Multiple Primary Neoplasms in Patients with Testicular Germ Cell Tumor

Abstract

The study of multiple primary neoplasms may provide more insight into the pathogenesis of specific cancers and, secondly, it addresses the issue of treatment-related induction of second tumors. 584 consecutive patients with testicular germ cell tumors treated during 1969-1992 in Berlin were retrospectively analyzed for the prevalence of multiple primary neoplasms. 23 patients (16 pure seminoma, 7 nonseminoma) developing nontesticular malignancies in addition to testis cancer were identified (3.9%, 95 confidence intervals ± 1.6%). The mean age at the time of the testis cancer was 42.8 years, and mean age at the time of nontesticular malignancy was 50.2 years. In 4 cases, the nontesticular malignancy preceded testis cancer, in 3 patients both neoplasms occurred simultaneously, and in 16, nontesticular malignancies developed subsequently to testis cancer. In 4 patients, triple malignancies were observed. Bladder carcinoma and bronchogenic cancer with each 3 cases were the most frequent second neoplasms seen in these patients. 9 consecutive cancers developed within radiation fields, the median latency period in these cases was 12 years. None of the subsequent cancers developed after chemotherapy. It is concluded that genetic predisposition and radiation effects are the most important factors contributing to the occurrence of multiple primary neoplasms in patients with testicular germ cell cancer. The high rate of multiple primary neoplasms in these patients lends further evidence to the theory of genetic anticipation of germ cell cancer.

Second Malignancies following Pure Seminoma

“…Other series usually reported higher rates of second cancers [27]. However, as the median time of follow-up is still quite low in the present series, the proportion of 1.1% is yet in line with the published data.…”

“…It is conceivable to postulate a general predisposition of patients with testicular cancer to develop multiple neoplasms, and this hypothesis might be corroborated by numerous observations of triple malignancies in patients with testicular cancer [20, 27, 35, 40]and by the observation of nontesticular neoplasms preceding germ cell cancer, as found in group B of the present investigation and in several other studies [27, 30, 41, 42, 43]. …”

“…An association of these two neoplasms has been reported several times [27, 34, 42, 43, 54, 55, 56], however, the evidence for a true association on the basis of shared risk factors or common pathogenetic pathways is far less convincing. Accordingly, there was no significant increase in the incidence of Hodgkin’s disease either in the present study or in any of the large registry-based series [4, 5, 6, 20, 35, 36].…”

Leydig Cell Tumor–Comparison of Results of Radical and Testis-Sparing Surgery in a Single Center

“…Between 1969 and 1995, 491 patients with testicular germ cell tumor were treated at our center (54% seminoma, 46% nonseminona; mean age of onset 42.8 years) [1], Thirty-one patients were treated for nonmalignant testicular tumors, in 1 complex case, a paratesticular epidermoid cyst that could not be separated from the tes tis and concomitant dermoid cyst of the spermatic cord was detected [2]: 10 patients were diagnosed to suffer from testicular epidermoid cyst [3], 1 patient had testicu lar dermoid cyst [4], 5 had granulomatous orchitis [5] and 15 had Leydig cell tumors.…”

New Guidelines for Clinical Stage I Testicular Seminoma?

“…Radiation is commonly known to be carcinogenic and induce secondary malignancies. This has been demonstrated for various tumor settings, especially germ cell tumors and Hodgkin’s disease [38, 39]. Nevertheless, the data published thus far remain controversial.…”