Teratoma identified after postchemotherapy retroperitoneal lymphadenectomy

Abstract

The histologic finding of teratoma occures in aproximately 40% of all postchemotherapy retroperitoneal lymphadenectomy (PC-RPLA) for disseminated nonseminomatous testicular tumors (NSTT). We evaluated patients undergoing PC-RPLA for teratoma to determine risk factors for recurrence and clinical outcome. Among a survey of 193 patients submitted to PC-RPLA due to metastatic NSTT from 1980-2005, we identified 82 patients (42%) who were found to have only teratoma in the retroperitoneum. Sixty-seven patients (82%) received only induction cisplatin-based chemotherapy, and 15 (18%) required 2nd line chemotherapy. PC-RPLA histology revealed mature teratoma (MT) in 86%, immature teratoma (IMT) in 12% and teratoma with malignant transformation (TMT) in 2%. Sixteen patients (19%) relapsed within median free interval of 22 months. Among 13 patients submitted to redo-RPLA, discordant histology occurred in 6 patients (46%) (2 TMT, 4 viable germ cell tumors [GCT]), all with worst histology in comparison to primary RPLA. One relapsing patient with only elevated serum tumor markers (STMs) achieved complete response with chemotherapy alone. Two patients relapsed at 21 and 74 months with widespread metastasis and died despite salvage chemotherapy. Seven of 13 patients (54%) who were rendered free of disease (FOD) with redo-RPLA, relapsed again. All but one died despite salvage treatment (2 of chemotherapy related toxicity) within mean survival time (MST) of 86.7+/-26.1 (95% confidence interval [CI],). At mean follow-up (MFU) of 135+/-62.6 months (95% CI, 98.79-149.21), alive and free of disease (AFD) are 90% patients. The probability of being reccurence-free at 5-and 10-year was 87% and 81%, respectively. The 5-and 10-year probability of disease speciphic survival (DSS) were 98% and Argirovi M. or e 1 , Argirovi . Aleksandar 2 1 Urološka Klinika, KCS, Poliklinika "Argirovi ", Urologija, Beograd, Srbija 2 Služba urologije, Klini ko Bolni ki Centar Zemun-Beograd, Srbija ApstraktHistološki nalaz teratoma postoji kod oko 40% od ukupnog broja posthemioterapijskih retroperitonealnih limfadenektomija (PH-RPLA) zbog metastatskog neseminomskog tumora testisa (NSTT). Evaluacija pacijenata podvrgnutih PH-RPLA je imala za cilj da odredi faktore rizika za pojavu recidiva i klini ki ishod. Od 193 pacijenata podvgnutih PH-RPLA zbog metastatskog NSTT u periodu izme u 1980-2005, identifikovali smo 82 pacijenta (42%) kod kojih je na eno samo prisustvo teratoma u retroperitoneumu. Šestdeset i sedam pacijenata (87%) je primilo samo indukcionu hemioterapiju na bazi cisplatine, dok je 15 (18%) iziskivalo hemioterapiju druge linije. Histologija na PH-RPLA je pokazala prisustvo zrelog teratoma u 86%, nezrelog teratoma u 12% i teratoma sa malignom transformacijom u 2%. Šesnaest pacijenata (19%) je imalo recidiv unutar srednjeg vremenskog intervala od 22 meseca. Od 13 pacijenata podvrgnutih ponovnoj RPLA, razli ita histologija je na ena kod 6 pacijenata (46%) (2 teratom sa malignom transformacijom, 4 vitalni karcinom), svi sa lošom histologijom u ...

Can we predict the presence of teratoma in the retroperitoneum before post-chemotherapy retroperitoneal lymphadenectomy?

“…Following induction chemotherapy approximately 40% of patients undergoing RPLA will have teratoma in the retroperitoneum, and an additional 10% to 15% will have viable cancer 5,6 . Teratoma is chemorefractory, and has an unpredictable biological potential with the possibility of growth, invasion of adjacent organs, and devastating late relapse if not completely resected [7][8][9][10] .…”