Germ cell tumour: late recurrence after 43 years

Mukhtar, Saheel; Beatty, John D.; Agrawal, Sachin; Christmas, Tim; Jameson, Charles; Huddart, Robert

doi:10.1308/147870811x580442

Cited by 12 publications

(9 citation statements)

References 6 publications

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“…To our knowledge, only two later cases have been reported 9,10 and only 1% of patients will relapse three or more years postorchiectomy. 3 This case and other rare late relapse cases raise the question of whether lifetime imaging surveillance should be performed for CSI NSGCT patients.…”

Section: Discussionmentioning

confidence: 84%

“…1 Additionally, a literature search found an additional two cases of very late relapse (32 and 43 years). 9,10 The nature of late relapse CSI NSGCT biology means that patients who relapse are commonly symptomatic and present most often with abdominal pain. 9,11,12 Case report We present a rare case of a 28-year post-orchiectomy late relapse in a 50-year-old male who underwent left radical orchiectomy in 1987.…”

Section: Introductionmentioning

confidence: 99%

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28-year late spermatic cord relapse of a testicular non-seminomatous germ cell tumour, managed robotically

Hayes

Jewett

Hamilton

2016

CUAJ

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E25728-year late spermatic cord relapse of a testicular non-seminomatous germ cell tumour, managed robotically AbstractWe present a patient who relapsed symptomatically 28 years postorchiectomy, initially followed by active surveillance for clinical stage I non-seminomatous germ cell tumour (CSI NSGCT). His relapse was localized to the pelvis, managed with robotic surgery, and achieved a complete resection with tumour markers normalized. We highlight the current Princess Margaret guidelines for followup of CSI NSGCT and discuss the trade-off between lifelong radiographic surveillance to detect the very small risk of late relapse. We discuss the incidence and presentation of late relapse, treatment options, and outcomes, highlighting that these tumours are typically refractory to chemotherapy and can often be managed with surgery alone.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

28-year late spermatic cord relapse of a testicular non-seminomatous germ cell tumour, managed robotically

Hayes

Jewett

Hamilton

2016

CUAJ

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“…Based on the report by Oldenburg et al [7], the incidence rates were 1.4 and 3.2% in pure seminoma and nonseminoma patients, respectively. In addition, Mukhtar et al [11] and Pavic et al [12] reported cases of late recurrence after 43 years and 32 years, respectively. Therefore, clinicians should be aware of the possibility of late relapse after successful treatment in patients with stage I testicular germ cell tumor.…”

Section: Discussionmentioning

confidence: 99%

“…In general, patients with stage I testicular germ cell tumors show relapse within 2–3 years after orchiectomy [2, 3, 4, 5, 6]. Although late relapse of testicular seminoma has been reported in the literature [7, 8, 9, 10, 11, 12], it is extremely rare. In particular, relapse over 10 years after treatment is extremely rare.…”

Section: Introductionmentioning

confidence: 99%

Late and Rapid Relapse in Mediastinum from Testicular Germ Cell Tumor Stage I Over 13 Years after Surgery

et al. 2019

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Patients with stage I testicular germ cell tumors have a long life expectancy, but the tumors have a potential to relapse after treatment. Although relapse is observed within a few years in most cases, late relapse over 10 years after initial treatment has also been reported in patients with stage I testicular germ cell tumors. We encountered a case of testicular seminoma that developed mediastinal lymph node metastasis 13 years after radical surgery for the primary tumor. The relapsed disease progressed rapidly and the patient died within 1 month due to respiratory failure without any chance for therapy. On postmortem examination, the thoracic lesions were pathologically confirmed to be metastases from the testicular seminoma with yolk sac tumor. Here, we report the clinical course and a review of the relevant literature. Based on our experience, we emphasize long-term follow-up and/or careful examination in patients with stage I testicular germ cell tumors.

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“…Two case reports are similar to this case, Arafat et al describe a case involving a patient with stage I NSGCT who relapsed with a retroperitoneal mass after 27 years [ 19 ] and Lattouf et al a case of stage I NSCGT who presented with a seminal vesicle relapse after 20 years [ 20 ]. For seminoma combined with yolk-sac tumour, late relapse after 43 years of surveillance has been described [ 21 ]. Notably, the published literature on case series in seminoma suggests that late relapse beyond 10 years is more common than for non-seminomas [ 7 , 8 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

Prostatic relapse of an undifferentiated teratoma 24 years after orchidectomy

et al. 2015

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BackgroundNon-seminomatous germ cell tumours make up about 40 % of all germ cell tumours, which in turn are the most common tumours in men aged 15–44 years. Low risk stage I non-seminomatous germ cell tumours, which are confined to the testes, are commonly treated by orchiectomy and surveillance. Up to 20 % of patients with this diagnosis relapse, usually within 1–2 years of follow up, but very rarely after more than 5 years. The most common sites of relapse are the retroperitoneal lymph nodes, the mediastinum, and the lungs. We describe a case of relapse in the prostate over 20 years after initial diagnosis, which has not been described in the literature so far.Case presentationThis report presents a 49-year-old white British man with relapsed testicular non-seminomatous germ cell tumour 22 years after initial treatment with orchidectomy only. He relapsed with a prostatic mass, haematospermia and back pain. His prostate specific antigen levels were within normal range. Alpha feto-protein and lactate dehydrogenase levels were elevated, and his human chorionic gonadotrophin levels were normal. A biopsy confirmed undifferentiated malignant tumour, shown immunohistochemically to be a yolk sac tumour. The patient was initially treated with bleomycin, etoposide and cisplatin chemotherapy, but developed bleomycin-related pulmonary side effects after two cycles. His treatment was changed and he completed four cycles of chemotherapy by receiving two cycles of etoposide, ifosfamide, and cisplatin. Post treatment blood tumour markers were normal, but a follow up computed tomography showed a mass in the base of the prostate, the trigone and the left distal ureter which was surgically resected. The histology from the surgical resection was of necrotic tissue. The patient is now in follow up at 3 years after treatment with no evidence of residual disease on computed tomography. His Alpha feto-protein, beta human chorionic gonadotrophin and lactate dehydrogenase levels are normal.ConclusionsVery late relapse in stage I non-seminomatous germ cell tumours is extremely rare and the prostate is a highly unusual site of relapsed disease. For diagnosis of late relapse, this case confirms the value of serum biomarkers in germ cell tumours, in particular non-seminomatous germ cell tumours.

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Germ cell tumour: late recurrence after 43 years

Cited by 12 publications

References 6 publications

28-year late spermatic cord relapse of a testicular non-seminomatous germ cell tumour, managed robotically

28-year late spermatic cord relapse of a testicular non-seminomatous germ cell tumour, managed robotically

Late and Rapid Relapse in Mediastinum from Testicular Germ Cell Tumor Stage I Over 13 Years after Surgery

Prostatic relapse of an undifferentiated teratoma 24 years after orchidectomy

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