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Nia AM, Allison RZ, Sweeney M, Briner RP. Late Testicular Yolk Sac Tumor With Cerebellar Metastasis and a Rapid Recurrence After a Gross Total Resection: A Case Report. Cureus 2021; 13:e17143. [PMID: 34532178 PMCID: PMC8437004 DOI: 10.7759/cureus.17143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/05/2022] Open
Abstract
Yolk sac tumor (YST) is the most common prepubertal testicular tumor. It is considered a subtype of non-seminoma germ cell tumor (NSGCT) that is presumed to have an aggressive behavior with high malignant potential, thus requiring multimodality treatment with resection and chemotherapy. Treatment is curative for the majority of patients, even the ones with relapse after a few years. Here, we describe for the first time an atypical case of YST recurrence 17 years after primary treatment of YST. This is a case of YST in a 32-year-old man who presented with a large cerebellar mass consistent with YST recurrence after being in remission for 17 years. He underwent suboccipital craniotomy and complete excision of the tumor, as evident on postoperative MRI with a plan for stereotactic radiosurgery with dose and fractionation determined by MRI at four weeks postoperatively. However, the four-week MRI postoperatively revealed a large mass that was engulfing the prior resection cavity, indicative of unusual rapid tumor recurrence despite evidence of complete resection. The highly aggressive nature of this tumor should prompt clinicians to consider chemotherapy and radiation earlier than four weeks postoperatively.
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Affiliation(s)
- Anna M Nia
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, USA
| | - Randall Z Allison
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, USA
| | - Megan Sweeney
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, USA
| | - Rudy P Briner
- Department of Neurosurgery, University of Texas Medical Branch, Galveston, USA
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Late Relapses in Stage I Testicular Cancer Patients on Surveillance. Eur Urol 2016; 70:365-71. [DOI: 10.1016/j.eururo.2016.03.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 03/06/2016] [Indexed: 11/21/2022]
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Wood L, Kollmannsberger C, Jewett M, Chung P, Hotte S, O'Malley M, Sweet J, Anson-Cartwright L, Winquist E, North S, Tyldesley S, Sturgeon J, Gospodarowicz M, Segal R, Cheng T, Venner P, Moore M, Albers P, Huddart R, Nichols C, Warde P. Canadian consensus guidelines for the management of testicular germ cell cancer. Can Urol Assoc J 2010; 4:e19-38. [PMID: 20368885 PMCID: PMC2845668 DOI: 10.5489/cuaj.815] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Lori Wood
- Division of Medical Oncology, Queen Elizabeth II Health Sciences Centre, Halifax, NS
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High risk NSGCT: case for surveillance. World J Urol 2009; 27:441-7. [DOI: 10.1007/s00345-009-0453-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/07/2009] [Indexed: 11/25/2022] Open
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Groll RJ, Warde P, Jewett MAS. A comprehensive systematic review of testicular germ cell tumor surveillance. Crit Rev Oncol Hematol 2007; 64:182-97. [PMID: 17644403 DOI: 10.1016/j.critrevonc.2007.04.014] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 02/27/2007] [Accepted: 04/11/2007] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Testicular cancer is the most common malignancy in men aged 15-34, and its incidence has been increasing over the past half-century. Survival for stage I testis cancer approaches 100% regardless of management strategy which is often dictated by other factors such as perceived morbidity. Advances in treatment have attempted to decrease morbidity and surveillance is thought to achieve this goal. METHODS An English language literature search of MEDLINE from 1966 to December 2005 and CINAHL from 1982 to December 2005 was conducted using a broad search strategy. Comparative and descriptive original articles on outcomes of seminoma or NSGCT surveillance would be deemed eligible and review articles containing no original data were omitted. One hundred and thirty-eight articles were selected for formal review, during which a database was compiled that documented the first author, publication year, tumor histologic type, study purpose or topic(s), methodology, sample size, median follow-up, and relevant results. RESULTS Most evidence for the efficacy of surveillance is from descriptive series or non-experimental comparative studies. Relapse occurs in approximately 28% and 17% of surveillance patients in NSGCT and seminoma, respectively, and cause-specific survival is approximately 98% and 100%, respectively. Compliance with surveillance ranges from poor to adequate, however there is no evidence that compliance impacts clinical outcome. Cost analyses have yielded inconsistent results when comparing treatment modalities. There is scant literature on quality of life and psychosocial issues and results are inconsistent. Active surveillance appears to be appropriate and perhaps optimal first line management of clinical stage I seminoma and non-seminomatous germ cell tumors. Further quantitative and qualitative research is warranted to deepen understanding of these issues that may impact treatment decision-making.
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Affiliation(s)
- R J Groll
- Department of Surgery, Division of Urology, University Health Network, University of Toronto, 610 University Avenue, 3-130, Toronto, Ontario, Canada M5G 2M9.
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Abstract
Most relapses of germ-cell tumors occur within 2 years of initial treatment. In 2% to 4% of patients, relapse may occur later. The retroperitoneum is the primary site of late relapse, and alpha-fetoprotein is the predominant marker. These tumors are highly resistant to chemotherapy. Surgical resection is the preferred treatment. If the recurrent disease is inoperable, chemotherapy may be instituted, followed by resection of residual masses. Patients successfully managed for testis cancer need lifelong surveillance.
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Affiliation(s)
- Yaron Ehrlich
- Department of Urology, Rabin Medical Center-Beilinson Campus, Petah Tikva, Israel
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Bradford TJ, Montie JE, Hafez KS. The Role of Imaging in the Surveillance of Urologic Malignancies. Urol Clin North Am 2006; 33:377-96. [PMID: 16829272 DOI: 10.1016/j.ucl.2006.03.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urologic malignancies are common, accounting for approximately 25% of all new cancer cases in the United States. Patients with urologic malignancies require long-term surveillance to detect progression or recurrence as early as possible. The urologist is faced with the task of balancing patient safety and cost-effectiveness, while finding the most practical follow-up regimen. For each urologic malignancy, this article reviews the commonly used radiologic techniques for surveillance and offers recommended follow-up schedules.
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Affiliation(s)
- Timothy J Bradford
- Department of Urology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0330, USA
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Abstract
OBJECTIVE To evaluate the incidence of inguinal metastases in patients with testicular cancer and relapse after initial stage I disease. PATIENTS AND METHODS Of 695 patients, 14 (2%) with stage I testicular cancer developed inguinal metastases during the follow-up on a surveillance programme. At orchidectomy, one patient had involvement of the tunica albuginea and one a history of cryptorchidism and development of testicular cancer on the contralateral side. The remaining patients had no history of previous surgery in the inguinal region or in the scrotal area, or any other known risk factors for developing inguinal-node metastases. Two patients had a seminoma (0.5%) and 12 (4%) a nonseminoma. The histopathological examination showed that the metastases were in lymph nodes in four patients, the remainder having a more diffuse involvement of the tissue in the inguinal region. At relapse, patients were treated by three or four cycles of bleomycin, etoposide and cisplatin, except those with low-stage seminomas (stage IIa and IIb), who were treated by radiation therapy. RESULTS All patients had a complete remission after treatment with chemotherapy or radiotherapy. No patients died or developed a recurrence during the median follow-up of 72 months. CONCLUSION Metastases to the inguinal region are found in approximately 2% of patients with testicular cancer; about a quarter have lymph-node metastases, the rest probably having metastases to the spermatic cord with direct invasion into the surrounding tissue. High ligation of the spermatic cord is therefore important. Chemotherapy for patients with nonseminoma and radiotherapy for patients with seminoma gives excellent results.
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Affiliation(s)
- Gedske Daugaard
- Department of Oncology, 5073 Rigshospitalet, Copenhagen National Hospital, 9-Blegdamsvej, DK-2100 Copenhagen, Denmark.
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Abstract
Germ cell tumors of the testes constitute approximately 1-2% of all tumors in males 15-35 years of age. Half of those present as clinical stage I disease. The traditional approach was either a retroperitoneal node dissection or radiotherapy. A historical review of the literature suggested that 70% of these patients were cured and did not benefit from further therapy. This coupled with the advent of tumor markers, advanced diagnostic techniques, and cisplatin based chemotherapy led to the consideration for surveillance programs, thereby offering therapy only to those who required it. This article reviews the surveillance programs described in the literature to date with respect to both suitability and program design.
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Affiliation(s)
- Roanne Segal
- Department of Medicine, Division of Medical Oncology, The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario, Canada.
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Atsü N, Eskiçorapçi S, Uner A, Ekici S, Güngen Y, Erkan I, Uygur MC, Ozen H. A novel surveillance protocol for stage I nonseminomatous germ cell testicular tumours. BJU Int 2003; 92:32-5. [PMID: 12823379 DOI: 10.1046/j.1464-410x.2003.04270.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To report the results of a novel surveillance policy for stage I nonseminomatous germ cell tumours (NSGCTs). PATIENTS AND METHODS Between 1978 and 2000, 132 patients (median age 28 years, range 16-52) who were regularly followed were included in a new surveillance policy. All pathology specimens were studied retrospectively by the same pathologist for embryonal carcinoma, yolk sac tumour and lymphovascular invasion components. A loose surveillance protocol was designed in which computed tomography (CT) was used only for the first year. RESULTS The median (range) follow-up was 38 (6-265) months; the relapse rate was 24% and all occurred before 23 months, with 87% diagnosed within the first year. Platinum-based chemotherapy was given to patients with relapse, and surgery used after chemotherapy in seven. Among all the risk factors, an embryonal carcinoma component was the only significant predictor of relapse. The overall survival rate was 99%. CONCLUSION The presence of embryonal carcinoma in the primary pathology is the only risk factor determining the relapse rate of the present surveillance policy for stage I NSGCTs. The overall survival was no different from those reported for retroperitoneal lymph node dissection and primary chemotherapy. Decreasing the frequency of CT in the first year and totally eliminating it after 1 year reduces the cost of surveillance. The possible compliance problems of patients are also minimized, without changing the overall survival. This surveillance protocol for patients with stage I NSGCT has reduced costs and provided a better quality of life for the patients, without jeopardizing the final outcome.
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Affiliation(s)
- N Atsü
- Department of Urology, Hacettepe University, School of Medicine, Ankara, Turkey
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Abstract
Treatment results on 695 stage I testicular cancer patients followed with surveillance are described. Seminoma (SGCT) was present in 394 patients and nonseminoma (NSGCT) in 301 patients. Relapses were detected in 155 patients (22%), in 69 patients with SGCT (17%) and 86 with NSGCT (29%). In patients with vascular invasion, relapse was detected in 54% of patients with NSGCT and 38% of patients with SGCT. Time to relapse was median 13 months (range 1 to 84 months) for SGCT and 5 months (range 1 to 171 months) for NSGCT. Forty-nine percent of relapses in SGCT patients were seen within the first year, 87% of the relapses were diagnosed within the first two years, and 98% of the relapses were detected within 5 years. The figures for NSGCT were 80%, 89% and 95%, respectively. Forty-five patients had carcinoma in situ in the contralateral testis, 62% had this together with a seminoma in the other testis. Ten patients died during the follow-up period. None of these deaths were caused by the germ cell tumour or the treatment. The overall survival for patients with stage I disease is 98.6%, and the cause specific survival 100%.
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Affiliation(s)
- Sam S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA
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Toner GC, Neerhut GJ, Schwarz MA, Thursfield VJ, Sandeman TF, Giles GG, Snow RM. The management of testicular cancer in Victoria, 1988-1993. Urology Study Committee of the Victorian Co-operative Oncology Group. Med J Aust 2001; 174:328-31. [PMID: 11346104 DOI: 10.5694/j.1326-5377.2001.tb143306.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the patterns of care and management of testicular cancer in Victoria. DESIGN AND SETTING Retrospective analysis of all cases of testicular cancer in Victoria from 1988 to 1993 identified through the Victorian Cancer Registry. MAIN OUTCOME MEASURES Description of patient characteristics, staging investigations, initial management, and outcome. RESULTS 667 eligible cases of testicular cancer were identified and questionnaires were returned for 633 of these patients (94.9% response rate). There were 357 (56.4%) patients with pure seminoma; 271 (42.8%) with non-seminomatous germ cell tumours, 3 (0.5%) with stromal tumours, and 2 (0.3%) with other tumours. The median age was 32 years (range, 0-80 years). Preoperative marker levels were not available for 8% of patients, and initial staging was considered inadequate in 6%. Surveillance programs used for patients with Stage I disease were considered inadequate in most. Relative survival at five years was 99% for patients with seminoma and 91% for non-seminoma. CONCLUSIONS There was considerable variation in the investigation, treatment, and follow-up of these patients, which is likely to have resulted in unnecessary morbidity. Clinical practice guidelines should be developed and implemented to promote optimal management.
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Affiliation(s)
- G C Toner
- Medical Oncology, Peter MacCallum Cancer Institute, Melbourne, VIC.
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Boyer MJ, Stockler MR. Testicular cancer management. Med J Aust 2001; 174:320-1. [PMID: 11346099 DOI: 10.5694/j.1326-5377.2001.tb143301.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sonneveld DJ, Koops HS, Sleijfer DT, Hoekstra HJ. Surgery versus surveillance in stage I non-seminoma testicular cancer. SEMINARS IN SURGICAL ONCOLOGY 1999; 17:230-9. [PMID: 10588851 DOI: 10.1002/(sici)1098-2388(199912)17:4<230::aid-ssu3>3.0.co;2-u] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Today, the standard treatment for patients with clinical Stage I non-seminomatous testicular germ cell tumors (NSTGCT) following orchidectomy is either primary retroperitoneal lymph node dissection (RPLND) or close surveillance with cisplatin-based polychemotherapy in case of a relapse. Both treatment modalities provide excellent overall survival rates up to 100%. Consequently, selection of the most appropriate management option is not primarily guided by survival considerations. The choice between the available options, each having its merits and its drawbacks, should be made based on a number of factors including treatment-related morbidity, views and expertise of the physician, patient preferences, the expected degree of patient compliance, and prognostic factor analysis. To date, the role of adjuvant chemotherapy as an alternative management option for patients with clinical Stage I NSTGCT at high risk of occult metastases is limited. This systemic treatment modality would be a realistic alternative if the reliability of prognostic factors to identify high-risk Stage I patients could be improved. This review addresses relevant issues in the management of patients with clinical Stage I NSTGCT to provide information that will allow a rational selection of the most appropriate management option.
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Affiliation(s)
- D J Sonneveld
- Department of Surgical Oncology, Groningen University Hospital, Groningen, The Netherlands
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