Intricacies of Radiographic Assessment in Testicular Germ Cell Tumors

Abstract

Testicular germ cell tumors (GCTs) are malignancies with a unique biology, pathology, clinical appearance, and excellent outcomes. A correct radiographic assessment of GCTs is extremely important for the clinical management in several typical scenarios. Advancements in the field of diagnostic medicine bring an increasing number of sophisticated imaging methods to increase the performance of imaging studies. The conventional computed tomography (CT) remains the mainstay of diagnostic imaging in the management of GCTs. While certain improvements in the sensitivity and specificity are suggested with magnetic resonance (MR) imaging with lymphotrophic nanoparticles in evaluating retroperitoneal lymph nodes during the staging procedure, further exploration in larger prospective studies is needed. A common diagnostic dilemma is assessing the post-chemotherapy residual disease in GCTs. Several studies have consistently shown advantages in the utility of positron emission tomography (PET) scanning in post-chemotherapy residual retroperitoneal lymph nodes in patients with seminoma, but not with non-seminoma. Recommendations suggest that seminoma patients with a residual disease in the retroperitoneum larger than 3 cm should be subjected for PET scanning with 18-fluorodeoxyglucose. Relatively high sensitivity, specificity and a negative predictive value (80–95%) may guide clinical decision to spare these patients of high morbidity of an unnecessary surgery. However, a positive predictive value of around 50% renders PET scanning difficult to interpret in the case of positive finding. These patients often require extremely difficult surgical procedures with the high risk of post-operative morbidity. Therefore, seminoma patients with PET positive residual masses larger than 3 cm still remain a serious challenge in the decision making of nuclear medicine specialist, oncologists, and urologic surgeons. In this article, we aim to summarize data on controversial dilemmas in staging procedures, active surveillance, and post-chemotherapy assessment of GCTs based on the available published literature.

The Lung Microbiome in COPD and Lung Cancer: Exploring the Potential of Metal-Based Drugs

“…Since then, cisplatin has been extensively studied as a chemotherapeutic drug and is broadly administered to various cancers, including ovarian, lung, head and neck, testicular, and bladder [150,151]. It is particularly effective in testicular germ cell tumours, leading to complete remission in approximately 70-80% of treated patients [152], and combination treatment with radiotherapy is more successful than radiotherapy alone in cohorts of NSCLC [153]. Cisplatin is structurally a coordination compound with square planar geometry and exerts its antitumour activity via intra-cellular hydrolysis and subsequent covalent binding to DNA-forming adducts, triggering apoptosis [154].…”

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“…The etiology of testicular GCTs is still poorly understood, but certain pre-existing medical conditions associated with testicular GCTs include cryptorchidism, radiation, impaired fertility, testicular dysgenesis, and family history or previous history of testicular cancer. 5…”

“…The etiology of testicular GCTs is still poorly understood, but certain pre-existing medical conditions associated with tes-ticular GCTs include cryptorchidism, radiation, impaired fertility, testicular dysgenesis, and family history or previous history of testicular cancer. 5 Malignant postpubertal GCTs (type II GCTs) commonly originate from the germ cell neoplasia "in situ" (GCNIS) and are subdivided into seminomas and NSGCTs. The rarer nonrelated GCNIS tumors comprise pre-pubertal type teratoma and yolk sac tumors (Type I GCT) and spermatocytic tumors (Type III GCT) seen in the elderly.…”