Very Late Recurrence in Germ Cell Tumor of the Testis: Lessons and Implications

Abstract

Background. Very late recurrence (LR), i.e., >5 years after initial presentation, occurs in about 1% of patients with germ cell tumors of the testis (TGCT) and is associated with poor prognosis. Methods. We retrospectively reviewed the records of patients at the M. D. Anderson Cancer Center who developed LR > 5 years after their initial diagnosis of TGCT. Results. We identified 25 patients who developed LR between July 2007 and August 2020. The median age at the time of LR was 46 years (range, 29–61). Pathology of LR: somatic transformation to carcinoma or sarcoma—11, nonseminoma with yolk sac tumor or teratoma—11, nonseminoma without yolk sac tumor or teratoma—2, not available—1. With a median follow-up of 3.5 years, 68% of patients are alive 3 years after LR. Patients with prior post-chemotherapy consolidation surgery do not have statistically significant longer survival compared to patients who did not receive post-chemotherapy consolidation surgery, 83.3% vs. 60.8% at 3 years, respectively, p = 0.50. Conclusions. Patients with LR > 5 years tend to harbor nonseminoma (with yolk sac tumor and or teratoma). Among these patients, a majority who did not undergo surgery to remove residual disease after chemotherapy developed somatic transformation and succumbed to their LR.

Predictors of Relapse and Survival in Testicular Germ cell Tumors in Children

“…The retroperitoneum was the most common site of relapse (58 %) with the majority having bulky retroperitoneal nodal size >10 cm, similar findings have been reported in the literature. 18,19 Furthermore, retroperitoneal relapse was seen even in the patients who had a prior history of retroperitoneal lymph node dissection (RPLND) in our study, comparable with results documented by Moore et al 19 , further emphasizing the critical role of RPLND by an experienced surgeon in the management of testicular GCT. The patients who received adjuvant first line chemotherapy also had a significant disease relapse as compared to chemotherapy-naive patients, which are comparable with the findings addressed by Friedlander et al, emphasizing that chemotherapy before relapse was a statistically significant and clinically relevant predictor of inferior outcome due to difference in the biology of chemotherapy-naive patients at late relapse from that of patients with a prior history of chemotherapy.…”

Unusual recurrence of sacrococcygeal mature teratoma: A case report

“…The presence of mature glial tissue is confirmed by anti-GFA immunostaining (Clone 6F2, dilution 1/1000), inset 10× F I G U R E 2 Nodules on the bottoms and the left leg with testicular teratoma were reported over 10 years from diagnosis. 13 These data and our case suggest that, in such an uncommon tumor, a longer follow-up may be warranted.…”

A case of testicular cancer with retroperitoneal lymph node metastasis of teratoma with somatic‐type malignancy 18 years after initial treatment

“…4 However, the longest time to LR was reported to be 33.1 years. 7 Ehrlish et al reported, with median follow-up of 15 years without RPLND of 141 patients with nonseminoma who achieved normalization of serum tumor markers and radiographic remission (residual mass <1 cm) after induction chemotherapy, 12 patients had relapse, and 2 (1.4%) experienced LR beyond 10 years. 10 The pathological types were germ cell tumors with elevated AFP in 2 patients.…”

“…7,13,14 The frequency of teratoma with STM increased in LR, accounting for 44% beyond 5 years after initial treatment. 7 Teratoma with STM was frequently found in the retroperitoneum, as well as in the testis. Necchi et al showed that, of 48 patients with teratoma with STM, teratoma with STM occurred in the retroperitoneum in 46%.…”