Burned-Out Testicular Cancer: Really a Different History?

Rare "Burned-Out" Testicular Mixed Germ Cell Tumor on 18 F-FDG PET/CT

ABSTRACT

Spontaneous regression of testicular mixed germ cell tumor is rare and is also called burned-out testicular tumor. We herein present the case of a 20-year-old man who was initially diagnosed with metastatic embryonal carcinoma. 18 F-FDG PET/CT demonstrated apparent metastases in the lymph node regions and both lungs. A covert right testicular lesion was noted according to the features on the CT component of PET/CT, which was subsequently confirmed as burned-out testicular mixed germ cell tumor.

Regressed testicular germ cell tumour in a post-pubertal male

Testicular germ cell regression is a rare, generally metastatic phenomenon which describes the spontaneous, complete, or partial regression of a testicular germ cell tumour. As a result, studies have focused on defining specific histopathological criteria to establish if the resected testis is the primary source of the germ cell tumour. There are few publications which describe its presentation in the absence of distant metastases with elevated tumour markers and suspicious findings on testicular ultrasound. We present the clinical presentation and radiological features of a non-metastatic regressed testicular germ cell tumour following scrotal trauma in a post pubertal male.

Comprehensive Assessment of Selected Immune Cell Subpopulations Changes in Chemotherapy-Naïve Germ Cell Tumor Patients

The pattern of immune cell distribution in testicular germ cell tumors (GCT) significantly differs from the immune environment in normal testicular tissues. The present study aimed to evaluate the role of different leukocyte subpopulation in GCTs. A cohort of 84 chemotherapy-naïve GCT patients was analyzed. Immunophenotyping of peripheral blood leukocyte subpopulations was carried out by flow cytometry. In addition, the data assessing the immunophenotypes and the baseline clinicopathological characteristics of the included subjects were statistically evaluated. Their prognostic value for the assessment of progression-free survival (PFS) and overall survival (OS) was estimated. The percentage of different innate/adaptive immune cell subpopulations was significantly associated with poor risk-related clinical features, including the number of metastatic sites, presence of retroperitoneal, mediastinal, lung, brain and non-pulmonary visceral metastases as well as with the S-stage and International Germ Cell Consensus Classification Group (IGCCCG) risk groups. In univariate analysis, the percentages of neutrophils, eosinophils, dendritic cells type 2, lymphocytes and T cytotoxic cells were significantly associated with PFS, while the neutrophil, non-classical monocyte and lymphocyte percentage were associated with OS. However, all these outcome correlations were not independent of IGCCCG in multivariate analysis. The data indicated a link among different innate/adaptive peripheral immune cell subpopulations in GCT patients. In addition, the association between these subpopulations and tumor characteristics was also investigated. The findings of the present study may contribute to a deeper understanding of the interactions between cancer and innate/adaptive immune response in GCT patients.

A Coculture Model Mimicking the Tumor Microenvironment Unveils Mutual Interactions between Immune Cell Subtypes and the Human Seminoma Cell Line TCam-2

Testicular germ cell cancer (TGCC) is the most common type of cancer in young men. Seminomas account for around half of them and are characterized by a pronounced infiltration of immune cells. So far, the impact of the tumor microenvironment (TME) on disease progression, especially the interaction of individual immune cell subtypes with the tumor cells, remains unclear. To address this question, we used an in vitro TME model involving the seminoma-derived cell line Tcam-2 and immune cell subsets purified from human peripheral blood. T cells and monocytes were strongly activated when individually cocultured with Tcam-2 cells as revealed by increased expression of activation markers and pro-inflammatory cytokines both on the mRNA and protein level. Importantly, the interaction between tumor and immune cells was mutual. Gene expression of pluripotency markers as well as markers of proliferation and cell cycle activity were upregulated in Tcam-2 cells in cocultures with T cells, whereas gene expression of SOX17, a marker for seminomas, was unaltered. Interestingly, the impact of monocytes on gene expression of Tcam-2 cells was less pronounced, indicating that the effects of individual immune cell subsets on tumor cells in the TME are highly specific. Collectively, our data indicate that seminoma cells induce immune cell activation and thereby generate a strong pro-inflammatory milieu, whereas T cells conversely increase the proliferation, metastatic potential, and stemness of tumor cells. Although the employed model does not fully mimic the physiological situation found in TGCC in vivo, it provides new insights potentially explaining the connection between inflammatory infiltrates in seminomas and their tendency to burn out and metastasize.

Spontaneous regression of congenital brain tumors: a report of two cases

BACKGROUND

Vanishing brain tumor is defined as spontaneously disappearing or decreasing of the initial brain mass volume to ≤ 70% before establishing the definitive diagnosis. The condition is rare and can be attributed to different factors. The exact mechanism is under debate, but the increasing rate and accuracy of neuroimaging studies and occurrence of similar scenario in other pathologies rather than brain tumors can be of particular importance in finding vanishing brain lesions.

CASE REPORT

We present two unusual cases of congenital brain masses which underwent spontaneous shrinkage within the first months of life.

CONCLUSION

The condition is scarcely observed in congenital brain masses. As congenital brain lesions are distinct entities with peculiar characteristics, this rare phenomenon may reflect different aspects in this age group.

'Burned-out' syndrome of testicular teratoma: A case report

The majority of testicular tumors are germ cell tumors (GCTs) which, although rare, frequently present in young adults. In exceptional circumstances, spontaneous regression of the primary tumor occurs. The appellation ‘burned-out’ is applied to situations in which a metastatic GCT is found to be present, accompanied by histological regression of the primary testicular lesion. It is of crucial importance that a clinical examination of the testis is performed, and scrotal sonography is essential in the preliminary diagnosis of such neoplasms. In the present case report, a burned-out, non-seminomatous testicular GCT case is described. A CT scan revealed that a 29-year-old male patient who was experiencing loss of weight and appetite had retroperitoneal and mediastinal masses. A testicular examination did not reveal the presence of any palpable lesion, and an ultrasound examination of the scrotum disclosed a normal left testis and an atrophic right testicle with heterogeneous architecture, but with no evidence of a tumor. Chemotherapy was administered to the patient following surgical intervention into the retroperitoneal and mediastinal mass. It is evident that it remains problematic to accurately differentiate between a primary retroperitoneal tumor and a metastatic testicular tumor with an occult testicular primary or a ‘burned-out’ testicular cancer. The burned-out phenomenon is a rare occurrence, and further research into its pathogenesis is required. Both the rarity of this phenomenon and the difficulties encountered in diagnosis prompted the writing of the present case report, especially considering that teratomas are categorized as belonging to the histology group that shows the least likelihood of regressing.

'Burned-Out' primary testicular tumour: Is retroperitoneal lymph node biopsy mandatory prior to initiation of chemotherapy? Report of three cases and a review of the literature

The term 'burned-out' tumour of the testis describes a spontaneously and completely regressed testicular tumour that presents at the stage of metastasis. We report three cases of burned-out testicular tumour to illustrate their clinical, radiological and histopathological features and to discuss the hypothesis of the efficacy of early adjuvant chemotherapy without a previous retroperitoneal lymph node biopsy. Subsequent to radical orchiectomy, each pathohistology report revealed testicular hypotrophy or microcalcifications, with no clearly visible germ cell tumours within the specimen. Additionally, following surgery, the patients received the standard (cisplatin-etoposide-bleomycin) chemotherapy protocol, which in two out of three cases showed a complete response. Only one examinee revealed a partial response and received salvage chemotherapy, but he remained in the remission phase during the last follow-up. This study illustrates the value of the early administration of adjuvant chemotherapy in patients with burned-out testicular tumour, which offers the possibility of omitting the diagnostic retroperitoneal lymph node biopsy. Considering the low threshold for testicular malignancy, it is clearly of the utmost importance that these rare patients be treated in a timely manner and without adjunctive procedures (lymph node biopsy) leading to additional morbidity.

A scoping review on the "burned out" or "burnt out" testicular cancer: When a rare phenomenon deserves more attention

The "burned out" or "burnt out" testicular cancer (BTC) indicates the spontaneous and complete regression of a testicular germ cell tumor in the presence of distant metastases at the diagnosis. As this condition was never reviewed systematically, a scoping review was conducted to scrutinize the available literature on clinical and histological features of BTC patients. Medline was searched from inception to 19 April 2020. A virtual cohort of 68 BTC patients was generated. Our findings highlighted some inconsistencies: BTC was diagnosed in 5,9% of patients not showing distant metastases and in 2,9% of patients who did not undergo an orchiectomy. Besides, evidence of residual tumor was found in 22,7% of testis specimens, recognized as seminoma in 40% of cases. The emerged inconsistencies may derive from the lack of an unequivocal definition of BTC. Larger collaborative studies are needed to define the best diagnostic workup and treatment for BTC patients.

Burned-out testicular germ cell tumour presenting as acute inferior vena cava syndrome

Germ cell tumours (GCT) are the most common testicular neoplasms, seen mainly in young adults. Rarely they can affect extragonadal tissues, either as primary tumours or as metastases, most commonly to retroperitoneal lymph nodes. A 'burned-out' testicular tumour is a metastatic GCT with a relatively occult primary testicular tumour, which has histologically spontaneously regressed. We report a case of a 26-year-old man who presented with an acute history of lower back pain and leg swelling. CT demonstrated a large retroperitoneal soft tissue mass causing right-sided hydronephrosis with inferior vena cava and iliofemoral vein thrombosis. Although clinical examination of the testis was normal, ultrasound imaging of the scrotum identified a burned-out testicular primary. Orchiectomy confirmed the diagnosis and the patient responded well to chemotherapy, with no viable residual tumour on follow-up imaging. However, despite nephrostomy insertion, a dimercaptosuccinic acid (DMSA) scan demonstrated loss of function of the right kidney after treatment.

Rare Presentation of Burned-Out Testicular Seminoma

A 28 year old male who complained of abdominal pain over the past several months was found on CT to have lymphadenopathy along the right aspect of the inferior vena cava. The patient was subsequently seen by an oncologist where further work up of the lymphadenopathy was performed. A MR of the abdomen demonstrated right aortocaval and para-caval lymph nodes measuring to 3.7cm. A testicular ultrasound was then performed, which demonstrated an apparent peripheral focal hypoechoic region with no associated internal vascularity within the right testes. Biopsy of the retroperitoneal lymph nodes pathologically confirmed the diagnosis of seminoma. Keywords: Seminoma, Testicular Cancer, Retroperitoneal Adenopathy, Oncology, Burned-Out Tumor.

Spontaneous testicular tumor regression: case report and historical review

Spontaneous regression of a primary testicular germ-cell tumour (GCT), over time known as 'Burned out', 'Shrinking Seminoma', 'pT0', 'Burnout' or 'Spontaneous Regression', is an uncommon, generally metastatic phenomenon, which may present elevated tumour markers and a suspicious testicular ultrasound image. The histological study of the testicle demonstrated morphological changes of complete or partial tumour regression and found fibrous scarring and other characteristic changes of this phenomenon, which in some cases include vestiges of GCT. There are few publications on testicular GCT tumour regression and those that exist present limited data on the biology of the disease and its etiopathogenesis. This entity was recently recognised in the latest edition of the World Health Organization's (WHO) Classification of Tumours. We present our clinical, imaging, laboratory, cytohistological and management experience, as well as a historical review of the literature.