Somatic-type Malignancies in Testicular Germ Cell Tumors

Abstract

The development of somatic-type malignancies (SMs) in testicular germ cell tumors (GCTs) is a rare but well-recognized phenomenon. We studied the pathologic features of 63 GCTs with SMs in the testis (n = 22) or metastases (n = 41) and correlated these features with clinical outcomes. The patients with SMs in the testis (median age, 26 y) were younger than those with metastatic SMs (median age, 38.5 y). The SMs consisted of carcinomas (n = 21), sarcomas (n = 21), primitive neuroectodermal tumors (n = 15), nephroblastomas (n = 3), and mixed tumors (n = 3). Sarcoma was the most common SM in the testis (n = 11), and most sarcomas were rhabdomyosarcomas (n = 9). Carcinoma was the most common SM in metastases (n = 20), and most carcinomas were adenocarcinomas (n = 12). In metastases, carcinomatous SMs developed after a longer interval from the initial orchiectomy (median times, 213 mo) than sarcomatous SMs (median times, 68 mo). Patients with metastatic SMs had significantly poorer overall survival than those with SMs in the testis (5-y survival rate, 35% vs. 87%; P = 0.011). Furthermore, patients with carcinomatous SMs had a significantly worse prognosis than those with sarcomatous or primitive neuroectodermal tumor SMs (5-y survival rates, 17%, 77%, and 73%, respectively; P = 0.002), when the whole cohort, including testicular and metastatic SMs, were analyzed. Our results demonstrate that SMs in metastatic GCTs are associated with a significantly worse prognosis than those in the testis. Furthermore, the histologic subtype of SM has a significant effect on the clinical outcome, with the carcinomatous SM carrying the highest risk for mortality.

Germ Cell Tumor With Somatic-Type Malignancy: A Case Report and Review of the Literature

“…Rarely, SMs can be hematological malignancies, a combination of different forms, or undifferentiated tumors [ 7 , 13 ]. Hwang et al, in a study of 63 cases, observed that rhabdomyosarcoma was the most common histological subtype of SM for tumors found in the testis, while carcinoma, particularly adenocarcinoma, was the predominant subtype found in the metastatic sites, as in our case [ 14 ].…”

Morphological spectrum and molecular features of somatic malignant transformation in germ cell tumours

“…Appropriate treatment for SMT GCT is challenging 13,19 . Available studies (Table S1) concur in that, when documented solely in the primary testicular tumour, the prognosis is not adversely affected by the presence of SMT 17,20 . However, SMT present in metastatic sites shows an inferior prognosis 19,21,22 .…”

“…13,19 Available studies (Table S1) concur in that, when documented solely in the primary testicular tumour, the prognosis is not adversely affected by the presence of SMT. 17,20 However, SMT present in metastatic sites shows an inferior prognosis. 19,21,22 This too was verified in our work, with all patients showing SMT exclusively in the primary tumour, ).…”

“…The true incidence of SMT, however, is difficult to ascertain, as well as the specific proportions of each kind of malignancy, since some series are dedicated exclusively to a specific kind of SMT (only ENET, 31,37,38 or only sarcomas 17,27 ), and others exclude specific subtypes 25,39 . Some series report sarcomas as the most frequent, but others ENET 20, 22, 26 . These epidemiological observations are even more challenging when considering primary versus metastatic tumours.…”

“…25,39 Some series report sarcomas as the most frequent, but others ENET. 20,22,26 These epidemiological observations are even more challenging when considering primary versus metastatic tumours. In our series, adenocarcinomas were only observed in a chemo-exposed metastatic or extragonadal context, as opposed to ENET that occurred in both primary/metastatic settings.…”