Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press113910.17650/1726-9776-2007-3-4-49-54DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. TESTICULAR CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак яичкаPrimary mature teratoma of the testis: clinical, morphological, and immnohistochemical predictorsПервичная зрелая тератома яичка: клинические, морфологические и иммуногистохимические факторы прогнозаOlmanK.ОльманК.
Germany

Subdivision of Urological Oncology, Department of Urology

Подразделение онкоурологии, отделение урологии

KeinderreichA.ХайденрайхА.
Germany

Subdivision of Urological Oncology, Department of Urology

Подразделение онкоурологии, отделение урологии

University of CologneУниверситет Кельна301220073449541602202016022020https://oncourology.abvpress.ru/oncur/article/view/1139

The clinical, pathomorphological, and immunohistochemical (p53, MIB-1, bcl-2, and cathepsin D) parameters were retrospectively analyzed to determine the molecular markers associated with the progression of a mature teratoma (MT) of the testis is presented.

Subjects and methods. Sixty-nine patients with pure primary MT of the testis were retrospectively selected. In all 69 cases, archival tumor blocks were accessible to histological re-evaluation. Fifty 55 (80%) patients with an early-stage tumorous process, including 44 patients with Stages I and 11 with IIA/B stage, had undergone radical orchiectomy, followed by retroperitoneal lymphadenectomy (RPLAE). Fourteen (20%) patients with a disseminated tumor received induction multidrug therapy (MDT), followed by residual tumor resection.

Results. The detection rates of metastases to the retroperitoneal lymph nodes were 14 and 73% in Stages I and IIA/B, retrospectively. The morphological diagnosis of pure MT was verified in all cases. However, 22 (79%) out of 28 patients with testicular metastases were found to have scars and calcification of the parenchyma; 6 patients had microscopic foci of a germ-cell tumor. In all, metastases were detected in 41% of patients. The mean follow-up was 92 (range 8—252) months. No recurrence developed in patients with Stage I; 5 patients with disseminated tumor had recurrences after RPLAE and 5 (7.3%) patients died from progressive cancer. The expression of p53, MIB-1, and cathepsin D in MT was low with an insignificant difference in different stages of the disease.

Conclusion. The molecular markers are of no clinical value in estimating the metastatic potential of MT. Additional serial paraffin sections should be made in all cases of pure MT. RPLAE should be performed when scar tissue or germ-cell tumor elements are found in the testis; a follow-up is indicated in other cases. If it is impossible to make additional serial paraffin sections, nerve-sparing RPLAE is the method of choice.

.

1. Mostofi F.K., Sesterhenn I.A. Pathology of germ cell tumors of testes. Prog Clin Biol Res 1985;203:1—34.Mostofi F.K., Sesterhenn I.A. Pathology of germ cell tumors of testes. Prog Clin Biol Res 1985;203:1—34.2. Read G., Stenning S.P., Cullen M.H. et al. Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol 1992;10:1762—8.Read G., Stenning S.P., Cullen M.H. et al. Medical Research Council prospective study of surveillance for stage I testicular teratoma. Medical Research Council Testicular Tumors Working Party. J Clin Oncol 1992;10:1762—8.3. Freedman L.S., Parkinson M.C., Jones W.G. et al. Histopathology in the prediction of of relapse of patients with stage I testicular treated by orchiectomy and alone. Lancet 1987;2:294—8.Freedman L.S., Parkinson M.C., Jones W.G. et al. Histopathology in the prediction of of relapse of patients with stage I testicular treated by orchiectomy and alone. Lancet 1987;2:294—8.4. Fung C.Y., Kalish L.A., Brodsky G.L. et al. Stage I nonsemimonatous germ cell tumor: prediction of metastatic potential by primary histopathology. J Clin Oncol 1988;6:1467—73.Fung C.Y., Kalish L.A., Brodsky G.L. et al. Stage I nonsemimonatous germ cell tumor: prediction of metastatic potential by primary histopathology. J Clin Oncol 1988;6:1467—73.5. Klepp O., Olsson A.M., Henrickson H. et al. Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. J Clin Oncol 1990;8:509—18.Klepp O., Olsson A.M., Henrickson H. et al. Prognostic factors in clinical stage I nonseminomatous germ cell tumors of the testis: multivariate analysis of a prospective multicenter study. J Clin Oncol 1990;8:509—18.6. Leibovitch I., Foster R.S., Ulbright T.M., Donohue J.P. Adult primary pure teratoma of the testis. Cancer 1995;75:2244—50.Leibovitch I., Foster R.S., Ulbright T.M., Donohue J.P. Adult primary pure teratoma of the testis. Cancer 1995;75:2244—50.7. Simmonds P.D., Lee A.H.S., Theaker J.M. et al. Primary pure teratoma of the testis. J Urol 1996;155:939—42.Simmonds P.D., Lee A.H.S., Theaker J.M. et al. Primary pure teratoma of the testis. J Urol 1996;155:939—42.8. Heidenreich A., Moul J.W., McLeod D.G. et al. The role of retroperitoneal lymphadenectomy in mature teratoma of the testis. J Urol 1997;157:160—3.Heidenreich A., Moul J.W., McLeod D.G. et al. The role of retroperitoneal lymphadenectomy in mature teratoma of the testis. J Urol 1997;157:160—3.9. Rabbani F., Farivar-Mohseni H., Leon A. et al. Clinical outcome after retroperitoneal lymphadenectomy of patients with pure testicular teratoma. Urology 2003;62:1092—6.Rabbani F., Farivar-Mohseni H., Leon A. et al. Clinical outcome after retroperitoneal lymphadenectomy of patients with pure testicular teratoma. Urology 2003;62:1092—6.10. Sesterhenn I.A., Weiss R.B., Mostofi F.K. et al. Prognosis and other clinical correlates of pathologic review in stage I and stage II testicular carcinoma: a report from the testicular cancer intergroup study. J Clin Oncol 1992;10:69—78.Sesterhenn I.A., Weiss R.B., Mostofi F.K. et al. Prognosis and other clinical correlates of pathologic review in stage I and stage II testicular carcinoma: a report from the testicular cancer intergroup study. J Clin Oncol 1992;10:69—78.11. Moul J.W., McCarthy W.F., Fernandez E.B., Sesterhenn I.A. Percentage of embryonal carcinoma and of vascular invasion predicts pathological stage in clinical stage I nonseminomatous testicular cancer. Cancer Res 1994;54(2):362—4.Moul J.W., McCarthy W.F., Fernandez E.B., Sesterhenn I.A. Percentage of embryonal carcinoma and of vascular invasion predicts pathological stage in clinical stage I nonseminomatous testicular cancer. Cancer Res 1994;54(2):362—4.12. Heidenreich A., Sesterhenn I.A., Mostofi K.F., Moul J.W. Prognostic risk factors to predict patients at low risk and at high risk for metastasis in clinical stage I nonseminomatous germ cell tumors. Cancer 1998;82:1002—11.Heidenreich A., Sesterhenn I.A., Mostofi K.F., Moul J.W. Prognostic risk factors to predict patients at low risk and at high risk for metastasis in clinical stage I nonseminomatous germ cell tumors. Cancer 1998;82:1002—11.13. Sella A., El Naggar A., Ro J.Y. et al. Evidence of malignant features in hitsologically mature teratoma. J Urol 1991;146(4):1025—8.Sella A., El Naggar A., Ro J.Y. et al. Evidence of malignant features in hitsologically mature teratoma. J Urol 1991;146(4):1025—8.14. Baniel J., Foster R.S., Gonin R. et al. Late relapse of testicular cancer. J Clin Oncol 1995;13:1170—6.Baniel J., Foster R.S., Gonin R. et al. Late relapse of testicular cancer. J Clin Oncol 1995;13:1170—6.15. Fung C.Y., Kalish L.A., Brodsky G.L. et al. Stage I nonseminomatous germ cell tumor: prediction of metastatic potential by primary histopathology. J Clin Oncol 1988;6:1467—73.Fung C.Y., Kalish L.A., Brodsky G.L. et al. Stage I nonseminomatous germ cell tumor: prediction of metastatic potential by primary histopathology. J Clin Oncol 1988;6:1467—73.16. Andre F., Fizazi K., Culine S. et al. The growing teratoma syndrome: results of therapy and long-term follow-up of 33 patients. Eur J Cancer 2000;36:1389—94.Andre F., Fizazi K., Culine S. et al. The growing teratoma syndrome: results of therapy and long-term follow-up of 33 patients. Eur J Cancer 2000;36:1389—94.17. Sturgeon J.F., Jewett M.A., Alison R.E. et al. Surveillance after orchiectomy for patients with clinical stage I nonseminomatous germ cell tumors. J Clin Oncol 1992;10:564—8.Sturgeon J.F., Jewett M.A., Alison R.E. et al. Surveillance after orchiectomy for patients with clinical stage I nonseminomatous germ cell tumors. J Clin Oncol 1992;10:564—8.18. Stevens M.J., Norman A.R., Fisher C. et al. Prognosis of testicular teratoma differentiated. Brit J Urol 1994;73:701—8.Stevens M.J., Norman A.R., Fisher C. et al. Prognosis of testicular teratoma differentiated. Brit J Urol 1994;73:701—8.19. Borge N., Fossa S.D., Ous S. et al. Late recurrence of testicular cancer. J Clin Oncol 1988;6:1248—54.Borge N., Fossa S.D., Ous S. et al. Late recurrence of testicular cancer. J Clin Oncol 1988;6:1248—54.20. Nicolai N., Pizzocaro G. Ten year follow-up of a surveillance study in clinical stage I nonseminomatous germ cell tumors of the testis. J Urol 1995;153(Suppl):245A:abstr #65.Nicolai N., Pizzocaro G. Ten year follow-up of a surveillance study in clinical stage I nonseminomatous germ cell tumors of the testis. J Urol 1995;153(Suppl):245A:abstr #65.21. Baniel J., Foster R.S., Rowland R.G. et al. Complications of primary retroperitoneal lymph node dissection. J Urol 1994;152:424—6.Baniel J., Foster R.S., Rowland R.G. et al. Complications of primary retroperitoneal lymph node dissection. J Urol 1994;152:424—6.22. Heidenreich A., Albers P., Hartmann M. et al. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol 2003;169:1710—4.Heidenreich A., Albers P., Hartmann M. et al. Complications of primary nerve sparing retroperitoneal lymph node dissection for clinical stage I nonseminomatous germ cell tumors of the testis: experience of the German Testicular Cancer Study Group. J Urol 2003;169:1710—4.23. Rabbani F., Gleave M.E., Coppin C.M. et al. Teratoma in primary testis tumor reduces complete response rates in the retroperitoneum after primary chemotherapy: case for primary retroperitoneal node dissection in stage IIB germ cell tumors with teratomatous elements. Cancer 1996;78:480—6.Rabbani F., Gleave M.E., Coppin C.M. et al. Teratoma in primary testis tumor reduces complete response rates in the retroperitoneum after primary chemotherapy: case for primary retroperitoneal node dissection in stage IIB germ cell tumors with teratomatous elements. Cancer 1996;78:480—6.24. Beck S.D.W., Foster R.S., Bihrle R. et al. Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in postchemotherapy nonseminomatous testis cancer. J Urol 2002;168:1402—4.Beck S.D.W., Foster R.S., Bihrle R. et al. Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in postchemotherapy nonseminomatous testis cancer. J Urol 2002;168:1402—4.25. Heidenreich A., Seger M., Schrader A.J. et al. Surgical considerations in residual tumor resection following chemotherapy for advanced testicular cancer. Eur Urol 2004;(Suppl 3):161; abstr #632.Heidenreich A., Seger M., Schrader A.J. et al. Surgical considerations in residual tumor resection following chemotherapy for advanced testicular cancer. Eur Urol 2004;(Suppl 3):161; abstr #632.26. Albers P., Weissbach L., Krege S. et al. for the German Testicular Cancer Study Group. Prediction of Necrosis after chemotherapy of advanced germ cell tumors: results of prospective multicenter trial of German Testicular Cancer Study Group. J Urol 2004;171(5):1835—8.Albers P., Weissbach L., Krege S. et al. for the German Testicular Cancer Study Group. Prediction of Necrosis after chemotherapy of advanced germ cell tumors: results of prospective multicenter trial of German Testicular Cancer Study Group. J Urol 2004;171(5):1835—8.27. Steyerberg E.W., Keizer H.J., Fossa S.D. et al. 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—87.Steyerberg E.W., Keizer H.J., Fossa S.D. et al. 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—87.28. Oldenburg J., Alsen G.C., Lien H.H. et al. Postchemotherapy retroperitoneal surgery for nonseminomatous germ cell tumours: recommendations for patient selection. J Clin Oncol 2003;21:3310—5.Oldenburg J., Alsen G.C., Lien H.H. et al. Postchemotherapy retroperitoneal surgery for nonseminomatous germ cell tumours: recommendations for patient selection. J Clin Oncol 2003;21:3310—5.29. Patel M.I., Beck S., Bosl G. et al. Histology of good risk non-seminomatous germ cell tumor (NSGCT) patients following retroperitoneal lymph node dissection (PC-RPLND) after four cycles of etoposide and cisplatin (Epx4). J Urol 2003;169(Suppl):176; abstr #681.Patel M.I., Beck S., Bosl G. et al. Histology of good risk non-seminomatous germ cell tumor (NSGCT) patients following retroperitoneal lymph node dissection (PC-RPLND) after four cycles of etoposide and cisplatin (Epx4). J Urol 2003;169(Suppl):176; abstr #681.30. Fossa S.D., Qvist H., Stenwig A.E. et al. Is postchemotherapyretroperitoneal surgery necessary in patients with nonseminonatous testicular cancer and minimal residual tumor masses? J Clin Oncol 1992;10:569—74.Fossa S.D., Qvist H., Stenwig A.E. et al. Is postchemotherapyretroperitoneal surgery necessary in patients with nonseminonatous testicular cancer and minimal residual tumor masses? J Clin Oncol 1992;10:569—74.