Effect of chemotherapy on the histological appearances of testicular teratoma metastatic to the lung: correlation with patient survival.

Abstract

SUMMARY We report on 20 patients with teratoma of the testis metastatic to the lungs who underwent surgical enucleation of the pulmonary metastases. Seven patients showed predominantly undifferentiated tumour in the pulmonary metastases; six of these died within 26 months, while the seventh was lost to follow up. Four patients showed only scarring or total necrosis of their pulmonary lesions. These patients all received full courses of chemotherapy before surgery and are alive and well with no evidence of recurrence up to four years after diagnosis. In nine patients the pulmonary nodules consisted entirely of well differentiated tissues of benign appearance, sometimes resembling primary pulmonary adenochondromas. These patients also received full courses of chemotherapy before surgery; one died of disseminated disease but the other eight are all alive and well with survival intervals of up to 14 years after presentation.These findings show that following chemotherapy, necrosis and differentiation of teratomatous pulmonary metastases signify a good prognosis.Chemotherapy is now standard treatment for patients with metastic testicular teratoma, and cure rates of more than 70% may be achieved.'-5 After chemotherapy residual metastases are not uncommon, and if practical, surgical resection of residual tumour in the retroperitoneum and lungs should be undertaken. Persistent radiological opacities in the lungs may represent metastatic tumour resistant to drug treatment, masses of totally necrotic chemosensitive tumour, or well differentiated teratoid tumours of benign histological appearance. These features are thought to relate to prognosis,6-9 and can be assessed only by the histopathologist examining the resected specimens. This paper reports on the histological appearances of resected pulmonary metastases from 20 patients with testicular teratoma and correlates these appearances with patient survival. Patients and methodsOver the period 20 patients with teratoma of the testis treated by orchidectomy followed by chemotherapy or radiotherapy or both underwent Accepted for publication 17 July 1984 thoracotomy at the Brompton Hospital for the enucleation of residual or freshly developing pulmonary metastases. Using the British Testicular Tumour Panel Classification,'0 we have reviewed the histological appearances of their primary and metastatic tumours and correlated these with patient survival. Many of our cases were referred from other hospitals after orchidectomy, and it is uncertain how well these primary tumours were sampled. The number of sections from the testicular tumours varied between 2 and 12. Details of patient treatment are to be published elsewhere.

Metastatic of mature component in a treated case of immature teratoma diagnosed on fine‐needle aspiration cytology of the liver

“…Theoretically, this change could be due to either selective destruction of the more malignant elements or the induction of differentiation within these elements. [7][8][9] The differential diagnoses of FNAC smear of this case may give rise to the remote possibilities of metastatic well-differentiated adenocarcinoma, endometriosis, or benign cystic lesion in the liver. Abundant round cells with vacuolated cytoplasm may resemble metastatic well-differentiated adenocarcinoma.…”