Seminoma of the Testis: Analysis of Treatment Success and Failure

Maier, John G.; Sulak, Michael H.; Mittemeyer, Bernard T.

doi:10.2214/ajr.102.3.596

Cited by 113 publications

(20 citation statements)

References 2 publications

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“…The pituitary and other tissues seem to be insensitive to circulating androgens from an undescended testis; consequently there is excessive secretion of pituitary gonadotropins. Chronic overstimulation of the gonads will enhance the development of seminoma [6]. The absence of feedback from such a testis may also lead to hyperactivity of the pituitary gland.…”

Section: Discussionmentioning

confidence: 99%

Testicular tumors in undescended testes

Omar

Eissa

Elsaid

et al. 1979

Archives of Andrology

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Twelve cases of malignant tumors in undescended testes were studied. Early diagnosis of these tumors was usually difficult as the testes were intraabdominal and the symptoms vague. Sixty percent of the seminoma cases were of the anaplastic aggressive variant. Early treatment of undescended testes included either orchiopexy or orchidectomy in early childhood. Exploratory laparotomy and frozen section examination of the abdominal nodes, followed by silver clip application, aided in better staging and the planning of further treatment.

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Section: Discussionmentioning

confidence: 99%

Testicular tumors in undescended testes

Omar

Eissa

Elsaid

et al. 1979

Archives of Andrology

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“…Platinum-based chemotherapy regimes however may be used as an alternative, especially in higher-stage tumors (7). Because only a small percentage (10-20%) of clinical stage I seminomas harbor occult retroperitoneal lymph node metastases (8,9), surveillance-only protocols are now being used as an alternative treatment strategy for these early tumors. Likewise, the primary treatment for stage I nonseminomatous tumor is controversial and includes retroperitoneal lymph node dissection and chemotherapy, whereas metastatic nonseminomatous tumor is primarily treated with chemotherapeutic agents (7).…”

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confidence: 99%

Identification of Two Molecular Groups of Seminomas by Using Expression and Tissue Microarrays

Hofer

Browne

et al. 2005

Clinical Cancer Research

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Highly effective tailored clinical management of testicular germ cell tumors is based on the identification of two major histologic subtypes: seminomatous and nonseminomatous germ cell tumors. Expression array analysis of these two histologic subtypes using hierarchical clustering reveals two tumor groups, one composed solely of seminomas and the other containing embryonal carcinomas and seminomas. Supervised analysis between these groups identified 55 significantly dysregulated genes (false discovery rate = 2.3).The genes with the highest overexpression in the first group compared with the second included SLC43A1 (POV1), NET-7, IGF2, and JUP ; down-regulated genes included GRB7, PFKP, and CDC6. In situ hybridization of SLC43A1mRNA showed significantly increased signal intensity in the seminomas. At the protein level, expression of the immunohistochemical markers cytokeratins (pan-cytokeratin staining), placental-like alkaline phosphatase, anti-cytokeratin clone 5.2, CD30, anion exchanger 1/3, junction plakoglobulin (JUP), and POU domain, class 5, transcription factor 1 (octomer-binding transcription factor 3/4) was significantly different between seminomas and embryonal tumors. Hierarchical clustering based on a refined protein expression profile identified two groups, the first consisting solely of seminomas the other of seminomas and embryonal carcinomas. No histomorphologic differences were observed between the two seminoma groups such as the presence or absence of lymphocytes or extent of stromal elements. In summary, using independent methodologies and samples, we have identified two groups of seminomas. One group of seminomas has a molecular profile similar to embryonal carcinoma.The findings in the current study may help explain aberrant immunoprofiles seen with some seminomas.Testicular germ cell tumors (TGCT) are the most common solid tumor in young men aged between 20 and 35 years and over the last several decades their incidence has increased (1, 2). Seminomas account for f50% of all TGCT. Both seminomas and nonseminomatous tumors are believed to arise from carcinoma in situ of the testis (3) and currently there are two models that describe their further development. One model suggests that seminomas and nonseminomatous tumors are derived independently from carcinoma in situ, whereas the other model suggests a continuum with semi-

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“…Surveillance following orchidectomy was introduced as an alternative with the rationale that a substantial proportion of patients with stage I seminoma would not need further treatment and could thus avoid the side-effects of radiotherapy. This supposition was based partly on a series of retroperitoneal lymph node dissection in stage I seminoma, which revealed microscopic nodal involvement in only 8% of patients (Maier et al, 1968), and partly on the success of a surveillance policy in stage I non-seminomatous tumours of the testis (Freedman et al, 1987;Horwich & Peckham, 1988;Cullen, 1991). Preliminary results of surveillance for stage I seminomas have been reported (Thomas et al, 1989;Duchesne et al, 1990) and it has become apparent that the policy presents some clinical difficulties, such as for example, the relatively indolent natural history of seminoma leading to a requirement for prolonged surveillance.…”

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Surveillance following orchidectomy for stage I testicular seminoma

Horwich

Alsanjari²,

A’Hern³

et al. 1992

Br J Cancer

191

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Summary An analysis of the primary tumour histopathology was performed on 103 patients managed by orchidectomy and surveillance for stage I seminoma. Patients have been followed for 14-141 months (median 62 months) after orchidectomy. Seventeen patients relapsed, the probability of remaining relapse free at 5 years being 82% (95% confidence intervals, 74%-88%). No patients died of progressive germ cell tumours. The only significant histological factor predicting relapse was the presence of lymphatic and vascular invasion. Four of 42 patients with neither lymphatic or vascular invasion recurred, nine of 53 patients with either lymphatic or vascular invasion recurred and three of eight cases with both lymphatic and vascular invasion recurred (P = 0.05-trend). Though initial recurrence was usually of moderate volume and confined to para-aortic nodes, eight patients were treated with chemotherapy either because of the extent of their initial relapse (four cases), or because of subsequent relapse (four cases). In view of the difficulties of identifying patients at risk and of detecting early relapse, surveillance for stage I seminoma should remain a research protocol.The conventional management of stage I seminoma of the testis is by adjuvant retroperitoneal node irradiation. This policy is highly successful, recurrence occuring in less than 5% of patients (Hamilton et al., 1986;Zagars, 1991). Surveillance following orchidectomy was introduced as an alternative with the rationale that a substantial proportion of patients with stage I seminoma would not need further treatment and could thus avoid the side-effects of radiotherapy. This supposition was based partly on a series of retroperitoneal lymph node dissection in stage I seminoma, which revealed microscopic nodal involvement in only 8% of patients (Maier et al., 1968), and partly on the success of a surveillance policy in stage I non-seminomatous tumours of the testis (Freedman et al., 1987;Horwich & Peckham, 1988;Cullen, 1991). Preliminary results of surveillance for stage I seminomas have been reported (Thomas et al., 1989;Duchesne et al., 1990) and it has become apparent that the policy presents some clinical difficulties, such as for example, the relatively indolent natural history of seminoma leading to a requirement for prolonged surveillance. A second problem is the lack of a sensitive serum marker for seminoma (in contrast to non-seminoma) making it difficult to monitor patients sufficiently closely to detect small volume relapse.In (median 36 years). They have been followed for a median of 5 years and 2 months from orchidectomy (range 14 months to 141 months).Initial staging investigations prior to registering the patient for surveillance always included thorough physical examination, assay of serum concentrations of the beta sub-unit of human chorionic gonadotrophin (HCG) and alpha-fetoprotein (AFP), CT scan of thorax abdomen and pelvis, lymphogram and chest X-ray. The histopathology had always been reviewed in the Department of Histopathology of The Ro...

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Seminoma of the Testis: Analysis of Treatment Success and Failure

Cited by 113 publications

References 2 publications

Testicular tumors in undescended testes

Testicular tumors in undescended testes

Identification of Two Molecular Groups of Seminomas by Using Expression and Tissue Microarrays

Surveillance following orchidectomy for stage I testicular seminoma

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