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Borgheresi A, Agostini A, Pierpaoli L, Bruno A, Valeri T, Danti G, Bicci E, Gabelloni M, De Muzio F, Brunese MC, Bruno F, Palumbo P, Fusco R, Granata V, Gandolfo N, Miele V, Barile A, Giovagnoni A. Tips and Tricks in Thoracic Radiology for Beginners: A Findings-Based Approach. Tomography 2023; 9:1153-1186. [PMID: 37368547 DOI: 10.3390/tomography9030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This review has the purpose of illustrating schematically and comprehensively the key concepts for the beginner who approaches chest radiology for the first time. The approach to thoracic imaging may be challenging for the beginner due to the wide spectrum of diseases, their overlap, and the complexity of radiological findings. The first step consists of the proper assessment of the basic imaging findings. This review is divided into three main districts (mediastinum, pleura, focal and diffuse diseases of the lung parenchyma): the main findings will be discussed in a clinical scenario. Radiological tips and tricks, and relative clinical background, will be provided to orient the beginner toward the differential diagnoses of the main thoracic diseases.
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Affiliation(s)
- Alessandra Borgheresi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Pierpaoli
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Alessandra Bruno
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Tommaso Valeri
- School of Radiology, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
| | - Ginevra Danti
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Eleonora Bicci
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Michela Gabelloni
- Nuclear Medicine Unit, Department of Translational Research, University of Pisa, 56126 Pisa, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Maria Chiara Brunese
- Department of Medicine and Health Sciences V. Tiberio, University of Molise, 86100 Campobasso, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health, Unit 1, 67100 L'Aquila, Italy
| | - Roberta Fusco
- Medical Oncology Division, Igea SpA, 80013 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale-IRCCS di Napoli, 80131 Naples, Italy
| | - Nicoletta Gandolfo
- Diagnostic Imaging Department, Villa Scassi Hospital-ASL 3, 16149 Genoa, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, Via Tronto 10/a, 60126 Ancona, Italy
- Department of Radiology, University Hospital "Azienda Ospedaliero Universitaria delle Marche", Via Conca 71, 60126 Ancona, Italy
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Sharma A, Reddy R, Pramanik R, Sahoo RK, Kaushal S, Kp H, Kumar S, Kumar L, Sharma A, Batra A. Primary mediastinal germ cell tumors (PMGCT): A real-world analysis from a tertiary cancer care centre in India. Cancer Invest 2023:1-7. [PMID: 36927242 DOI: 10.1080/07357907.2023.2188947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Primary mediastinal GCT (PMGCT) is a rare entity and comprises 10-15% of all mediastinal tumors . We present our institutional experience of MGCT treated with multimodality management. MATERIALS AND METHODS We conducted a retrospective analysis between 2010 to 2020 of all mediastinal germ cell tumors registered at our center. Data on patient demographics, treatments received, treatment toxicities and response were recorded. Overall survival and relapse free survival were estimated using Kaplan-Meier methods. RESULTS A total of 30 patients were identified. The median age was 25.5 (range, 18-45) years. Common presenting features included cough (70%) and shortness of breath (70%) . Histology wise, 60% patients were non seminomatous histology whereas 33.3% patients were Seminoma.Twenty seven (90%) patients received chemotherapy as the first-line treatment, of whom five patients (16.6%) underwent surgery and radiation therapy subsequently. Median follow-up was 26.9 months. Thirteen patients (43.3%) had complete response (43.3%) and 8 patients had partial response (26.7%), while three patients (5.5%) had progressive disease. Three year relapse free survival rate was 69.6% (95% confidence interval [CI], 42.8-85.6%). Overall survival (OS) at 3 years was 73.4% (95% CI, 49.4- 87.3%). Patients with seminoma had a 3 year OS of 90.0% (95% CI, 47.3-98.5%) compared to those with non-seminoma (63.53% [95% CI, 32.3-83.3%]). CONCLUSIONS Multiagent chemotherapy is the backbone of treatement in PMGCT. Seminomatous PMGCT have excellent prognosis, while further improvement is needed in those with non-seminomatous tumor.
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Affiliation(s)
- Aparna Sharma
- Department of Medical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Rohit Reddy
- Department of Medical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Raja Pramanik
- Department of Medical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Ranjit Kumar Sahoo
- Department of Medical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Seema Kaushal
- Department of Pathology , All India Institute of Medical Sciences, New Delhi
| | - Haresh Kp
- Department of Radiation Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Sunil Kumar
- Department of Surgical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Lalit Kumar
- Department of Medical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Atul Sharma
- Department of Medical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
| | - Atul Batra
- Department of Medical Oncology, Dr, B.R.A. IRCH, All India Institute of Medical Sciences, New Delhi
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Ghigna MR, Thomas de Montpreville V. Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach. Eur Respir Rev 2021; 30:30/162/200309. [PMID: 34615701 PMCID: PMC9488622 DOI: 10.1183/16000617.0309-2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/08/2021] [Indexed: 12/02/2022] Open
Abstract
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years. Given the mediastinal anatomical heterogeneity, the correct positioning of mediastinal lesions becomes primal, in order to first establish a clinical suspicion and then to assist in planning biopsy and surgical procedurehttps://bit.ly/3p0gsk3
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Affiliation(s)
- Maria-Rosa Ghigna
- Dept of Pathology, Marie Lannelongue Hospital, Le Plessis Robinson, France
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Géczi L, Budai B, Polk N, Fazekas F, Bodrogi I, Biró K. Neutrophil-to-lymphocyte ratio in primary mediastinal germ cell tumors: A retrospective analysis of >20 years single institution experience. Curr Probl Cancer 2020; 44:100537. [PMID: 31980147 DOI: 10.1016/j.currproblcancer.2020.100537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/12/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To obtain information on outcome stratified by histology, extent and primary treatment patients' data with primary malignant mediastinal germ cell tumors treated between 1998 and 2018 were retrospectively analyzed. METHODS The primary treatment for localized malignant mediastinal germ cell tumors was neoadjuvant bleomycin + etoposid + cisplatin (BEP) ± surgery (n = 22); or surgery ± adjuvant BEP (n = 16). For disseminated disease (n = 21) first line BEP ± second line chemotherapy were administered. For nonseminomas (NS) the NLR at start of BEP was analyzed in relation to disease-free survival (DFS), progression-free survival (PFS), and overall survival (OS). RESULTS After neoadjuvant treatment the 5-year DFS was 100% for seminomas (S), and 63.4% for NS. The 5-year OS was 100% for S, and 76.9% for NS. The 5-year DFS and OS after surgery ± BEP for S was 72.9% and 100%, for NS was 75% and 87.5%, respectively. The 5-year PFS and OS of metastatic patients for S was 60% and 80%, while the median PFS and OS of NS were 5.7 and 11.1 months, respectively. Objective response (P = 0.006) and low NLR (P = 0.043) were independent prognostic markers of longer OS. CONCLUSIONS We confirmed the good outcome of BEP-treated S, while NS had poorer prognosis. Previously published prognostic models for NS were validated. Based on NLR and response a new prognostic model was developed.
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Affiliation(s)
- Lajos Géczi
- National Institute of Oncology, Budapest, Hungary
| | - Barna Budai
- National Institute of Oncology, Budapest, Hungary.
| | - Nándor Polk
- National Institute of Oncology, Budapest, Hungary
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Broncano J, Alvarado-Benavides AM, Bhalla S, Álvarez-Kindelan A, Raptis CA, Luna A. Role of advanced magnetic resonance imaging in the assessment of malignancies of the mediastinum. World J Radiol 2019; 11:27-45. [PMID: 30949298 PMCID: PMC6441936 DOI: 10.4329/wjr.v11.i3.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
In the new era of functional magnetic resonance imaging (MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, “do not touch lesions” could be identified with the associated impact in the management of those patients. One of the hot-spots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free survival. Therefore, in this review we will analyze the current functional imaging techniques available (18F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.
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Affiliation(s)
- Jordi Broncano
- Cardiothoracic Imaging Unit, Hospital San Juan de Dios, Health Time, Cordoba 14012, Spain
| | - Ana María Alvarado-Benavides
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | - Sanjeev Bhalla
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | | | - Constantine A Raptis
- Cardiothoracic Department, Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO 63110, United States
| | - Antonio Luna
- MR imaging Unit, Clínica Las Nieves, Jaen 23007, Spain
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Verification of the diagnostic strategy for anterior mediastinal tumors. Int J Clin Oncol 2018; 24:385-393. [DOI: 10.1007/s10147-018-1362-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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Shimizu J, Yazaki U, Kinoshita T, Tatsuzawa Y, Kawaura Y, Nonomura A. Primary Mediastinal Germ Cell Tumor in a Middle-Aged Woman: Case Report and Literature Review. TUMORI JOURNAL 2018; 87:269-71. [PMID: 11693807 DOI: 10.1177/030089160108700412] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although primary mediastinal germ cell tumors are found much more frequently among young males than among other people, we recently encountered a middle-aged woman with the disease. The patient was a 59-year-old woman who complained mainly of anterior chest pain. Chest CT scans revealed a nonhomogeneous mass measuring 7 x 7 cm in the anterior mediastinal area, accompanied by signs suggestive of mediastinal invasion of the tumor. Reduction surgery was performed. The pathologic diagnosis was mediastinal dysgerminoma. The patient received postoperative radiochemotherapy but died due to liver metastasis 11 months after surgery.
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Affiliation(s)
- J Shimizu
- Department of Surgery, Saiseikai Kanazawa Hospital, Japan.
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Abstract
The mediastinum contains vital vascular and nonvascular structures and organs, and a wide variety of abnormalities may arise from this region of the thorax. Although mediastinal masses may be initially detected on chest radiography, cross-sectional imaging plays an important role in the identification and evaluation of mediastinal lesions, enabling the formulation of focused differential diagnoses and ultimately guiding management. Computed tomography (CT) is considered the imaging modality of choice for evaluating most mediastinal masses; however, the role of magnetic resonance (MR) imaging continues to expand, as it is superior to CT in differentiating between cystic and solid masses, identifying cystic and solid components within complex lesions, and distinguishing thymic hyperplasia and normal thymus from thymic epithelial neoplasms and other neoplasms. In addition, it facilitates the staging and restaging of patients with thymic epithelial neoplasms and other tumors that cannot undergo contrast-enhanced CT imaging due to severe contrast allergy and/or impaired renal function. As division of the mediastinum into specific compartments is beneficial for diagnostic and treatment planning purposes and facilitates communication between clinicians in a multidisciplinary setting, a new classification model based on cross-sectional imaging has been developed by the International Thymic Malignancy Interest Group (ITMIG) and accepted as a new standard. In this article, we describe the role of MR imaging in the evaluation of mediastinal masses in conjunction with the new mediastinal compartment classification system introduced by ITMIG.
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Affiliation(s)
- Brett W Carter
- The University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Houston, TX
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Carter BW, Benveniste MF, Madan R, Godoy MC, de Groot PM, Truong MT, Rosado-de-Christenson ML, Marom EM. ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses. Radiographics 2017; 37:413-436. [PMID: 28129068 DOI: 10.1148/rg.2017160095] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Division of the mediastinum into specific compartments is beneficial for a number of reasons, including generation of a focused differential diagnosis for mediastinal masses identified on imaging examinations, assistance in planning for biopsies and surgical procedures, and facilitation of communication between clinicians in a multidisciplinary setting. Several classification schemes for the mediastinum have been created and used to varying degrees in clinical practice. Most radiology classifications have been based on arbitrary landmarks outlined on the lateral chest radiograph. A new scheme based on cross-sectional imaging, principally multidetector computed tomography (CT), has been developed by the International Thymic Malignancy Interest Group (ITMIG) and accepted as a new standard. This clinical division scheme defines unique prevascular, visceral, and paravertebral compartments based on boundaries delineated by specific anatomic structures at multidetector CT. This new definition plays an important role in identification and characterization of mediastinal abnormalities, which, although uncommon and encompassing a wide variety of entities, can often be diagnosed with confidence based on location and imaging features alone. In other scenarios, a diagnosis may be suggested when radiologic features are combined with specific clinical information. In this article, the authors present the new multidetector CT-based classification of mediastinal compartments introduced by ITMIG and a structured approach to imaging evaluation of mediastinal abnormalities. ©RSNA, 2017.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Rachna Madan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Myrna C Godoy
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Mylene T Truong
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
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Abstract
The mediastinum is among the most frequent anatomic region in which germ cell tumors (GCT) arise, second only to the gonads. Mediastinal GCT (mGCT) account for 16 % of all mediastinal neoplasms. Although the morphology and (according to all available data) the molecular genetics of mediastinal and gonadal GCT are identical, a number of unique aspects exist. There is a highly relevant bi-modal age distribution. In pre-pubertal children of both sexes, mGCT consist exclusively of teratomas and yolk sac tumors. The prognosis is generally favorable with modern treatment. In post-pubertal adults, virtually all patients with malignant mGCT are males; the prognosis is more guarded and depends (among other factors) on the histological GCT components and is similar to GCT in other organs. So-called somatic type malignancies (i. e. clonally related, non-germ cell neoplasias arising in a GCT) are much more frequent in mGCT than in other organs, and the association between mediastinal yolk sac tumors and hematological malignancies, such as myelodysplasias and leukemias, is unique to mediastinal tumors. The prognosis of GCT with somatic type malignancies is generally dismal.
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Affiliation(s)
- F Bremmer
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - P Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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Wang J, Bi N, Wang X, Hui Z, Liang J, Lv J, Zhou Z, Feng QF, Xiao Z, Chen D, Zhang H, Yin W, Wang L. Role of radiotherapy in treating patients with primary malignant mediastinal non-seminomatous germ cell tumor: A 21-year experience at a single institution. Thorac Cancer 2015; 6:399-406. [PMID: 26273393 PMCID: PMC4511316 DOI: 10.1111/1759-7714.12190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 10/08/2014] [Indexed: 12/25/2022] Open
Abstract
Background The aim of this study was to investigate the clinical characteristics and outcomes of patients with primary malignant mediastinal non-seminomatous germ cell tumor (MMNSGCT) by comparing the efficacies of different treatment modalities. Methods The charts of 62 consecutive patients with MMNSGCT between 1990 and 2010 were reviewed. Analyses included Kaplan-Meier survival and Cox multivariate regression. Results There was sufficient data of 61 patients for inclusion in the study. The median age was 25 years. At diagnosis, 35 patients had tumors located in the mediastinum, 26 had lung and/or distant metastases. At a median follow-up of 47.2 months, 32 patients had died and 43 had developed progressive disease. The one, three, and five-year overall survival (OS) and progression-free survival (PFS) rates were 72.1%, 50.8%, 49.2% and 47.5%, 32.8%, 32.8%, respectively. Patients who received radiotherapy in the primary treatment regimen showed improved five-year OS (68.2% vs. 38.5%, P = 0.043), PFS (45.5% vs. 20.5%, P = 0.023), and local recurrence-free survival (LRFS) (77.3% vs. 38.5%, P = 0.003) compared with those who did not receive radiotherapy. Multivariate analysis revealed that radiotherapy was an independent prognostic factor of five-year OS (hazard ratio [HR] 0.39, P = 0.037), PFS (HR 0.42, P = 0.017), and LRFS (HR 0.31, P = 0.019). Conclusion Radiotherapy in a chemotherapy-based treatment regimen could significantly reduce local recurrence and improve survival of MMNGCT patients.
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Affiliation(s)
- Jianyang Wang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Nan Bi
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Xiaozhen Wang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Zhouguang Hui
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Jun Liang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Jima Lv
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Zongmei Zhou
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Qin Fu Feng
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Zefen Xiao
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Dongfu Chen
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Hongxing Zhang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Weibo Yin
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
| | - Luhua Wang
- Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Radiation Oncology Beijing, China
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Berardi R, Pellei C, Valeri G, Pistelli M, Onofri A, Morgese F, Caramanti M, Mirza RM, Santoni M, De Lisa M, Savini A, Ballatore Z, Giuseppetti GM, Cascinu S. Chromium exposure and germinal embryonal carcinoma: first two cases and review of the literature. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2015; 78:1-6. [PMID: 25424542 DOI: 10.1080/15287394.2015.958416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the study was to determine the potential role of occupational exposures to chromium (Cr) in the onset of extragonadal germinal embryonal carcinoma. The first two cases of workers in a company with Cr exposure are reported. The published scientific literature regarding the topic in peer-reviewed journals including MEDLINE and CancerLit databases was extensively reviewed. Two young patients who were coworkers in the same company, exposed to Cr, developed extragonadal germinal embryonal carcinomas. One of them also developed angiosarcoma of the mediastinum. To the best of our knowledge these are the first two cases of germinal embryonal carcinoma in patients with occupational exposure to Cr.
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Affiliation(s)
- Rossana Berardi
- a Medical Oncology , Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-GM Lancisi-G Salesi , Ancona , Italy
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13
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Mixed germ cell tumour of mediastinum—an unusual presentation. Indian J Thorac Cardiovasc Surg 2014. [DOI: 10.1007/s12055-014-0324-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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14
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Tumeurs germinales primitives du médiastin : expérience de l’Institut de cancérologie de Lorraine sur une période de 20 ans (1990-2012). Bull Cancer 2014; 101:1067-73. [DOI: 10.1684/bdc.2014.2047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Zhao GQ, Dowell JE. Hematologic malignancies associated with germ cell tumors. Expert Rev Hematol 2014; 5:427-37. [DOI: 10.1586/ehm.12.24] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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Rodney AJ, Tannir NM, Siefker-Radtke AO, Liu P, Walsh GL, Millikan RE, Swisher SG, Tu SM, Pagliaro LC. Survival outcomes for men with mediastinal germ-cell tumors: the University of Texas M. D. Anderson Cancer Center experience. Urol Oncol 2010; 30:879-85. [PMID: 20933444 DOI: 10.1016/j.urolonc.2010.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 08/07/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Primary mediastinal germ-cell tumors are rare, and the effect of newer drugs and treatment strategies in this disease on overall survival is not known. We retrospectively assessed treatment outcomes at a single institution. MATERIALS AND METHODS We identified men seen at our institution from 1998 through 2005 for mediastinal germ-cell tumors. Medical records were reviewed for patient characteristics, histology, tumor markers, treatment, and survival outcome. RESULTS Thirty-four patients met study criteria, of whom 27 had nonseminomatous germ-cell tumor (NSGCT) and 7 had pure seminoma. Eleven patients (41%) with NSGCT were alive at last contact with a median overall survival time of 33.5 months. Among 13 patients with NSGCT referred to us at initial diagnosis, 7 (54%) were alive and recurrence-free at a median follow-up of 56.5 months. Progression-free survival was associated with absence of risk factors (any histology other than endodermal sinus tumor, β-hCG > 1000 mIU/mL, or disease outside the mediastinum). For the patients whose disease progressed (n = 5) or who had been referred to us for salvage treatment (n = 14), the 3-year overall survival from the date of first progression was 23%. Conversely, patients with seminoma did uniformly well with platinum-based chemotherapy; most did not undergo radiation or surgery. CONCLUSION Chemotherapy given to maximum effect followed by surgical consolidation resulted in long-term progression-free survival for 54% of patients with mediastinal NSGCT. The number of risk factors present at diagnosis may be associated with survival outcome and should be studied in a larger test group.
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Affiliation(s)
- Alan J Rodney
- Department of Genitourinary Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Chetaille B, Massard G, Falcoz PE. [Mediastinal germ cell tumors: anatomopathology, classification, teratomas and malignant tumors]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:63-70. [PMID: 20207298 DOI: 10.1016/j.pneumo.2009.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/12/2023]
Abstract
Mediastinal germ cell tumors are rare tumors. It is classic to divide those tumors into two categories, seminomas and nonseminomatous germ cell tumors: teratomas (mature or immature), embryonal carcinomas, yolk sac tumors, and choriocarcinomas. Each histological sub-type can be associated to another sub-type that realise a so-called mixed germ cell tumor. Diagnosis strategy is currently well codified for malignant mediastinal germ cell tumors. It greatly benefits from tumoral markers (alpha-fetoprotein and beta human chorionic gonadotrophin). For instance, the treatment strategy still raises some specific problems to each histological type. The treatment of seminomatous tumors is standardised--chemotherapy/surgery on residual tumor greater than 3 cm/radiotherapy on viable persistent residual tumors--and provides very satisfying results. As for the nonseminomatous germ cell tumors, the situation is dramatically different. The treatment strategy is less standardised--association of chemotherapy and surgery--and the prognosis is very severe.
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Affiliation(s)
- B Chetaille
- Département de Biopathologie, Institut Paoli-Calmettes, 232 Boulevard Sainte- Marguerite, BP 156, 13272 Marseille cedex 9, France
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Margery J, Le Berre JP, Bredin C, Bordier L, Dupuy O, Mayaudon H, Guigay J, Bauducea B. Diagnostic d’un syndrome de Klinefelter trois ans après chirurgie d’exérèse d’un tératome médiastinal. Presse Med 2005; 34:1078-9. [PMID: 16334884 DOI: 10.1016/s0755-4982(05)84120-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The association between some types of tumor and Klinefelter's syndrome (KS) is often missed and diagnosis of the latter delayed, as in this case report. CASE We present the case of a 20 year-old patient for whom KS was not diagnosed until three years after thoracic surgery for a mediastinal teratoma. DISCUSSION The association between KS and mediastinal germ-cell tumors is not coincidental; it illustrates the relation between aneuploidy and oncogenesis. In a young adult male, palpation of the scrotum to look for microorchidism is justified when these tumors are diagnosed because 25% occur in patients with KS.
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Affiliation(s)
- J Margery
- Service de pneumologie, HIA Percy, Clamart (92).
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20
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21
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Wright CD, Kesler KA. Surgical techniques and outcomes for primary nonseminomatous germ cell tumors. CHEST SURGERY CLINICS OF NORTH AMERICA 2002; 12:707-15. [PMID: 12471873 DOI: 10.1016/s1052-3359(02)00030-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with primary mediastinal nonseminomatous germ cell tumors are usually young men with large anterior mediastinal masses. The diagnosis can usually be established with measurement of serum tumor markers and a fine-needle aspiration biopsy. The mainstay of treatment is cisplatin-based chemotherapy. Resection of the residual postchemotherapy mass is usually necessary and is performed even with persistently elevated tumor markers if a clean resection is possible. The finding of necrotic tumor predicts long-term survival, whereas persistent germ cell cancer has a less favorable prognosis.
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Affiliation(s)
- Cameron D Wright
- Harvard Medical School, Section of General Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA.
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22
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Omezzine N, Khouatra C, Larivé S, Freyer G, Isaac-Pinet S, Gérinière L, Droz JP, Souquet PJ. Rhabdomyosarcoma arising in mediastinal teratoma in an adult man: a case report. Ann Oncol 2002; 13:323-6. [PMID: 11886012 DOI: 10.1093/annonc/mdf022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report a case of rhabdomyosarcoma which occurred in a mediastinal teratoma in a 44-year-old man. Presentation symptoms were chest pain, hoarseness and a cough. Diagnosis was fortuitous, performed by the histological and immunohistochemical study of a mediastinal tumour biopsy specimen that showed embryonal carcinoma and yolk sac tumour components associated with the rhabdomyosarcoma. After cisplatin-based chemotherapy (bleomycin-etoposide-cisplatin), surgical resection of the residual mediastinal tumour was performed. Histological and immunohistochemical study of this tumour confirmed the presence of mature teratoma and embryonal rhabdomyosarcoma. Evolution was marked by a local extension of the mediastinal tumour, occurrence of multiple metastases and bone marrow involvement. The patient died 8 months after diagnosis despite chemotherapy and radiotherapy. A review of the literature reveals that the development of rhabdomyosarcoma in primary mediastinal teratomas is unusual in adults. The diagnostic, therapeutic and prognostic implications of such an association are reviewed.
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Affiliation(s)
- N Omezzine
- Department of Pneumology, Centre Hospitalier Lyon-Sud, Pierre-Benite, France
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23
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Vuky J, Bains M, Bacik J, Higgins G, Bajorin DF, Mazumdar M, Bosl GJ, Motzer RJ. Role of postchemotherapy adjunctive surgery in the management of patients with nonseminoma arising from the mediastinum. J Clin Oncol 2001; 19:682-8. [PMID: 11157018 DOI: 10.1200/jco.2001.19.3.682] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the role of postchemotherapy surgery in patients with nonseminomatous germ cell tumors arising from the anterior mediastinum. PATIENTS AND METHODS Thirty-two patients with nonseminoma arising from a mediastinal primary site were treated on a clinical trial at our center, and they underwent postchemotherapy surgery. The results of postchemotherapy surgical resection, frequency of viable tumor found during postchemotherapy surgery, and prognostic factors for survival were assessed. RESULTS Complete resection of all gross residual disease was achieved in 27 patients (84%). Histologic analysis of resected residua postchemotherapy revealed viable tumor in 66%, teratoma in 22%, and necrosis in 12% of the specimens. Viable tumor included embryonal carcinoma, choriocarcinoma, yolk sac carcinoma, seminoma, and teratoma with malignant transformation to nongerm cell histology (eg, sarcoma). Clinical characteristics associated with a shorter survival after surgery included the presence of viable tumor in a resected specimen (P =.003) and more than one site resected during surgery (P =.06). There were no statistically significant differences in survival for patients who underwent surgical resection with normal markers compared with patients with elevated serum tumor markers (P =.33). A trend toward shorter survival was found in patients with increasing tumor markers before surgery compared with patients with normal and declining serum tumor markers (P =.09). CONCLUSION Surgical resection of residual mass after chemotherapy plays an integral role in the management of patients with primary mediastinal nonseminoma. Teratoma and viable tumor were found in the majority of resected residua after chemotherapy. Because patients who undergo conventional salvage chemotherapy programs rarely achieve long-term disease-free status, selected patients with elevated markers after chemotherapy are considered candidates for surgical resection.
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Affiliation(s)
- J Vuky
- Genitourinary Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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24
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Bokemeyer C, Droz JP, Horwich A, Gerl A, Fossa SD, Beyer J, Pont J, Schmoll HJ, Kanz L, Einhorn L, Nichols CR, Hartmann JT. Extragonadal seminoma. Cancer 2001. [DOI: 10.1002/1097-0142(20010401)91:7<1394::aid-cncr1144>3.0.co;2-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Walsh GL, Taylor GD, Nesbitt JC, Amato RJ. Intensive chemotherapy and radical resections for primary nonseminomatous mediastinal germ cell tumors. Ann Thorac Surg 2000; 69:337-43; discussion 343-4. [PMID: 10735660 DOI: 10.1016/s0003-4975(99)01472-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Primary nonseminomatous germ cell tumors of the mediastinum (PNSGM), unlike malignancies of gonadal origin, have a poor prognosis. We report a single institutional experience over a 5-year period of PNSGM treated with intensive chemotherapy, followed by radical operation in those who responded to this neoadjuvant regimen. METHODS From 1993 to 1998, 20 patients were referred for the management of PNSGM. All were male, with a median age of 30.5 years (range 18 to 48). Eighteen of 20 (90%) presented with symptoms. Most tumors were large, with a median diameter of 10 cm (range 3 to 20 cm). Thirteen patients (65%) had metastatic disease at the time of presentation. Eleven patients had received no prior treatment (initial group) and 9 were referred for salvage therapy after progression of their tumors, following treatment at other facilities (salvage group). All had elevated serum tumor markers (beta hCG and alpha-fetoprotein). Preoperative chemotherapy included alternating cycles of combinations of 3 or more drugs, including cisplatin, bleomycin, etoposide, vincristine, methotrexate, actinomycin, cyclophosphamide, and doxorubicin. An average of 10 cycles of chemotherapy was given to each patient in the initial group, and six to those in the salvage group. Five patients (25%) developed transient renal insufficiency, and 35% developed pulmonary infiltrates related to bleomycin. There were 3 chemotherapy related deaths. RESULTS After chemotherapy, 11 patients underwent operation, with 10 complete resections of the residual mediastinal tumors. There were no perioperative deaths. The 2-year survival in the initial group is 72%, and 42% for the salvage group. CONCLUSIONS An aggressive, multidisciplinary approach of alternating cycles of chemotherapy, followed by complete surgical resection of all remaining disease in patients whose markers normalize, can be associated with prolonged survival in patients with PNSGM.
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Affiliation(s)
- G L Walsh
- Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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26
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27
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Kołodziejski L, Duda K, Niezabitowski A, Dyczek S, Staniec B. Occurrence of malignant non-germ cell components in primary mediastinal germ cell tumours. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1999; 25:54-60. [PMID: 10188856 DOI: 10.1053/ejso.1998.0600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
METHODS Thirty-five patients with primary mediastinal germ cell tumours (PMGCT) underwent primary thoracotomy in a 30-year period (1965-1994). Of the 35 patients, 12 had benign teratomas, five pure seminomas and 18 non-seminomatous germ cell tumours. RESULTS Out of 18 non-seminomatous germ cell tumours, 14 comprised more than one malignant component. In two cases malignant teratomas had an additional malignant non-germ cell component: one a mixed sarcomatous component and the other a neuroendocrinal component. There were different methods of treatment between 1965 and 1994. All but one of patients with seminomas survived for 5 years. Among 18 patients with malignant PMGCT, all but two died within 5 years (mean survival rate was 15 months). CONCLUSIONS When planning treatment of patients with malignant PMGCT we have to take into account the fact that malignant non-germ-cell components may occur. In this circumstances, surgical resection after initial chemotherapy is recommended.
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Abstract
BACKGROUND There have been few reports on results after extended radical resection for primary mediastinal tumors invading neighboring organs. METHODS A retrospective analysis of 89 patients who underwent total or subtotal resection of a primary mediastinal tumor with resection of at least part of an adjacent structure between 1979 and 1995 was performed. Clinical data were collected from the medical records. RESULTS There were 35 invasive thymomas, 12 thymic carcinomas, 17 germ cell tumors, 16 lymphomas, 3 neurogenic tumors, 3 thyroid carcinomas, 2 radiation-induced sarcomas, and 1 mediastinal mesothelioma. The tumor was located in the anterior mediastinum in 74% of patients. Residual masses after chemotherapy were excised in 14 patients with germ cell tumor and 8 with lymphoma. A median sternotomy was the most frequently used approach (79% of patients). Total resection was achieved in 79% and significantly improved survival (p < 0.01). Adjacent resected structures included 38 phrenic nerves, 21 superior venae cavae, 16 upper lobes, and 13 innominate veins, in 5 patients, a pneumonectomy was required. The complication rate was 17% and the mortality rate, 6%. With follow-up available for 86 patients, the overall 5-year survival rate was 69% for patients with thymoma, 42% for patients with thymic carcinoma, 48% for patients with germ cell tumor, and 83% for patients with lymphoma. CONCLUSIONS Malignant mediastinal tumors can be safely resected even if they have invaded other mediastinal structures. Complete resection is important to achieve satisfactory long-term survival. A median sternotomy is an excellent approach, and a preoperative diagnosis by biopsy is desirable. Residual masses after chemotherapy for lymphoma or germ cell tumor should be resected. Extensive resection without a preoperative diagnosis is not indicated.
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Affiliation(s)
- E A Bacha
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Centre Chirurgical Marie-Lannelongue, Paris-Sud University, Le Plessis-Robinson, France
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Morishima Y, Satoh H, Ohtsuka M, Yazawa T, Yamashita Y, Hasegawa S. Primary mediastinal nonseminomatous germ cell tumour in an adult female. Respir Med 1998; 92:882-4. [PMID: 9850377 DOI: 10.1016/s0954-6111(98)90395-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Y Morishima
- Department of Internal Medicine, University of Tsukuba, Japan
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Hachiya T, Koizumi T, Hayasaka M, Kubo K, Sekiguchi M, Hanyuuda M, Honda T. Spontaneous regression of primary mediastinal germ cell tumor. Jpn J Clin Oncol 1998; 28:281-3. [PMID: 9657016 DOI: 10.1093/jjco/28.4.281] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A case of primary mediastinal germ cell tumor, which demonstrated spontaneous regression, is presented. The serum human chorionic gonadotropin level was elevated on admission and then decreased to the normal range with decrease in the size of the anterior mediastinal mass. Thoracotomy was performed with artificial replacement by grafts between the bilateral brachiocephalic veins and the right atrium. Histological diagnosis of combined teratoma with seminoma was made. After subsequent chemotherapy, the patient has remained alive without recurrence for over 10 years.
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Affiliation(s)
- T Hachiya
- First Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan
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Fizazi K, Culine S, Droz JP, Terrier-Lacombe MJ, Théodore C, Wibault P, Rixe O, Ruffié P, Le Chevalier T. Initial management of primary mediastinal seminoma: radiotherapy or cisplatin-based chemotherapy? Eur J Cancer 1998; 34:347-52. [PMID: 9640220 DOI: 10.1016/s0959-8049(97)10021-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Primary mediastinal seminoma is an uncommon neoplasm, the optimal management of which is still debated. Radiotherapy produces a 65% disease-free survival rate. We assess whether these results have been improved with the advent of cisplatin-based chemotherapy. Data from 14 patients treated at the Institut Gustave-Roussy were reviewed. 9 had received cisplatin-based chemotherapy (Group 1): their outcome was compared with that of 5 patients treated with radiotherapy without chemotherapy (Group 2). We also reviewed data from the English literature using strict criteria, and report results concerning patients who received cisplatin-based chemotherapy and those who received radiotherapy. 8 of the 9 patients (89%) in Group 1 are long-term disease-free survivors and only 3 of 5 patients in Group 2. The patient who died in Group 1 was the only one who refused surgical resection of residual masses after chemotherapy. The review of the literature revealed that 59 of 68 (87%) patients initially managed with cisplatin- or carboplatin-based chemotherapy and for whom sufficient data are available, are long-term survivors and free of disease. Some of these patients had also received radiotherapy. Only 64 of 103 (62%) treated with thoracic radiotherapy without chemotherapy were long-term disease-free survivors. The disease-free survival rate of 51 patients who received cisplatin-based chemotherapy (excluding those who received carboplatin) was 86%. The difference in survival between patients administered cisplatin-based chemotherapy and those who underwent radiotherapy is apparently not due to unbalanced prognostic factors, the effect of time or non-specific medical management. We conclude that cisplatin-based chemotherapy allows long-term disease-free survival in approximately 85% of patients. These results seem to be higher than those obtained without cisplatin-based chemotherapy. However, a randomised study is required for definitive conclusions, but it is very unlikely that such a study will be performed due to the rarity of this neoplasm. Another alternative would be a meta-analysis based on individual data.
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Affiliation(s)
- K Fizazi
- Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
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Bower M, Brock C, Holden L, Nelstrop A, Makey AR, Rustin GJ, Newlands ES. POMB/ACE chemotherapy for mediastinal germ cell tumours. Eur J Cancer 1997; 33:838-42. [PMID: 9291802 DOI: 10.1016/s0959-8049(96)00403-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mediastinal germ cell tumours (MGCT) are rare and most published series reflect the experiences of individual institutions over many years. Since 1979, we have treated 16 men (12 non-seminomatous germ cell tumours and 4 seminomas) with newly diagnosed primary MGCT with POMB/ACE chemotherapy and elective surgical resection of residual masses. This approach yielded complete remissions in 15/16 (94%) patients. The median follow-up was 6.0 years and no relapses occurred more than 2 years after treatment. The 5 year overall survival in the non-seminomatous germ cell tumours (NSGCT) is 73% (95% confidence interval 43-90%). One patient with NSGCT developed drug-resistant disease and died without achieving remission and 2 patients died of relapsed disease. In addition, 4 patients with bulky and/or metastatic seminoma were treated with POMB/ACE. One died of treatment-related neutropenic sepsis in complete remission and one died of relapsed disease. Finally, 4 patients (2 NSGCT and 2 seminomas) referred at relapse were treated with POMB/ACE and one was successfully salvaged. The combination of POMB/ACE chemotherapy and surgery is effective management for MGCT producing high long-term survival rates.
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Affiliation(s)
- M Bower
- Medical Oncology Unit, Charing Cross Hospital, London, U.K
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Chan AT, Ho S, Yim AP, Chang AR, Cheng P, Yuen J, Leung TW, Johnson PJ. Primary mediastinal malignant germ cell tumour. Single institution experience in Chinese patients and correlation with specific alpha-fetoprotein bends. Acta Oncol 1996; 35:221-7. [PMID: 8639319 DOI: 10.3109/02841869609098505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Ten Chinese patients were reviewed, all with mediastinal germ cell tumours and treated in our centre during the past 8 years. Three patients with pure seminomas were given chemotherapy with or without radiotherapy. AB achieved complete remission with no relapse. Seven patients with non-seminomatous germ cell tumours (NSGCT) were given chemotherapy, with or without surgery. Two patients with rapid decay of alpha-fetoprotein (AFP) levels (half-life less than or equal to 7.2 days) during chemotherapy achieved complete remission with no relapse. Five patients with prolonged decay of AFP levels (half-life > 7.2 days) failed to achieve complete remission with initial chemotherapy and all but one patient died between 5 and 9 months later. One patient developed acute megakaryocytic leukaemia. Using isoelectric focusing, AFP bands specific to NSGCT were quantified, and comparison was made with the total AFP in five cases. In each case the change in NSGCT-specific AFP concentration in response to therapy closely paralleled that of total AFP. Estimation of NSGCT-specific AFP offers no apparent advantage in monitoring disease response or progression.
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Affiliation(s)
- A T Chan
- Department of Clinical Oncology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Granetzny A, Winter J, Kantartzis M, Steinbach M, Borchard F, Jungblut MR, Schulte HD. [Primary seminoma. A rare mediastinal tumor]. LANGENBECKS ARCHIV FUR CHIRURGIE 1995; 380:149-53. [PMID: 7791485 DOI: 10.1007/bf00207720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
This is a report on three patients with primary mediastinal seminoma. Two patients had no symptoms, and one had had thoracic pain for the last few years. The preoperative diagnosis was thymoma in all cases, and in one patient the radiologist had suspected a seminoma. We removed the tumor after performing median sternotomy (n = 2) and anterolateral left thoracotomy (n = 1). The presence of a primary gonadal seminoma was excluded with a urological and ultrasound examination. All patients are still alive following adjuvant chemotherapy (n = 2; 120 and 8 months) and radiotherapy (n = 1; 84 months). Chemotherapy consisted of four cycles of cisplatin, etoposide and ifosfamide or combination therapy with cisplatin, bleomycin and velbe.
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Affiliation(s)
- A Granetzny
- Klinik für Thorax- und Kardiovaskuläre Chirurgie, Heinrich-Heine-Universität Düsseldorf
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