Effects of multiple-drug chemotherapy (cis-diammine-dichloroplatinum, bleomycin, and vinblastine) on the maturation of retroperitoneal lymph node metastases of nonseminomatous germ cell tumors of the testis: No evidence for de novo induction of differentiation

Abstract

Investigating the mechanisms underlying maturation of metastases of nonseminomatous germ cell tumors on administration, of chemotherapy, the histologic characteristics of primary testis tumors was compared to the histologic characteristics of their retroperitoneal metastases in three historical patient groups. The metastases in Group I (20 patients) were not treated; those in Groups II (nine patients) and III (24 patients) were treated, respectively, with three cycles of dactinomycin and with four cycles of cis‐diammine‐dichloroplatinum, vinblastine, and bleomycin, before retroperitoneal lymph node dissection. In Group III there was a significant increase of metastases consisting of differentiated teratoma only, as compared to the metastases of Group I. However, both with and without chemotherapy, the metastases contained fewer areas of differentiated teratoma than the primary lesions. Metastases containing differentiated teratoma with and without other components, with one exception in Group III, were derived from primary tumors containing mature areas as well. Components other than mature teratoma were almost completely eradicated in Group III. These findings strongly suggest that selective destruction of components other than differentiated teratoma causes the mature histologic characteristics in the metastases upon administration of chemotherapy. The results do not support the hypothesis of induction of differentiation by the chemotherapeutic agents.

Testicular Cancer

“…Oosterhuis et al (35) have presented data indicating a progressive increase in the proportion of patients with mature teratoma as chemotherapy has become more effective; however, this increase is largely confined to patients who have teratocarcinoma primary tumours. Induction of complete differentiation leading to mature end cells has obvious attractions as a therapeutic manoeuvre in germ cell tumours.…”

Posterior fossa immature teratoma in an infant with trisomy 21: A case report and review of the literature

“…[4] Clinical and experimental observation suggest that this apparent maturation results from destruction of the less-differentiated elements of the tumor by chemotherapy. [6910] However, the role of chemotherapy in intracranial immature teratoma maturation is still not explicitly clear, because of the rarity of such cases, with only two cases previously reported by Shaffrey et al . [15]…”

Differentiated rhabdomyomatous tumors after chemotherapy for metastatic testicular germ-cell tumors: a clinicopathological study of seven cases mandating separation from rhabdomyosarcoma

“…This mechanism has been previously suggested for the formation of teratomatous elements in post-chemotherapy specimens of patients with testicular germ-cell tumors, 12 and is the pathogenesis suggested by Molenaar et al 8 based on their study of childhood rhabdomyosarcomas. Others, however, postulate that chemotherapy itself may induce tumor differentiation.…”