Sequential germ cell tumor without prior involvement of the testes

Extragonadal germ cell tumour

We report a rare case of extragonadal germ cell tumour in a 55-year-old man. He presented with a painless mass in right inguinal region, a few days after hernioplasty for right direct inguinal hernia, which caused diagnostic difficulties and treatment problems.

Late recurrences in long-term survivors of germ cell neoplasms

Patients with germ cell neoplasms who are in complete remission 2 years after treatment have a very high probability of cure, and reports of recurrences occurring after 2 years are rare. Of 81 testicular cancer patients treated for advanced disease at Vanderbilt University between 1970 and 1985, five developed a recurrent or metachronous germinal tumor 58 to 195 months after the initial treatment. Only two of these patients had received prior cisplatin-based combination chemotherapy. Four patients had unfavorable prognostic features when tumor recurrence was diagnosed. All five patients responded to salvage chemotherapy, although there were only two complete responses. The extent of disease was a significant factor in predicting response to salvage therapy. The possible mechanisms of development of a late recurrence of germinal neoplasms include the following: (1) malignant degeneration of mature teratoma to germinal malignancy; (2) growth of an occult testicular tumor not eliminated by chemotherapy due to the presence of a blood-testicular barrier; (3) development of a second primary germ cell neoplasm; or (4) late relapse due to persistent microscopic viable tumor with an atypical less aggressive biologic behavior. "Cured" germ cell tumor patients need careful follow-up beyond 2 years. At a minimum, these patients should be seen annually. Patients found to have teratomas following cisplatin-based chemotherapy should probably undergo more frequent evaluations.

Incipient germ cell tumor in Sertoli-cell-only syndrome testis, accompanied with retroperitoneal teratocarcinoma and widespread metastases

Incipient germ cell tumor in Sertoli-cell-only syndrome testis was examined in an autopsy case of retroperitoneal teratocarcinoma with widespread metastases. Although both testes of a 28-year-old man had clinically been small and free from tumor mass to palpation, histopathological examinations revealed a malignancy in the right testis with the appearance of Sertoli-cell-only syndrome. The left testis showed solely the histology of Sertoli-cell-only syndrome. The testicular malignancy consisted of undifferentiated, atypical germ cells mainly confined within approximately one-tenth of seminiferous tubules, and only one small cartilage nodule. Some tubules showed intratubular growth pattern suggestive of seminoma. A few syncytiotrophoblast-like giant cells occurred in the tubules. These findings seem to furnish substantial evidence to the concept that atypical germ cells are the origin of testicular germ cell tumors of different types.

Extragonadal retroperitoneal germ cell tumors without apparent testicular involvement. A search for the source

Extratesticular germ cell neoplasms without apparent testicular primary tumors are rare. The origin of these neoplasms has been debated in the literature for decades. With the advent of effective chemotherapy for extratesticular germ cell neoplasms, the origin of these tumors becomes more than academic. We report on 3 cases of retroperitoneal germ cell neoplasms with microscopic intratesticular primary tumors. All patients with extragonadal germinal cell tumors of the testes should undergo thorough investigation for an occult testicular primary tumor despite a normal testis examination. We review previously reported cases of extratesticular germ cell neoplasms without an apparent testicular primary tumor.