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*

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

Adenoma ; metabolism ; pathology ; Adult ; Alkaline Phosphatase ; metabolism ; Antibodies, Monoclonal, Murine-Derived ; metabolism ; Diagnosis, Differential ; Ear Canal ; Ear Neoplasms ; metabolism ; pathology ; radiotherapy ; surgery ; GPI-Linked Proteins ; metabolism ; Humans ; Isoenzymes ; metabolism ; Lymphoma, Large-Cell, Anaplastic ; metabolism ; pathology ; Male ; Mast-Cell Sarcoma ; metabolism ; pathology ; Proto-Oncogene Proteins c-kit ; metabolism ; Seminoma ; metabolism ; pathology ; radiotherapy ; surgery ; Vimentin ; metabolism ; 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

BACKGROUND AND OBJECTIVEPatients with clinical stage I seminoma accounts for 70%-80% of patients with this disease. This study was to analyze the relationship between different therapeutic methods and the prognosis of this disease.

METHODSThe data of all patients with clinical Stage I seminoma treated by multi-disciplinary approach from 1999 to 2008 in Sun Yat-sen University Cancer Center were analyzed. The patients were divided into 3 groups based on the treatment they received after orchiectomy: 30 patients treated with chemotherapy, 8 with radiotherapy, and 20 under surveillance. The prognosis of different treatment groups was evaluated.

RESULTSAmong the 58 patients with stage I seminoma, 57 were followed up successfully. The median follow-up time was 50 months (range, 8-115 months). No relapse or metastasis was seen in the chemotherapy group. One patient relapsed in the radiotherapy group. Four patients had metastasis of retroperitoneal lymph node in the surveillance group. The disease-free survival was higher in the chemotherapy group than that in the surveillance group (P=0.005). There was no significant difference in the relapse-free survival between the surveillance group and the radiotherapy group (P=0.364).

CONCLUSIONSChemotherapy is a safe and effective treatment for patients with Stage-1 seminoma after radical orchidectomy.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Disease-Free Survival ; Etoposide ; therapeutic use ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Orchiectomy ; methods ; Retrospective Studies ; Seminoma ; drug therapy ; pathology ; radiotherapy ; surgery ; Testicular Neoplasms ; drug therapy ; pathology ; radiotherapy ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo analyze the correlation of long-term survival with the treatment strategies in patients with testicular seminoma.

METHODSClinical data of 294 patients with testicular seminoma treated in our hospital between 1959 and 2004 were collected and analyzed. The median age of the patients was 37 years (range 13 - 70 years). Among them, 260 were in stage I disease, 16 in stage II, and 18 in stage III. The patients were treated by surgical resection plus chemotherapy and/or radiotherapy. The survival rate was calculated using Kaplan-Meier method and log-rank test using SPSS 13.0 software.

RESULTSThe overall 5-, 10-, 20- and 30-year survival rates in this series were 92.1%, 91.8%, 85.5% and 71.4%, respectively. The major prognostic factor was found to be clinical stage. The patients with adjuvant chemotherapy after orchiectomy had better 10-year survival than the patients without (97.5% vs. 79.2%, P = 0.001). For stage II/III patients, the patients with chemotherapy and the patients with chemotherapy plus radiotherapy had a similar progression-free survival (PFS) and overall survival (OS) (P > 0.05).

CONCLUSIONTesticular seminoma is sensitive to chemotherapy and radiotherapy, and a good cure rate can still be achieved in the relapsed patients with a salvage treatment. Therefore, wide excision and long-term chemotherapy should be avoided in order to maintain the quality of life in those patients.

Adolescent ; Adult ; Aged ; Chemotherapy, Adjuvant ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; therapy ; Neoplasm Staging ; Orchiectomy ; methods ; Proportional Hazards Models ; Radiotherapy, Adjuvant ; Retrospective Studies ; Salvage Therapy ; Seminoma ; pathology ; therapy ; Survival Rate ; Testicular Neoplasms ; pathology ; therapy ; Young Adult

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

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

OBJECTIVETo investigate the clinical characterstics, effective treatment and prognosis in patients with primary germ cell tumors in the mediastinum.

METHODSThe data of 47 such patients treated from 1967 to 2005 were retrospectively reviewed.

RESULTSOf these 47 patients, 41 were male and 6 female with a median age of 26 years; 8 (17.0%) had seminoma, and 39 (83.0%) non-seminoma. The overall 1-, 3-, 5-year survival rate was 63.4%, 37.5% and 34.8% with a median survival time of 16 months; which was 100%, 83.3% and 83.3% for seminoma and 56.4%, 30% and 27.3% for nonseminoma, respectively. The pathologic type was found to be the only independent prognostic factor (P = 0.045).

CONCLUSIONPrimary mediastinal serminoma is sensitive to radiotherapy or chemotherapy with a good prognosis, but the prognosis of primary mediastinal non-seminoma is poor. Cisplatin-based chemotherapy still plays a key role in the treatment of primary mediastinal non-seminoma as the survival of those has been improved.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Child ; Cisplatin ; administration & dosage ; Combined Modality Therapy ; Cyclophosphamide ; administration & dosage ; Drug Therapy ; methods ; statistics & numerical data ; Female ; Fluorouracil ; administration & dosage ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Male ; Mediastinal Neoplasms ; surgery ; therapy ; Middle Aged ; Neoplasms, Germ Cell and Embryonal ; surgery ; therapy ; Prognosis ; Proportional Hazards Models ; Radiotherapy ; methods ; statistics & numerical data ; Retrospective Studies ; Seminoma ; surgery ; therapy ; Vincristine ; administration & dosage

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