Teratoma With Malignant Transformation: Diverse Malignant Histologies Arising in Men With Germ Cell Tumors

Abbreviations & AcronymsAbstract: We report a rare case of stage I non-seminomatous testicular germ cell tumor with malignant transformation. The patient received two cycles of chemotherapy (cisplatin, bleomycin and etoposide) tailored to testicular germ cell tumors as an adjuvant therapy after orchiectomy. However, 22 months later, the patient developed a metastasis in the occipital region that consisted of solely rhabdomyosarcoma through malignant transformation of a teratoma component. This case highlights an issue related to adjuvant chemotherapy for testicular germ cell tumors with components of malignant transformation.

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“…4 Motzer et al have advocated the use of histology-based therapies. However, none of the patients obtained complete remission in their series.…”

Section: Discussionmentioning

confidence: 99%

Recurrent rhabdomyosarcoma after adjuvant chemotherapy for stage I non‐seminomatous germ cell tumor with malignant transformation

Ushida

Koizumi²,

Katoh³

et al. 2012

Int J of Urology

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“…4 Complete surgical resection of residual or recurrent disease is recommended when feasible. 1,4,6 The role of CHT has not been well defined. The CR rate was estimated at 30% for CHT alone, and at 38% for CHT and surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The CR rate was estimated at 30% for CHT alone, and at 38% for CHT and surgery. 6 Patients with a mediastinal tumor, neural or rhabdomyosarcomatous differentiation and distant metastases usually have the shortest survival. 4,6 Diffuse BM metastases with hypercalcemia are a very rare manifestation of these tumors.…”

Section: Discussionmentioning

confidence: 99%

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Testicular germ cell tumor with rhabdomyosarcoma successfully treated by disease-adapted chemotherapy including high-dose chemotherapy: case report and review of the literature

Korfel

Fischer

Foss

et al. 2001

Bone Marrow Transplant

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A teratoma is associated with malignant nongerm cell tumors in 3 to 6% of patients with metastatic GCT who are treated with platinum-based CHT. 1-3 A derivation from preexistent mesenchymal elements of the teratomatous tissue is assumed. 4 Alternatively, the nongerm tissue may arise from the malignant transformation of totipotential germ cell subpopulations showing partial differentiation into somatic mesenchymal tissue. 5 Up to 80% of patients present with metastases. 4 Most nongerm cell malignancies associated with GCT are sarcomas, rhabdomyosarcoma being the most common subtype. 6 Sarcomas can be present in the primary tumor or appear in metastases. 1,7 Teratomas with rhabdomyosarcomatous differentiation have a poor prognosis. 4 Here, we report a rare case of a combination of seminoma, teratoma and rhabdomyosarcoma. To our knowledge, this is the first report of successful treatment of a metastasized teratoma with rhabdomyosarcomatous differentiation, with HD-CHT and APBSCT. Case reportA 51-year-old man with a left testicular mass underwent inguinal orchidectomy in November 1996. Histologically, the tumor was a combined seminoma, partially immature teratoma and rhabdomyosarcoma. Biopsy of the right testis revealed no malignancy. AFP and ␤HCG serum levels were normal. Retroperitoneal lymph node dissection was performed 3 weeks later due to the unfavorable histology and revealed no evidence of malignant spread.Three months later, the patient was admitted to our hospital because of generalized seizures. There was a 4-week history of back pain, appetite loss, nausea, vomiting, and lethargy. On physical examination, the patient was somnolent but there were no other significant abnormalities. CT scan of the brain and lumbar puncture yielded normal findings. Hematologic and blood chemical tests showed an elevated creatinine (489 mol/l; normal 58-110 mol/l), lactate dehydrogenase (1099 U/l; normal 120-240 U/l), and calcium (4.0 mmol/l; normal 2.24-2.78 mmol/l). A bone scan revealed no radiolabeled technetium uptake. Cytologic and histologic BM examination showed massive rhabdomyosarcoma involvement (Figure 1a), which was confirmed by histochemical stains positive for muscle-specific antigen and desmin (Figure 1b). MRI of the vertebral column revealed multiple spots with low signal intensity in T1-and high signal intensity in T2-weighted images typical of tumor infiltration (Figure 2a). A solitary metastasis was found in the liver.Infusions of normal saline, furosemide, steroids, and pamidronate were given. CHT with 50 mg/m 2 epirubicin for 1 day, etoposide 250 mg/m 2 , 2000 mg/m 2 ifosfamide, and 25 mg/m 2 cisplatin for 2 days each was initiated. The patient regained normal conciousness, and calcium and creatinine levels returned to normal. Four CHT courses were given (total epirubicin dose 200 mg/m 2 ) and 90 mg pami-

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“…Among STMs arising in GCTs, neuroendocrine carcinoma is extremely rare. In general, advanced STM suggests a poor prognosis because it has been considered resistant to systemic chemotherapy, unlike GCT (2,3). To the best of our knowledge, only 1 other case of a neuroendocrine carcinoma arising in a mediastinal teratoma has been previously reported (4).…”

Section: Introductionmentioning

confidence: 95%

Neuroendocrine Carcinoma Arising in a Mediastinal Teratoma with Pulmonary Metastasis: A Case Report and the Chemotherapy Response

Lee

et al. 2015

Intern. Med.

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Neuroendocrine carcinoma as a somatic-type malignancy (STM) arising in an extragonadal teratoma is extremely rare. The effect of chemotherapy has been poorly evaluated in such cases contrary to teratomas with other STMs. We herein demonstrate that systemic chemotherapy may be beneficial in a case of neuroendocrine carcinoma arising in a mediastinal teratoma with pulmonary metastasis. A 31-year-old man presented with mediastinal widening visualized on a chest radiograph. Computed tomography showed a huge mediastinal mass with two pulmonary nodules. Surgical resection confirmed the presence of a neuroendocrine carcinoma arising in a mediastinal teratoma and pulmonary metastasis. The patient subsequently received chemotherapy and has had no recurrence during the 28-month follow-up.

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Teratoma With Malignant Transformation: Diverse Malignant Histologies Arising in Men With Germ Cell Tumors

Cited by 371 publications

References 20 publications

Recurrent rhabdomyosarcoma after adjuvant chemotherapy for stage I non‐seminomatous germ cell tumor with malignant transformation

Recurrent rhabdomyosarcoma after adjuvant chemotherapy for stage I non‐seminomatous germ cell tumor with malignant transformation

Testicular germ cell tumor with rhabdomyosarcoma successfully treated by disease-adapted chemotherapy including high-dose chemotherapy: case report and review of the literature

Neuroendocrine Carcinoma Arising in a Mediastinal Teratoma with Pulmonary Metastasis: A Case Report and the Chemotherapy Response

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