seminoma patients. Surveillance versus CHT versus RT use rates were investigated using estimated annual percentage change (EAPC) analyses. After propensity score (PS) matching, cumulative incidence plots and multivariable competing risks regression models (MCRRMs) tested for CSM and OCM. RESULTS: Of all 11,206 patients, 4434 (40%), 918 (8%), and 5854 (52%), respectively, underwent surveillance, CHT, or RT after initial orchiectomy. Surveillance (EAPC: 7.5%; P < .001) and CHT (EAPC: 13.5%; P < .001) rates increased over time, whereas RT rates decreased (EAPC: -3.8%; P < .001). After PS matching, in MCRRMs surveillance was an independent predictor of CSM, relative to AT (hazard ratio [HR], 2.59; P = .04). Conversely, surveillance versus AT did not affect OCM (HR, 1.52; P = .051). All other analyses that focused on CSM and OCM, namely surveillance versus RT, surveillance versus CHT, and RT versus CHT resulted in nonsignificant differences (all P > .5). CONCLUSION: Surveillance and CHT use in stage I testicular seminoma rates increased, whereas RT rate decreased over time. A protective effect of AT defined as either RT or CHT was identified on CSM, relative to surveillance. This protective effect was not described for OCM. No differences in survival were recorded, when individual management strategies (surveillance vs. RT vs. CHT) were compared with each other.


Assuntos
Orquiectomia/métodos , Seminoma/mortalidade , Neoplasias Testiculares/mortalidade , Conduta Expectante/métodos , Adulto , Humanos , Masculino , Estadiamento de Neoplasias , Pontuação de Propensão , Programa de SEER , Seminoma/patologia , Seminoma/cirurgia , Análise de Sobrevida , Taxa de Sobrevida , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia
19.
Cancer Imaging ; 19(1): 24, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31097025

RESUMO

OBJECTIVE: To discuss the diagnostic value of multislice spiral tomography (CT) combined with CT angiography (CTA) technology in intra-abdominal undescended testis secondary seminoma cases. METHODS: We retrospectively analyzed the CT and CTA imaging features of CT and CTA findings of nine patients with an intra-abdominal undescended testis secondary seminoma. RESULTS: The tumors in all nine patients were mainly solid, and the average CT value was 38.4 ± 3.4 HU. Low-density areas of various sizes were visible in the tumors, and calcifications were detected in two patients. The tumors in eight patients had a complete capsule, which pressed on the surrounding structures. In one patient, the tumor had an incomplete capsule, which invaded the surrounding structures. Some of the solid tumors showed progressive and slight enhancement on the CT-enhanced scans. The values in the arterial phase, venous phase, and delayed phase were 46.3 ± 5.1 (40-55 HU), 57.3 ± 7.3HU (48-68 HU), and 65.1 ± 7.2HU (56-77 HU), respectively, with an average increase rate of 27.0 ± 7.2 HU. No enhancement was found in low-density areas on the CTA scans, and the supply arteries of the tumors in the nine patients all originated from the abdominal aortic wall 2-3 cm below the renal ostia. These arteries became thickened and tortuous when near the tumors, and there were no branching vessels. In eight patients, the supply arteries of the tumors originated from the posterior tumor and ended inside the tumor, and they originated from anterior of the tumor in one patient. Testicular venous drainage was detected in three patients, and lymph node metastasis in the abdominal aorta detected in two cases. CONCLUSION: An intra-abdominal undescended testis secondary seminoma exhibits a characteristic appearance on CT. CTA shows a three-dimensional testicular vascular pedicle sign of a seminoma. A combination of CT and CTA can improve the diagnostic accuracy of an intra-abdominal undescended testis secondary seminoma.


Assuntos
Angiografia por Tomografia Computadorizada/normas , Criptorquidismo/diagnóstico por imagem , Seminoma/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Tomografia Computadorizada Espiral/normas , Adulto , Idoso , Criptorquidismo/complicações , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Seminoma/etiologia , Seminoma/patologia , Neoplasias Testiculares/etiologia , Neoplasias Testiculares/patologia
20.
Bull Cancer ; 106(10): 887-895, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31088678

RESUMO

Stage I germ-cell tumors are rare and highly curable diseases. As such, management of these tumours should carefully follow guidelines. Initial management is based on orchiectomy and several options as adjuvant therapy. Pro's and con's should be discussed with the patient for a personalized management. Patients with stage 1 germ-cell tumours should be addressed to expert centers.


Assuntos
Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Fidelidade a Diretrizes , Humanos , Masculino , Estadiamento de Neoplasias , Prognóstico , Seminoma/patologia , Seminoma/cirurgia
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