Mature Teratoma Identified After Postchemotherapy Surgery in Patients With Disseminated Nonseminomatous Testicular Germ Cell Tumors: A Plea for an Aggressive Surgical Approach

Sonneveld, D.J.A.; Sleijfer, Dirk; Koops, H. Schraffordt; Keemers-Gels, Mariël E; Molenaar, W. M.; Hoekstra, Harald J.

doi:10.1016/s0022-5347(01)62318-8

Cited by 25 publications

(38 citation statements)

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“…[3][4][5][6][7][8] Metastatic mature teratoma is usually treated by surgery alone, whereas the presence of yolk sac tumor requires additional neoadjuvant therapy. [33][34][35] Proliferative or hyperplastic endodermal glandular epithelium of teratoma or rare somatic adenocarcinoma arising from teratoma can mimic glandular yolk sac tumor. [3][4][5][6][7][8] Myxoid/reticular/microcystic yolk sac tumor may also be mistaken as edematous mesodermal teratomatous element or embryonal carcinoma-associated stroma, in particular when yolk sac tumor and embryonal carcinoma/teratoma are intimately associated.…”

Section: Discussionmentioning

confidence: 99%

ZBTB16: a novel sensitive and specific biomarker for yolk sac tumor

Xiao

Unger

et al. 2016

Modern Pathology

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Although the function of zinc finger and BTB domain containing 16 (ZBTB16) in spermatogenesis is well documented, expression of ZBTB16 in germ cell tumors has not yet been studied. The aim of this study was to investigate the immunohistochemical expression and diagnostic utility of ZBTB16 in germ cell tumors. A total of 67 adult germ cell tumors were studied (62 testicular germ cell tumors, 2 ovarian yolk sac tumors, 1 mediastinal yolk sac tumor, and 2 retroperitoneal metastatic yolk sac tumors). The 62 testicular primary germ cell tumors are as follows: 34 pure germ cell tumors (20 seminomas, 8 embryonal carcinomas, 2 teratomas, 1 choriocarcinoma, 1 carcinoid, and 2 spermatocytic tumors) and 28 mixed germ cell tumors (composed of 13 embryonal carcinomas, 15 yolk sac tumors, 15 teratomas, 7 seminomas, and 3 choriocarcinomas in various combinations). Thirty-five cases contained germ cell neoplasia in situ. Yolk sac tumor was consistently reactive for ZBTB16. Among the 15 testicular yolk sac tumors in mixed germ cell tumors, all displayed moderate to diffuse ZBTB16 staining. ZBTB16 reactivity was present regardless of the histologic patterns of yolk sac tumor and ZBTB16 was able to pick up small foci of yolk sac tumor intermixed/embedded in other germ cell tumor subtype elements. Diffuse ZBTB16 immunoreactivity was also observed in 2/2 metastatic yolk sac tumors, 1/1 mediastinal yolk sac tumor, 2/2 ovarian yolk sac tumors, 2/2 spermatocytic tumors, 1/1 carcinoid, and the spermatogonial cells. All the other non-yolk sac germ cell tumors were nonreactive, including seminoma (n = 27), embryonal carcinoma (n = 21), teratoma (n = 17), choriocarcinoma (n = 4), and germ cell neoplasia in situ (n = 35). The sensitivity and specificity of ZBTB16 in detecting yolk sac tumor among the germ cell tumors was 100% (20/20) and 96% (66/69), respectively. In conclusion, ZBTB16 is a highly sensitive and specific marker for yolk sac tumor.

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Section: Discussionmentioning

confidence: 99%

ZBTB16: a novel sensitive and specific biomarker for yolk sac tumor

Xiao

Unger

et al. 2016

Modern Pathology

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“…Others reported lower proportion of cancer-related death among their patients. Sonneveld et al 5 reported incidence of death in 2%, while Carver et al 11 observed death from disease in 4.7% of their 210 patients. For men relapsed after PC-RPLA with solitary site of metastasis and and normal STMs, redoresection is the optimal mode of treatment.…”

Section: Discussionmentioning

confidence: 98%

“…The incidence of malignant transformation is approximately 3% to 6% in men undergoing PC-RPLA after induction chemotherapy, but increases to 12% and 18% in men undergoing redo-RPLA and in men experiencing late relapse [1][2][3] . Recurrence rates for patients with teratoma histology at PC-RPLA ranged from 6% to 39% 4,5 . Late recurrences with MT/IMT and TMT have been reported and account approximately 25% and 14% of all late relapse 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Teratoma identified after postchemotherapy retroperitoneal lymphadenectomy

Argirovic¹,

Argirović²

2013

Mat Med

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The histologic finding of teratoma occures in aproximately 40% of all postchemotherapy retroperitoneal lymphadenectomy (PC-RPLA) for disseminated nonseminomatous testicular tumors (NSTT). We evaluated patients undergoing PC-RPLA for teratoma to determine risk factors for recurrence and clinical outcome. Among a survey of 193 patients submitted to PC-RPLA due to metastatic NSTT from 1980-2005, we identified 82 patients (42%) who were found to have only teratoma in the retroperitoneum. Sixty-seven patients (82%) received only induction cisplatin-based chemotherapy, and 15 (18%) required 2nd line chemotherapy. PC-RPLA histology revealed mature teratoma (MT) in 86%, immature teratoma (IMT) in 12% and teratoma with malignant transformation (TMT) in 2%. Sixteen patients (19%) relapsed within median free interval of 22 months. Among 13 patients submitted to redo-RPLA, discordant histology occurred in 6 patients (46%) (2 TMT, 4 viable germ cell tumors [GCT]), all with worst histology in comparison to primary RPLA. One relapsing patient with only elevated serum tumor markers (STMs) achieved complete response with chemotherapy alone. Two patients relapsed at 21 and 74 months with widespread metastasis and died despite salvage chemotherapy. Seven of 13 patients (54%) who were rendered free of disease (FOD) with redo-RPLA, relapsed again. All but one died despite salvage treatment (2 of chemotherapy related toxicity) within mean survival time (MST) of 86.7+/-26.1 (95% confidence interval [CI],). At mean follow-up (MFU) of 135+/-62.6 months (95% CI, 98.79-149.21), alive and free of disease (AFD) are 90% patients. The probability of being reccurence-free at 5-and 10-year was 87% and 81%, respectively. The 5-and 10-year probability of disease speciphic survival (DSS) were 98% and Argirovi M. or e 1 , Argirovi . Aleksandar 2 1 Urološka Klinika, KCS, Poliklinika "Argirovi ", Urologija, Beograd, Srbija 2 Služba urologije, Klini ko Bolni ki Centar Zemun-Beograd, Srbija ApstraktHistološki nalaz teratoma postoji kod oko 40% od ukupnog broja posthemioterapijskih retroperitonealnih limfadenektomija (PH-RPLA) zbog metastatskog neseminomskog tumora testisa (NSTT). Evaluacija pacijenata podvrgnutih PH-RPLA je imala za cilj da odredi faktore rizika za pojavu recidiva i klini ki ishod. Od 193 pacijenata podvgnutih PH-RPLA zbog metastatskog NSTT u periodu izme u 1980-2005, identifikovali smo 82 pacijenta (42%) kod kojih je na eno samo prisustvo teratoma u retroperitoneumu. Šestdeset i sedam pacijenata (87%) je primilo samo indukcionu hemioterapiju na bazi cisplatine, dok je 15 (18%) iziskivalo hemioterapiju druge linije. Histologija na PH-RPLA je pokazala prisustvo zrelog teratoma u 86%, nezrelog teratoma u 12% i teratoma sa malignom transformacijom u 2%. Šesnaest pacijenata (19%) je imalo recidiv unutar srednjeg vremenskog intervala od 22 meseca. Od 13 pacijenata podvrgnutih ponovnoj RPLA, razli ita histologija je na ena kod 6 pacijenata (46%) (2 teratom sa malignom transformacijom, 4 vitalni karcinom), svi sa lošom histologijom u ...

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“…Sonneveld et al evaluated 51 patients with residual teratoma after postchemotherapy RPLND, of whom 15.7% (8) were deemed by the surgeon to be "incomplete" resections. Of these 8 patients, 4 relapsed with disease in the retroperitoneum, emphasizing the importance of complete resection [59]. Another more recent study evaluated the outcomes of 18 patients undergoing repeat RPLND, of whom 3 (16.7%) were deemed "out-of-field" recurrence, leaving the remaining 83% as "in-field" recurrences.…”

Section: Laparoscopymentioning

confidence: 99%

Postchemotherapy Surgery for Germ Cell Tumors—What Have We Learned in 35 Years?

et al. 2014

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Postchemotherapy surgery for advanced testicular cancer has evolved over the last couple of decades. Patients with nonseminomatous germ cell tumors and residual retroperitoneal mass ≥1 cm should undergo postchemotherapy retroperitoneal lymph node dissection (RPLND). For seminoma, RPLND is considered in those patients with masses ≥3 cm that are also positron emission tomography positive. Masses that occur outside of the retroperitoneum should be completely resected with the possible exception of bilateral lung masses when resection of the first mass shows necrosis. The role of surgery in patients with extragonadal germ cell tumors is most vital in those with primary mediastinal nonseminomatous germ cell tumors. Importantly, patient selection, surgical planning, and consideration of referral to centers with this expertise are important to optimize success.

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Mature Teratoma Identified After Postchemotherapy Surgery in Patients With Disseminated Nonseminomatous Testicular Germ Cell Tumors: A Plea for an Aggressive Surgical Approach

Cited by 25 publications

References 0 publications

ZBTB16: a novel sensitive and specific biomarker for yolk sac tumor

ZBTB16: a novel sensitive and specific biomarker for yolk sac tumor

Teratoma identified after postchemotherapy retroperitoneal lymphadenectomy

Postchemotherapy Surgery for Germ Cell Tumors—What Have We Learned in 35 Years?

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