Stage I seminoma: treatment outcome at King Hussein Cancer Center in Jordan

Abstract

BackgroundThe aim of this report is to address treatment outcomes of patients with early-stage seminoma in a single institution with special reference to patients with history of surgical violation of the scrotum.MethodsSeventy four patients with pure seminoma were treated at King Hussein Cancer Center (Amman, Jordan) between 2003 and 2010. All patients underwent orchiectomy. All but 3 patients received adjuvant radiotherapy. Patients who underwent surgical violation of the scrotum prior to referral were managed by further excision or irradiation of the scrotal scar. The follow-up ranged from 1 to 200 months (mean, 33 months).ResultsAt the time of follow-up; all but one patient remain alive. The 3-year relapse-free survival for the entire cohort was 95.9%. Three patients developed relapse, all of whom received adjuvant irradiation following inguinal orchiectomy and initially harbored tumors larger than 4 cm upon pathological examination. Median time to relapse was 14 months (range, 8–25 months). None were associated with elevated tumor markers prior to detection of relapse. All but one patient were successfully salvaged by chemotherapy.ConclusionsOur results confirm the excellent prognosis of patients with early-stage seminoma treated by orchiectomy and adjuvant radiotherapy in a developing country. Although all patients who developed relapse demonstrated adverse pathological findings upon initial assessment, no consistent predictor of relapse was found. Scrotal scar re-excision or irradiation in patients with prior history of surgical violation of the scrotum are effective measures in preventing local failure.

An 81-year-old patient with recent diagnosis of classic testicular seminoma

“…1,3 Inguinal orchiectomy followed by radiotherapy or watchful waiting may achieve cure in over than 99% of patients with seminoma in early-stage. 5 Relapses may occur in 15% to 20% of stage I seminoma submitted to surgery alone, due to subclinical retroperitoneal metastases, which can be effectively controlled by chemotherapy.…”

“…1 Germ cell tumors (90-95%) are intratubular germ cell neoplasia (ITGCN) unclassified type; seminoma (pure or classic, syncytiotrophoblastic, and spermatocytic); embryonal carcinoma; yolk sac tumor; choriocarcinoma; other trophoblastic tumors; teratoma (mature, immature, or malignant); and mixed tumors. [1][2][3] Classic seminoma represents 35% to 70% of germinative cell tumors, [2][3][4][5] and is the most common type in this group. More often occurs in the third and fourth decades of life, 2,3,[5][6][7] as an asymptomatic mass and palpation of genitals is the best way to prevent underestimation of these tumors.…”

“…[1][2][3] Classic seminoma represents 35% to 70% of germinative cell tumors, [2][3][4][5] and is the most common type in this group. More often occurs in the third and fourth decades of life, 2,3,[5][6][7] as an asymptomatic mass and palpation of genitals is the best way to prevent underestimation of these tumors. 8 On clinical evaluation, 75% of the individuals will present tumors limited to the testicle, 5 20% will have retroperitoneal lymph node enlargement and, in 5% of cases, blood borne implants can be found.…”

“…4 The aim of this report is to describe a classic seminoma in stage I diagnosed in elderly patient, evolving with retroperitoneal relapse in spite of inguinal orchiectomy. Population-based studies about testicular stage I seminoma are scarce, 5,9 and case studies may contribute to better knowledge on early-stage seminoma in elderly patients.…”

Unusual case of classic testicular seminoma in a 90-year-old patient: a case report

“…Less than 20% of patients with stage I seminoma will have retroperitoneal lymph node metastatic disease [6].…”