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*

If a testicular cancer patient has a mass in the retroperitoneum, a metastasis is often the first suspicion, probably leading to improper diagnosis and overtreatment. Here we report a case of retroperitoneal schwannoma mimicking metastatic seminoma. A 29-year-old man, who had a history of seminoma, presented with a single retroperitoneal mass suspected to be a metastasis. Because the patient refused radiotherapy, 3 cycles of cisplatin, etoposide, and bleomycin were offered. Post-chemotherapy computed tomography scan revealed persistence of the retroperitoneal mass, with no change in tumor size or characteristics. Subsequently, retroperitoneal lymph node dissection was performed. The dissected tissue contained negative lymph nodes but a single mass in the attached fat. Pathology revealed retroperitoneal schwannoma, which was confirmed by immunohistochemistry. Thus, clinicians should be aware of retroperitoneal schwannoma and its distinction from metastatic seminoma to avoid misdiagnosis and ensure proper treatment.
Adult ; Antibiotics, Antineoplastic ; therapeutic use ; Antineoplastic Agents ; therapeutic use ; Antineoplastic Agents, Phytogenic ; therapeutic use ; Bleomycin ; therapeutic use ; Cisplatin ; therapeutic use ; Diagnostic Errors ; Etoposide ; therapeutic use ; Humans ; Lymph Node Excision ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Neoplasms, Multiple Primary ; Neurilemmoma ; diagnostic imaging ; drug therapy ; pathology ; Radiography ; Retroperitoneal Neoplasms ; diagnostic imaging ; drug therapy ; pathology ; secondary ; Retroperitoneal Space ; Seminoma ; secondary ; surgery ; Testicular Neoplasms ; surgery

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

We report a case of a 59-year-old man with testicular germ cell tumor who showed new hypermetabolic lesions at the left axillary lymph nodes on a post-treatment positron emission tomography-computed tomography (PET-CT) scan. The hypermetabolic lesions were found to be caused by an influenza vaccination 10 days prior to the PET-CT scan and disappeared without additional treatment. To date, he is alive with complete remission.
Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; False Positive Reactions ; Humans ; Influenza Vaccines/*administration & dosage/adverse effects ; Injections, Intramuscular ; Lymph Nodes/drug effects/*radiography/*radionuclide imaging ; Male ; Middle Aged ; *Positron-Emission Tomography ; Predictive Value of Tests ; Seminoma/*diagnosis/drug therapy/pathology/radiography/radionuclide imaging ; Testicular Neoplasms/*diagnosis/drug therapy/pathology/radiography/radionuclide imaging ; *Tomography, X-Ray Computed ; Treatment Outcome ; *Whole Body Imaging

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 study the clinicopathologic features, immunohistochemical findings and prognosis of primary diffuse large B-cell lymphoma (DLBCL) of testis.

METHODSFourteen cases of primary DLBCL of testis, diagnosed according to the 2001 World Health Organization staging standards for hematopoietic and lymphoid tumors, were retrospectively studied. Immunohistochemical study was performed and follow-up information analyzed.

RESULTSThe median age of the patients was 62 years. There were 10 patients in stage I, 3 in stage II and 1 in stage IV. Follow-up information was available in 11 patients (78.6%). Three of which were still alive and eight died (with duration of survival ranging from 5 to 19 months). The patients usually presented with unilateral painless enlargement of testis. Histologically, the lymphoma cells of all cases showed a centroblastic appearance. One case belonged to the germinal center B cell-like subtype on immunohistochemical study, while the remaining 13 cases were classified as non-germinal center B cell-like subtype. Ten of the 14 cases (71.4%) showed overexpression of p53 protein. Most cases demonstrated high proliferation index. Six of the 14 cases (42.9%) were positive for bcl-2 protein. The overall 1-year, 2-year and 5-year survival rates were 45.5%, 17.0% and 17.0%, respectively.

CONCLUSIONSMost cases with primary DLBCL of testis were of peripheral activated B-cell origin. The prognosis is usually not favorable, with propensity of local relapse and systemic dissemination. Accurate pathologic diagnosis relies on detailed histologic examination and immunohistochemical study.

Adult ; Aged ; Aged, 80 and over ; Antigens, CD20 ; metabolism ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Diagnosis, Differential ; Doxorubicin ; therapeutic use ; Follow-Up Studies ; Gene Expression Regulation, Neoplastic ; Germinoma ; drug therapy ; metabolism ; pathology ; surgery ; Humans ; Lymphoma, Large B-Cell, Diffuse ; drug therapy ; metabolism ; pathology ; surgery ; Male ; Middle Aged ; Neprilysin ; metabolism ; Orchiectomy ; Prednisone ; therapeutic use ; Proto-Oncogene Proteins c-bcl-2 ; metabolism ; Retrospective Studies ; Seminoma ; pathology ; Survival Rate ; Testicular Neoplasms ; drug therapy ; metabolism ; pathology ; surgery ; Tumor Suppressor Protein p53 ; metabolism ; Vincristine ; therapeutic use

Aleukemic leukemia cutis is a rare condition characterized by invasion of leukemic cells in the skin before their appearance in the peripheral blood or bone marrow. We report a case of a 24-year-old man who presented with a 2-month history of nodules on his chin and left thigh. His medical history included acute myelocytic leukemia which had been in complete remission for 13 years and seminoma of the right testis which had been treated with orchiectomy 1 year before. Biopsy of the cutaneous lesions revealed infiltrating cells characterized by irregular shaped or kidney bean-shaped nuclei with abundant pale, slightly eosinophilic cytoplasm. These atypical cells stained positive for leukocyte common antigen, lysozyme and myeloperoxidase. His peripheral blood examination and bone marrow biopsy failed to demonstrate leukemic changes. With these results, a diagnosis of aleukemic leukemia cutis was made. We then performed another immunohistochemical stain for lysozyme and myeloperoxidase on the testicular specimen which had been diagnosed as seminoma 1 year previously. The tumor cells of seminoma were lysozyme- and myeloperoxidase-positive. We were also able to diagnose seminoma as isolated granulocytic sarcoma. A complete remission of the cutaneous lesion was achieved with chemotherapy, but recurrent leukemia cutis reappeared six months later. He underwent a bone marrow transplant but died 3 months later.
Antigens, CD45 ; Biopsy ; Bone Marrow ; Chin ; Cytoplasm ; Diagnosis ; Drug Therapy ; Eosinophils ; Humans ; Kidney ; Leukemia* ; Leukemia, Myeloid, Acute ; Muramidase ; Orchiectomy ; Peroxidase ; Sarcoma, Myeloid ; Seminoma ; Skin ; Testis ; Thigh ; 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 clinical characteristics, outcome, prognostic factors and survival of patients with testicular germ cell tumors (TGCTs).

METHODS107 TGCT patients received chemotherapy after orchiectomy. The median age of the patients was 32 years. 30.8% (33/107) patients had seminomas with 14 (42.4%) stage I lesions. Seventy-four patients had non-seminomatous germ cell tumors (NSGCTT) with 21 (28.4%) stage I lesions. The response rate was analyzed with chi(2) test. The survival rate was calculated with Kaplan-Meier method and log-rank test. Therapy including chemotherapy, radiation and necessary salvage operation were performed after orchiectomy.

RESULTSClinical stage and pathological type were the main prognostic factors. The 3-, 5- and 10-year survival rates were 75.8%, 73.5%, 73.5% for all patients, 100%, 96.8%, 96.8% for seminoma and 63.5%, 61.7%, 61.7% for NSGCTTs, respectively. Sixty-four patients were evaluable for response. Seventeen (26.6%) patients achieved CR by chemotherapy alone and an additional 8 patients (12.5%) achieved CR by chemotherapy plus salvage operation or radiation. The 5-year survival rates were 91.7% and 26.2% for patients who achieved CR or not.

CONCLUSIONThe long-term outcome for stage I germ cell tumors is excellent. The treatment outcome and survival in patients with metastatic TGCTs can be greatly improved by adopting multi-modality therapy with combined chemotherapy as the chief means.

Adolescent ; Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Bleomycin ; therapeutic use ; Child ; Child, Preschool ; Cisplatin ; therapeutic use ; Combined Modality Therapy ; Etoposide ; therapeutic use ; Follow-Up Studies ; Germinoma ; drug therapy ; secondary ; surgery ; Humans ; Lung Neoplasms ; drug therapy ; secondary ; Male ; Middle Aged ; Neoplasm Staging ; Orchiectomy ; Seminoma ; drug therapy ; secondary ; surgery ; Survival Rate ; Testicular Neoplasms ; drug therapy ; pathology ; surgery ; Treatment Outcome