Objective
To determine the pathologic findings and clinical outcome of patients with pure embryonal
carcinoma (EC) of the testis who were diagnosed with testis cancer from January 1989
to January 2013 who underwent an orchiectomy, cisplatin-based chemotherapy and a postchemotherapy
retroperitoneal lymph node dissection (PC-RPLND).
Methods
We compared those patients with 100% EC with those with mixed nonseminomatous germ
cell tumor pathology who underwent a PC-RPLND.
Results
Of 1105 patients who underwent a PC-RPLND, 145 had pure EC. Twenty-six percent of
patients presented with metastatic disease outside the retroperitoneum. Patients with
mixed histologies tended to have worse International Germ Cell Cancer Collaborative
Group risk compared to those with EC at orchiectomy (P = .037). Histology at PC-RPLND revealed fibrosis or necrosis in 76%, mature teratoma
in 19% and viable cancer in 4%. Over one-third of the patients had a residual mass
of <1 cm prior to RPLND; of whom 15% harbored mature teratoma in PC-RPLND histology.
The Kaplan–Meier estimated probability of recurrence at 5 years of follow-up was 3.1%
(95% CI 1.2%, 8.0%) for EC histology, 7.3% lower than mixed histology. For cancer-specific
mortality, the Kaplan–Meier estimated probability at 5 years was 4.6% (95% CI 3.3%,
6.3%) and 1.7% (95% CI 0.4%, 6.8%) for mixed and pure EC histologies, respectively.
Conclusion
Approximately 20% of patients with pure EC had teratoma at PC-RPLND. We have shown
that those with a maximum node size of <1 cm should not be precluded from RPLND.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Etoposide and cisplatin chemotherapy for metastatic good-risk germ cell tumors.J Clin Oncol. 2005; 23: 9290-9294
- Testicular embryonal carcinoma: a morphologic study of 180 cases highlighting unusual and unemphasized aspects.Am J Surg Pathol. 2014; 38: 689-697
- Risk factors for relapse in patients with clinical stage I testicular nonseminomatous germ cell tumors.Med Oncol. 2013; 30: 494
- The role of retroperitoneal lymph node dissection in the management of testicular cancer.Urol Oncol. 2004; 22 (discussion 234-225): 225-233
- Autopsy findings in 154 patients with germ cell tumors of the testis.Cancer. 1982; 50: 548-551
- Late relapse of testicular cancer.J Clin Oncol. 1995; 13: 1170-1176
- European consensus conference on diagnosis and treatment of germ cell cancer: a report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): part I.Eur Urol. 2008; 53: 478-496
- Postchemotherapy retroperitoneal surgery remains necessary in patients with nonseminomatous testicular cancer and minimal residual tumor masses.J Clin Oncol. 2003; 21: 3310-3317
- Surgical management of low-stage nonseminomatous germ cell testicular cancer.BJU Int. 2009; 104: 1362-1368
- Apoptosis in spermatocytic and usual seminomas: a light microscopic and immunohistochemical study.Mod Pathol. 2007; 20: 1036-1044
- European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG).Ann Oncol. 2004; 15: 1377-1399
- Prediction of residual retroperitoneal mass histology after chemotherapy for metastatic nonseminomatous germ cell tumor: multivariate analysis of individual patient data from six study groups.J Clin Oncol. 1995; 13: 1177-1187
- Postchemotherapy retroperitoneal lymph node dissection in advanced testicular cancer: radical or modified template resection.Eur Urol. 2009; 55: 217-224
- Predicting teratoma in the retroperitoneum in men undergoing post-chemotherapy retroperitoneal lymph node dissection.J Urol. 2006; 176 (discussion 103-104): 100-103
- Long-term clinical outcome after postchemotherapy retroperitoneal lymph node dissection in men with residual teratoma.J Clin Oncol. 2007; 25: 1033-1037
- Teratoma with malignant transformation: diverse malignant histologies arising in men with germ cell tumors.J Urol. 1998; 159: 133-138
- Late relapse of testicular germ cell neoplasms: a descriptive analysis of 122 cases.J Urol. 2005; 173: 824-829
Article info
Publication history
Published online: February 02, 2018
Accepted:
January 10,
2018
Received:
November 14,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: This work was supported by: National Cancer Institute [P50-CA92629 and P30-CA008748], the Sidney Kimmel Center for Prostate and Urologic Cancers, and David H. Koch through the Prostate Cancer Foundation, the Richard Capri Foundation.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
