Summary
Approximately 30% of patients with disseminated testicular cancer who receive platinum-based chemotherapy will experience normalization of tumor markers but have persistent, radiographically evident disease in the retroperitoneum. These patients are usually subjected to retroperitoneal lymph-node dissection (RPLND). In all, 45 of 557 patients (8.1%) undergoing postchemotherapy RPLND at Indiana University Medical Center (IUMC) were found to have neoplastic elements distinct from the classic germ-cell tumor types within their resected specimens. Examples included various sarcomas in 14 patients (3.7%), other nonsarcomatous non-germ-cell cancers in 18 patients (3.2%), and cystic atypical choriocarcinoma in 8 patients (1.4%). No distinct patient characteristic or histologic pattern in the primary tumor was predictive of these unusual findings in the RPLND specimen, although sampling error in the orchiectomy specimen could be the reason for this lack of correlation. Surgical resection of these chemoresistant tumors is potentially curative, with disease-free survival being obtained in 13 of 19 patients (68.4%) with sarcoma, 10 of 18 patients (55.6%) with nonsarcomatous cancers, and 7 of 8 patients (87.5%) with cystic atypical choriocarcinoma at mean follow-up intervals of 30.6, 42.5, and 24.7 months, respectively.
Similar content being viewed by others
References
Einhorn LH (1979) Combination chemotherapy with cisdichlorodiammineplatinum in disseminated testicualar cancer. Cancer Treat Rep 63:1659
Einhorn LH, Williams SD, Mandelbaum I, Donohue JP (1989) Surgical resectin in disseminated testicular cancer following chemotherapeutic cytoreduction. Cancer 48:904
Ulbright TM, Loehrer PJ (1988) Choriocarcinoma-like lesions in patients with testicular germ cell tumors: two histologic variants. Am J Surg Pathol 12:531
Strauss LH, Conti PS (1991) The applications of PET in clinical oncology. J Nucl Med 32:623
McGrath PC, Neifeld JP, Lawrence W Jr, DeMay RM, Kay S, Horsley JS III, Parker GA (1984) Improved survival following complete excision of retroperitoneal sarcomas. Ann Surg 200:200
Serio G, Tenchini P, Nifosi L, Iacono C (1989) Surgical strategy in primary retroperitoneal tumors. Br J Surg 76:385
Jaques DP, Goit DG, Hajdu SI, Brennan MF (1990) Management of primary and recurrent soft tissue sarcoma of the retroperitoneum. Ann Surg 212:51
Van Dam PA, Lowe DG, McKenzie-Gray B, Shepherd JH (1990) Retroperitoneal soft tissue sarcomas: a review of the literature. Obstet Gynecol Surv 45:670
Karakousis CP, Velez AF, Emrich LJ (1985) Management of retroperitoneal sarcomas and patient survival. Am J Surg 150:376
Dalton RR, Donohue JR, Much P Jr, Van Heerden JA, Reiman HM, Chen S (1989) Management of retroperitoneal sarcomas. Surgery 106:725
Tucker MA, Meadows AT, Bolce JD Jr, Stovall M, Oberlin O, Stone BJ, Birch J, Voute PA, Hoover RN, Fraumeni JF Jr (1987) Leukemia after therapy with alkylating agents for childhood cancer. J Natl Cancer Inst 78:459
Henne T, Schmahl D (1985) Occurrence of second primary malignancies in man: a second look. Cancer Treat Rev 12:77
Robinson E, Neugut AI, Wylie P (1988) Clinical aspects of post irradiation sarcomas. J Natl Cancer Inst 80:233
Wicklund TA, Blomqvist CP, Raty J, Elomaa I, Rissanen P, Miettinen M (1991) Post irradiation sarcoma. Cancer 68:524
Laskin WB, Silverman TA, Enzinger FM (1988) Post irradition soft tissue sarcomas — an analysis of 53 cases. Cancer 62:2330
Loehrer PJ, Hui S, Clark S, Seal M, Einhorn LH, Williams SD, Ulbright T, Mandelbaum I, Rowland RG, Donohue JP (1986) Teratoma following cisplatin based combination chemotherapy for nonseminomatous germ cell tumors: a clinicopathological correlation. J Urol 135:1183
Ulbright TM, Loehrer PJ, Roth LM, Einhorn LH, Williams SD, Clark SA (1984) The development of non-germ cell malignancies within germ cell tumors: a clinicopathologic study of eleven cases. Cancer 54:1824
Nichols CR, Hoffman R, Einhorn LH, Williams SD, Wheeler LA, Garnick MB (1985) Hematologic malignancies associated with primary mediastinal germ cell tumors. Ann Intern Med 102:603
Orazi A, Neiman RS, Ulbright TM, Heerema NA, John K, Nichols CR (1993) Hematopoietic precursror cells within the yolk sac tumor component are the source of secondary hematopoietic malignancies in patients with mediastinal germ cell tumors. Cancer 71:3873
Author information
Authors and Affiliations
Additional information
With the kind permission of Williams & Wilkins journal, Journal of Urology
Rights and permissions
About this article
Cite this article
Little, J.S., Foster, R.S., Ulbright, T.M. et al. Unusual neoplasms detected in testicular cancer patients undergoing postchemotherapy retroperitoneal lymphadenectomy. World J Urol 12, 200–206 (1994). https://doi.org/10.1007/BF00185674
Issue Date:
DOI: https://doi.org/10.1007/BF00185674