Teratoma Following Cisplatin-Based Combination Chemotherapy for Nonseminomatous Germ Cell Tumors: A Clinicopathological Correlation

Abstract

From April 1975 through May 1981, 51 patients had teratoma resected from residual disease following cisplatin-based combination chemotherapy. All patients had normal serum markers before resection of abdominal (25), lung (12), mediastinal (5), thoracoabdominal (8) or other (1) disease. Teratoma was classified as mature in 29 cases, immature in 15 or immature with nongerm cell elements in 7. Of the 51 patients 31 (61 per cent) remain free of recurrent disease, while 20 either had recurrent carcinoma (10) or teratoma (10) requiring further therapy. Nine patients died, including 1 in whom angiosarcoma developed, which was thought to be secondary to previous radiation therapy. In 4 patients the initial relapse of carcinoma developed beyond 2 years after resection. Univariate factors predicting for relapse include tumor burden, immature teratoma with nongerm cell elements and site (mediastinum), while only immature teratoma with nongerm cell elements and site predicted for survival. Patients with immature teratoma had a comparable relapse-free and over-all survival as those with mature teratoma. Using a multivariate analysis, primary tumor site at the mediastinum was the most significant adverse factor predictive for relapse and survival. This study appears to support the various pre-clinical models that demonstrate multipotential capabilities of teratoma. Complete surgical excision of teratoma remains the most effective treatment with continued close followup recommended for high risk patients (immature teratoma with nongerm cell elements, large tumor burden and primary mediastinal tumors) with resected teratoma.

Retrospective Analysis of Postchemotheraphy Retroperitoneal Lymph Node Dissection (PC-RPLND) Results in Patients with Non-Seminomatous Testicular Cancers

“…Donohue et al asserted that RPLND is unnessary in patients whose orchiectomy pathology result is without teratoma and tumor markers are normal with more than 90% decrease in mass (10). However, in the same studies of the group and other groups 26-34% teratoma presence observed after PC-RPLND in patients whose primary tumor pathology was without teratoma (6,21,28). In our series, in patients with teratoma in the orchiectomy pathology, teratoma presence rate in PC-RPLND was 72%.…”

Teratoma identified after postchemotherapy retroperitoneal lymphadenectomy

“…Similarly, 9 of 97 patients (9.3%) in the Svatek et al 12 series died of disease. Loehrer et al 4 also observed that 8 of 51 patients (15.7%) with teratoma at PC-RPLA died. Others reported lower proportion of cancer-related death among their patients.…”

“…In an effort to establish appropriate clinical follow-up protocols, some investigators have evaluated variables oredicting for disease recurrence in men after chemotherapy for metastatic NSTT, Loehrer et al 4 identi ed the initial tumor burden, the presence of IMT, and mediastinal disease site as signi cant predictors of disease recurrence on multivariate analysis. Svatek et al 12 reported that patiens with mediastinal site at presentation or an elevated serum AFP before PC-RPLA were at higher risk for disease recurrence.…”

“…The incidence of malignant transformation is approximately 3% to 6% in men undergoing PC-RPLA after induction chemotherapy, but increases to 12% and 18% in men undergoing redo-RPLA and in men experiencing late relapse [1][2][3] . Recurrence rates for patients with teratoma histology at PC-RPLA ranged from 6% to 39% 4,5 . Late recurrences with MT/IMT and TMT have been reported and account approximately 25% and 14% of all late relapse 6,7 .…”

Current status and future perspectives in the treatment of advanced testicular cancer

“…Patients with necrosis or teratoma that is completely resected have a good prognosis without further therapy, although additional chemotherapy is necessary for the cases with residual cancer. [71][72][73] Due to the difficulty of predicting the probability of teratoma or carcinoma of the residual tumors with imaging studies, salvage surgery is mandatory for patients with a normal serum level of tumor markers and radiologically recognized residual masses in order to decide further treatment strategy. 72 Surgical resection is not indicated for patients with elevated tumor markers, which means that viable malignant components remain.…”