Does retroperitoneal lymph node dissection have a curative role for patients with sex cord–stromal testicular tumors?

Abstract

BACKGROUND Sex cord–stromal tumors account for < 5% of all adult testicular tumors, and 10% are malignant. Due to the limited reported experience, there is no agreement on the best management, especially in patients who have tumors with malignant pathologic features or who present with metastatic disease. The authors attempt to evaluate the role of retroperitoneal lymph node dissection (RPLND) in the management of patients with these malignant sex cord–stromal tumors. METHODS Reviewing the Indiana University testis cancer registry revealed 17 patients who underwent RPLND for sex cord–stromal tumors. Pathology was reviewed for features suggestive of malignancy. The data examined included clinical and pathologic stage, surgical procedure, additional therapy received, and outcome. RESULTS Pathology included Leydig tumors in six patients, Sertoli tumors in four patients, sex cord–stromal tumors in five patients, a granulosa cell tumor in one patient, and a poorly differentiated non–germ cell tumor in one patient. Nine patients had histologic features suggestive of malignancy. Clinical stage at surgery was Stage I in nine patients and Stage IIA–IIIA in eight patients. Patients underwent modified or bilateral RPLND. Nine patients had pathologic Stage I tumors, and the remaining eight patients and had pathologic Stage IIB–IIIA tumors. Follow‐up ranged from 8 months to 11 years. Of the eight patients with Stage II–III disease, six patients eventually died of metastatic disease despite additional radiotherapy and/or chemotherapy. CONCLUSIONS Sex cord–stromal tumors have a potentially aggressive malignant behavior that is difficult to predict based on clinical and pathologic features. Although the therapeutic role of RPLND in patients with small‐volume metastatic retroperitoneal tumors is unclear, RPLND remains an option to be performed immediately after orchiectomy, especially in patients who have tumors with malignant features and/or small‐volume metastatic disease. Cancer 2003;98:753–7. © 2003 American Cancer Society.

Testicular Adult Type Granulosa Cell Tumor: A Very Rare Case Report and Review of Literature

“…Hanson and Ambaye have suggested that tumor size larger than 5 cm is a feature associated with malignancy in the testes. 5 Jimenez-Quintero et al considered size >7 cm, vascular or lymphatic invasion, and hemorrhage or necrosis somewhat predictive of spread. 6 Thus, follow-up for patients receiving radical orchiectomy should be extended.…”

“…Retroperitoneal lymph node dissection (RPLND) is also a treatment option for patients with lymph node metastasis in testicular germ cell tumor. Although the therapeutic role of RPLND is unclear, it is still an option after radical orchiectomy in aGrCT patients with malignant features, as described by Ashraf et al 5 Except surgical management, Jimenez-Quintero et al 6 suggested that etoposide based chemotherapy with adjuvant radiotherapy may be a curative option for metastatic disease. To date, in the absence of guidelines regarding aGrCT, it is difficult for urologists to implement a follow-up program.…”

A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

“…11 Of these, four patients (31%) with clinical stage I disease were reclassified as pathological stage II following RPLND. None of the nine patients with pathologic stage I disease had recurrence after 4.5 years, but 6/8 patients with stage II or III disease died of disease progression, with a mean survival of 2.4 years.…”

“…Some "centres of excellence" support testes-sparing surgery in small tumours, while other centres routinely perform prophylactic retroperitoneal lymph node dissection (RPLND) after the initial radical orchiectomy. [4][5][6][7]11 Some centres have employed highrisk histological features in the orchiectomy specimen to riskstratify patients and identify those who may benefit most from RPLND, although none of these findings have been well validated. 8,[11][12][13][14] In addition, no data have been published to date regarding population-level characteristics of this malignancy.…”

“…[4][5][6][7]11 Some centres have employed highrisk histological features in the orchiectomy specimen to riskstratify patients and identify those who may benefit most from RPLND, although none of these findings have been well validated. 8,[11][12][13][14] In addition, no data have been published to date regarding population-level characteristics of this malignancy. Therefore, the objective of this current study is to describe population-level characteristics of SCSTs, ascertain current practice patterns regarding treatment, and assess predictors of overall survival (OS) and cancer-specific survival (CSS).…”