To develop a more appropriate therapeutic strategy for treatment of nonpulmonary visceral metastatic testicular seminoma based on the International Germ Cell Consensus Classification, we reviewed the medical records of patients with nonpulmonary visceral metastatic testicular seminoma who were treated over a 20-year period. Only 15 (2.2%) of the 686 cases of testicular seminoma were nonpulmonary visceral metastatic seminoma. The median age of patients was 38 years (range, 22-53 years). Ten (67%) of the patients had an initial diagnosis of supradiaphragmatic or visceral metastatic disease. In addition to nonpulmonary visceral metastasis, all patients had lymph node metastasis as well, the majority of which involved the retroperitoneal lymph nodes. The median and mean progression-free survival durations after chemotherapy for advanced disease were 19 months and 63.7 months, respectively. Six patients (40%) survived, five relapsed after radiation therapy and four died of chemorefractory disease not dependent on the specific regimen. Although the number of cases reviewed in this study was small, we conclude that the choice of chemotherapeutic regimen among the current treatments for nonpulmonary visceral metastatic seminoma of testis primary does not present a different outcome. Therefore, multimodality therapies using new strategies or new agents are well indicated.
Adult ; Antineoplastic Agents, Combined/administration & dosage* ; Bone Neoplasms/secondary ; Bone Neoplasms/radiotherapy ; Bone Neoplasms/drug therapy ; Combined Modality Therapy ; Human ; Lung Neoplasms/secondary ; Lung Neoplasms/radiotherapy ; Lung Neoplasms/drug therapy ; Lymphatic Metastasis ; Male ; Middle Age ; Retroperitoneal Neoplasms/secondary* ; Retroperitoneal Neoplasms/radiotherapy ; Retroperitoneal Neoplasms/drug therapy* ; Retrospective Studies ; Seminoma/secondary* ; Seminoma/radiotherapy ; Seminoma/drug therapy* ; Testicular Neoplasms/pathology*

Adolescent ; Diagnosis, Differential ; Disorders of Sex Development ; Female ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal ; pathology ; radiotherapy ; surgery ; Seminoma ; pathology ; Testicular Neoplasms ; pathology ; radiotherapy ; surgery

PURPOSE: To analyze treatment outcome and side effects of adjuvant radiotherapy using radiotherapy fields and doses which have evolved over the last two decades in a single institution. MATERIALS AND METHODS: Forty-one patients received radiotherapy after orchiectomy from 1996 to 2007. At our institution, the treatment field for stage I seminoma has changed from dog-leg (DL) field prior to 2003 to paraaortic (PA) field after 2003. Fifteen patients were treated with the classic fractionation scheme of 25.5 Gy at 1.5 Gy per fraction. Other patients had been treated with modified schedules of 25.05 Gy at 1.67 Gy per fraction (n=15) and 25.2 Gy at 1.8 Gy per fraction (n=11). RESULTS: With a median follow-up of 112 months, the 5-year and 10-year survival rates were 100% and 96%, respectively, and 5-year and 10-year relapse-free survival rates were both 97.1%. No in-field recurrence occurred. Contralateral seminoma occurred in one patient 5 years after treatment. No grade III-IV acute toxicity occurred. An increased rate of grade 1-2 acute hematologic toxicity was found in patients with longer overall treatment times due to 1.5 Gy per fraction. The rate of grade 2 acute gastrointestinal toxicity was significantly higher with DL field than with PA field and also higher in the 1.8-Gy group than in the 1.5-Gy and 1.67-Gy groups. CONCLUSION: Patients with stage I seminoma were safely treated with PA-only radiotherapy with no pelvic failure. Optimal fractionation schedule needs to be explored further in order to minimize treatment-related toxicity.
Adult ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/pathology ; Radiotherapy, Adjuvant/adverse effects ; Seminoma/*radiotherapy ; Testicular Neoplasms/*radiotherapy ; Treatment Outcome ; Young Adult

BACKGROUNDPrimary malignant germ cell tumors (GCTs) of mediastinum are rare neoplasms. We introduce our institutional experience in managing patients with primary malignant GCTs of the mediastinum, focusing on the analysis of therapeutic modalities.

METHODSA retrospective review was done in 39 consecutive patients with mediastinal malignant GCTs treated in our institution between 1991 and 2007.

RESULTSA total of 39 patients were enrolled in this study with a median age of 27 years. The 5-year overall survival (OS) and progression-free survival (PFS) rates of the whole population were 60.2% and 57.7%, respectively. Stratified by the histology, 18 patients (46.2%) had seminoma and 21 patients (53.8%) had nonseminomatous germ cell tumors (NSGCTs). The 5-year OS rate of patients with seminoma was 87.4% as compared with 36.7% in patients with NSGCTs (P = 0.0004). The 5-year PFS rate was also significantly higher in seminoma patients (87.4% vs. 31.6%, P = 0.003). For 19 patients with NSGCTs managed with multi-modality treatment, chemotherapy exposure appeared to impact the prognosis. The 5-year OS rate was 44.9% in patients with chemotherapy exposure as compared with 20.0% in patients without it (P = 0.43).

CONCLUSIONOur study confirmed the significance of systemic chemotherapy in the treatment of primary mediastinal GCTs.

Adolescent ; Adult ; Disease-Free Survival ; Female ; Humans ; Male ; Mediastinal Neoplasms ; drug therapy ; radiotherapy ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; drug therapy ; radiotherapy ; Retrospective Studies ; Seminoma ; drug therapy ; radiotherapy ; Testicular Neoplasms ; Young Adult

OBJECTIVETo investigate a therapeutic method for male infertility caused by radiotherapy after surgical treatment of spermatocytoma.

METHODSA case of azoospermia caused by radiotherapy after surgical treatment of spermatocytoma was reported and the Chinese medicine Jiaweishuiluerxiandan was used as a major therapy for 3 years.

RESULTSThe patient's health condition was improved dramatically two years after being treated by the Chinese medicine but no sperm was found in his semen. However, three years after the treatment, his spermatozoon density was recovered from zero to 2.0 x 10(6)/ml with normal morphology. His sperm was subsequently used for intracytoplasmic sperm injection, which made his spouse pregnant successfully, and an healthy male infant was born by caesarean birth.

CONCLUSIONChinese medicine is a successful try at treating male infertility caused by radiotherapy after surgical treatment of spermatocytoma. For those who have failed to get their sperm frozen before surgery, Chinese medicine is a choice for remediation.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Oligospermia ; drug therapy ; etiology ; Phytotherapy ; Pregnancy ; Radiotherapy ; adverse effects ; Seminoma ; radiotherapy ; surgery ; Sperm Count ; Testicular Neoplasms ; radiotherapy ; surgery ; Treatment Outcome

A 52-year-old man was presented with a huge left testicular mass and palpable cervical lymphadenopathy with retroperitoneal lymph node enlargement on an abdominal computed tomography. A left radical orchiectomy and an ultrasound-guided neck node biopsy were performed. A pathological examination revealed spermatocytic seminoma with extensive rhabdomyosarcomatous transformation, a condition known to be highly resistant to platinum-based chemotherapy. The patient received four cycles of etoposide, ifosfamide and cisplatin (VIP) chemotherapy. A repeat computed tomography revealed a substantial regression consistent with a partial response. Retroperitoneal lymph node dissection was attempted, which revealed rhabdomyosarcoma; however, complete microscopic resection was not achieved. After surgery, the residual abdominal lymph node progressed and salvage paclitaxel, ifosfamide and cisplatin (TIP) chemotherapy was employed, which again achieved a partial response. Here, we present a first case report of a spermatocytic seminoma with extensive rhabdomyosarcomatous transformation and multiple metastatic lymphadenopathies that showed a favorable response to platinum-based systemic chemotherapy.
Biopsy ; Cisplatin ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide ; Humans ; Ifosfamide ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Diseases ; Middle Aged ; Neck ; Orchiectomy ; Paclitaxel ; Radiotherapy ; Rhabdomyosarcoma ; Seminoma*

Clinical observations and histopathologic behaviors of testicular tumors were made on 39 cases who were admitted to the Department of Urology, Seoul National University Hospital, during the period from January, 1966 to December, 1979. The results are summarized as follows; 1) Among the 4220 cases of male inpatients, 718 (17. 0%) were G. U tract tumors and 39(0. 92%) were testicular tumors. 2) Age distribution was between 8 months and 72 years old, showing the highest incidence under the 5 year-old age group (38%). 3) Twenty one cases (53. 8%) arose on the right and eighteen cases (46. 2%) on the left. 4) Twenty two cases (56. 4%) visited the hospital within 6 months after the onset of the symptoms and 30 cases (77. 1%) within 1 year. 5) The presenting symptoms were painless scrotal mass (79. 5%). painful scrotal mass (7.7%) and metastatic symptoms (12. 8%) 6) Three cases (7.7%) arose from undescended testis. 7) Twelve cases (30. 8%) had already metastasis when first seen. 8) We had measured the level of serum A. F. P. by gel agar precipitation method or radioimmunoassay in 18 cases. Normal levels of A. F. P. were seen it seminoma and nongerminal testicular tumor. Of 11 cases with no metastatic non-seminomatous germinal cell tumor, 5 had elevated serum A. F. P. All the 3 cases with metastatic non-seminomatous germinal cell tumor had elevated serum A. F. P 9) These patients were managed by surgery, radiotherapy and chemotherapy. Serum and urine H. C. G. was checked during chemotherapy on 1 case for the evaluation of response to chemotherapy.
Agar ; Age Distribution ; Aged ; Child, Preschool ; Cryptorchidism ; Drug Therapy ; Humans ; Incidence ; Inpatients ; Male ; Neoplasm Metastasis ; Radioimmunoassay ; Radiotherapy ; Seminoma ; Seoul ; Testicular Neoplasms* ; Urology

Forty-six patients with testicular tumor were treated at our hospital From 1971 to 1990. There were 25 children (13 yolk sac tumors, 10 teratomas, 1 teratocarcinoma and 1 acute lymphocytic leukemia) and 21 adults(11 seminomas, 4 non-seminomatous germ cell tumors and 6 non-germ cell tumors). Testicular lumors with clinical evidence of cryptorchidism were 4 seminomas and 2 non seminomts. Serum AFP or HCG were observed in 8 patients of 8 seminomas, 1 of 5 teratomas, 7 of 9 yolk sac tumors and 4 or 5 non-seminomatous germ cell tumors(NSGCT). Four stage 1 seminomas and 1 NSGCT were tumor free of 2 years after radical orchiectomy and 2 of 4 seminomas were received prophylactic radiotherapy. Two stage II seminomas and 1 NSGCF treated with PVB nomas and radiotherapy were tumor free of 2 years but stage III seminomas and NSGCT died during chemotherapy. All stage 1 yolk sac tumors and teratomas were tumor Free of 2 years by surveillance only following radical orchiectomy but stage II and III yolk sac tumors died during chemotherapy. We have suggested that poor result of stage III testicular tumors can be attributed to few cases with more aggressive and more toxic chemotherapy in the unfavorable prognosis disease(advanced extent) and poor compliance of patient of therapy.
Child ; Compliance ; Cryptorchidism ; Drug Therapy ; Endodermal Sinus Tumor ; Germ Cells ; Humans ; Male ; Neoplasms, Germ Cell and Embryonal ; Noma ; Orchiectomy ; Prognosis ; Radiotherapy ; Seminoma ; Teratocarcinoma ; Teratoma ; Testicular Neoplasms ; Testis*

OBJECTIVETo study the diagnosis, treatment and prognosis of testicular germ cell tumor.

METHODSFrom Oct. 1980 to Oct. 2000, 176 cases with testicular germ cell tumor treated in West China Hospital of Sichuan University were reported, and the clinical manifestations, diagnosis and treatment were analyzed retrospectively.

RESULTSThere were 111 cases of testicular seminoma, 43 cases of testicular non-seminoma and 22 cases of mixture testicular germ cell tumor, and 46 out of 176 cases were complicated with cryptorchidism. The prognosis of patients was related to clinical stages, treatment and cryptorchidism.

CONCLUSIONSince there is no significant difference in the oncological control effects in Stage I testicular seminoma, radiotherapy is not necessary after radical orchiectomy to avoid the side effects of radiation. The treatment of testicular non-seminoma, testicular seminoma in the stage II and III should combine the radical orchiectomy and radiotherapy. Early diagnosis and early treatment are the two most important factors affecting the survival of patients with testicular germ cell tumor.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Combined Modality Therapy ; Follow-Up Studies ; Humans ; Infant ; Male ; Neoplasm Staging ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Seminoma ; pathology ; therapy ; Testicular Neoplasms ; pathology ; therapy

OBJECTIVETo investigate the clinical and pathological features, optimal treatment and prognostic factor in primary mediastinal germ cell tumors (PMGCT).

METHODSThe clinical presentation, pathological features and therapeutic results of 29 patients with PMGCT were retrospectively analyzed.

RESULTSAll the 29 patients were male with a mean age of 26.1 +/- 9.6 years at diagnosis. All tumors were originated from the anterior mediastinum with a mean diameter of 16.0 +/- 5.2 cm. There were 5 (17.2%) primary mediastinal seminomas (PMSGCT) and 24 (82.8%) primary mediastinal nonseminomas (PMNSGCT) in this series. Dyspnea, cough and chest pain were the most common symptoms. Multimodality treatment consisting of cisplatin-based chemotherapy, surgery and radiotherapy was the principal therapy for PMGCT patients. The median survival of the 24 PMNSGCT patients was 19.0 months with 1-, 2-year survival rate of 65.3% and 28.1%, respectively; whereas the median survival of the 5 PMSGCT patients has not reached but longer with significant differences (P = 0.008). Cox multivariate analysis indicated that limited mediastinal disease at diagnosis (P = 0.004) and the use of cisplatin-based combined chemotherapy (P = 0.005) were independent good prognostic factors of PMNSGCT.

CONCLUSIONPrimary mediastinal nonseminoma constitutes the most of primary mediastinal germ cell tumors. Cisplatin-based combined chemotherapy may be the most effective for the treatment of primary mediastinal germ cell tumors. The prognosis of primary mediastinal nonseminomas is significantly worse than that of primary mediastinal seminomas, and correlated with the extent of disease and chemotherapy.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Child ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Etoposide ; therapeutic use ; Follow-Up Studies ; Humans ; Ifosfamide ; therapeutic use ; Male ; Mediastinal Neoplasms ; radiotherapy ; therapy ; Mediastinum ; surgery ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; radiotherapy ; therapy ; Remission Induction ; Retrospective Studies ; Seminoma ; radiotherapy ; therapy ; Survival Rate ; Taxoids ; therapeutic use ; Young Adult