Cisplatin-based chemotherapy of testicular cancer - Two decades after a major breakthrough

Two decades ago the introduction of cisplatin-based combination chemotherapy has dramatically improved the prognosis of patients with metastatic testicular cancer, At present 3 cycles of cisplatin, etoposide and bleomycin are considered as standard treatment for good-risk metastatic disease. Outside of clinical trials patients in the intermediate and poor prognosis categories should receive 4 cycles of this standard regimen, Clinical trials currently evaluate the role of high-dose chemotherapy in first-line treatment of high-risk patients and in the salvage setting, Post-chemotherapy resection of tumor residuals remains an important part of therapy. Attention should be focused on long-term toxicity of therapy and the occurrence of late relapse

Lymphangiography to treat postoperative lymphatic leakage: a technical review.

In addition to imaging the lymphatics and detecting various types of lymphatic leakage, lymphangiography is a therapeutic option for patients with chylothorax, chylous ascites, and lymphatic fistula. Percutaneous thoracic duct embolization, transabdominal catheterization of the cisterna chyli or thoracic duct, and subsequent embolization of the thoracic duct is an alternative to surgical ligation of the thoracic duct. In this pictorial review, we present the detailed technique, clinical applications, and complications of lymphangiography and thoracic duct embolization

Surgical salvage in patients with advanced testicular cancer: indications, risks and outcomes

The purpose of this review is to present a comprehensive and updated review of the literature and summary of the indications, risks and outcomes related to salvage, desperation and late relapse surgery for advanced testicular cancer. After completing a thorough review of the current literature, this review has attempted to provide an overview of the indications for salvage, desperation and late relapse retroperitoneal lymph node dissection (RPLND) followed by a summary of the histopathologic and clinical outcomes regarding each. Recent literature, combined with a significant contribution from historical studies suggest that while testicular cancer is a relatively uncommon malignancy overall, it represents the most common solid organ malignancy for young men. Although a significant number of men are cured with a combination of first-line treatments, the remaining men are a diverse and often challenging cohort who require the benefit of expertise to improve their outcomes. The role of surgical strategies in the salvage, desperation and late relapse settings is unquestionable, although the most important question remains who will benefit. This often requires a multi-disciplinary approach at centers specializing in this disease process in order to recognize who should get surgery, what surgery to do and how to minimize the potential morbidity associated with the operation

Testicular germ-cell tumours and penile squamous cell carcinoma: Appropriate management makes the difference

Germ-cell tumours (GCT) of the testis and penile squamous cell carcinoma (PeSCC) are a rare and a very rare uro-genital cancers, respectively. Both tumours are well defined entities in terms of management, where specific recommendations - in the form of continuously up-to-dated guide lines-are provided. Impact of these tumour is relevant. Testicular GCT affects young, healthy men at the beginning of their adult life. PeSCC affects older men, but a proportion of these patients are young and the personal consequences of the disease may be devastating. Deviation from recommended management may be a reason of a significant prognostic worsening, as proper treatment favourably impacts on these tumours, dramatically on GCT and significantly on PeSCC. RARECAREnet data may permit to analyse how survivals may vary according to geographical areas, histology and age, leading to assume that non-homogeneous health-care resources may impact the cure and definitive outcomes. In support of this hypothesis, some epidemiologic datasets and clinical findings would indicate that survival may improve when appropriate treatments are delivered, linked to a different accessibility to the best health institutions, as a consequence of geographical, cultural and economic barriers. Finally, strong clues based on epidemiological and clinical data support the hypothesis that treatment delivered at reference centres or under the aegis of a qualified multi-institutional network is associated with a better prognosis of patients with these malignancies. The ERN EURACAN represents the best current European effort to answer this clinical need

A case of synchronous cervical lymph node metastases from testicular and thyroid cancers showing mixed response to chemotherapy

37歳.精巣腫瘍の治療中, 偶然甲状腺癌の合併が判明し摘出術を施行した.化学療法に反応せずに残存した病変に対しては, 組織型の違いもさることながら, 重複癌の可能性も考慮に入れる必要があると考えられたWe report a case of synchronous presentation of thyroid cancer and testicular seminoma with lymph node metastasis. A 37-year-old man presented with right scrotal swelling and multiple lymph node swelling. We performed right radical orchiectomy, and histological examination revealed a seminoma of the testis. After systemic work-up for staging, we diagnosed the patient with multiple lymph node metastasis of the seminoma, and administered three cycles of bleomycin, etoposide, and cisplatin (BEP) therapy. Although the chemotherapy was very effective for the retroperitoneal and left cervical lymph node metastases, the right cervical tumor did not change. Retroperitoneal lymphadenectomy combined with right cervical lymph node dissection and hemi-thyroidectomy were performed on September 8, 1998. Pathological examination of the thyroid revealed papillary thyroid cancer and its right cervical lymph node metastasis. There was no evidence of viable cancer cells from either of the primary cancers in the retroperitoneal lymph node. Unresponsiveness to chemotherapy for metastatic lesions from testicular cancer might be a useful clue to detect primary tumors of other origins

Extra-gonadal germ cell tumour – what about the testis!

Extra-gonadal germ cell tumours (EGGCT) are rare. Therefore further investigations of the testis is aimed at sourcing a possible primary origin of gonadal tumour. Over the years, various case series on EGGCT have been reported questioning its true nature as in a majority of them, a primary source is found in the testis, thus representing a metastatic gonadal tumour. The testis pathology could be either a true germ cell foci, an intra-tubular epithelial neoplasia or an area of fibrosis, indicating a „burnt out tumour‟. We report a 39-year-old male who underwent laparotomy and excision of a retroperitoneal tumour. Histopathological examination revealed retroperitoneal lymph node of mixed germ cell tumour origin. Clinical and ultrasound examination of bilateral testis was normal. The patient refused orchidectomy or a testicular biopsy. He underwent four cycles of bleomycin, cisplatin, and etoposide with no evidence of tumour recurrence on follow up and remains disease free after 12 months of diagnosis. A literature review of EGGCT, its relation and factors relating with future testicular tumour is presented

Mandatory multidisciplinary approach for the evaluation of the lymph node status in rectal cancer

Colorectal cancer is the third most frequently reported malignancy and also the third leading cancer-related cause of death worldwide. Lymph node evaluation, both preoperatively and postoperatively, represents an important aspect of the diagnosis and therapeutic strategy in colorectal cancer, such that an accurate preoperative staging is required for a correct therapeutic strategy. Treatment of rectal cancer with positive lymph nodes, a very important predictive prognostic parameter, is currently based on neoadjuvant chemoradiotherapy followed by total/ surgical mesorectal excision and adjuvant regimen. Preoperative evaluation of the lymph node status in rectal cancer is based on endoscopic ultrasound and magnetic resonance imaging, but their accuracy, specificity, and sensitivity still require improvement. Postoperative evaluation also presents points of debate, especially related to the role of sentinel lymph node mapping and their final implication, represented by detection of micrometastases and isolated tumor cells. The pathologic interpretation of tumor deposits represents other points in discussion. From a surgical perspective, extended lateral lymph node dissection vs. abstinence and (neo)adjuvant therapeutic approach represent another unresolved issue. This review presents the major controversies existing today in the treatment and pathologic interpretation of the lymph nodes in rectal cancer, the role/ indication and value of the lateral pelvic lymph node dissection, and the postoperative interpretation of the value of the micrometastatic disease and tumor deposits

Extraperitoneal laparoscopic retroperitoneal lymph node dissection in non-seminomatous testicular cancer

Indexación: Web of Science; ScieloObjective: The aim is to describe the technique of extraperitoneal laparoscopic access for retroperitoneal lymph node dissection in a series of patients with testis cancer stage A. Material and Methods: The extraperitoneal approach was performed in 5 patients with stage A testicular cancer. The technique includes the creation of a totally extraperitoneal space, full exposition of the retroperitoneum and classic retroperito-neal lymph node dissection. We analyzed demographic data, histology, access and surgical complications, estimated blood loss and follow up. Results: The average age was 29.4 years old (22-41). The mean operative time was 144 minutes, with an estimated blood loss of 42.4 ml. There were no surgical complications. The average hospital stay was 33.6 hr, and mean number of lymph nodes was 27.4 (24 -32). In long-term follow up there was no recurrence. Discussion: The extraperitoneal approach is an alternative access for retroperitoneal lymph node dissection in testis cancer patients. It allows avoiding potential intestinal lesions and there is no contraindication in patients with prior abdominal surgery.Objetivo: Mostrar la experiencia en la técnica de disección lumboaórtica por vía totalmente extra-peritoneal, en un grupo de pacientes con cáncer testicular en estadio A. Material y Métodos: La serie está formada por 5 pacientes, portadores de un tumor testicular no seminoma, en estadio A. En ellos se planteó como alternativa la linfadenectomía retroperitoneal lumboaórtica laparoscópica. La técnica quirúrgica consistió en la formación de un espacio extraperitoneal, con rechazo de peritoneo, exposición del retroperitoneo y disección linfática clásica. Se analizaron los datos demográficos, histología, complicaciones del acceso y la técnica quirúrgica, tiempo operatorio, sangrado estimado y seguimiento a largo plazo. Resultados: El tiempo operatorio medio fue de 144 min, con un sangrado medio estimado en 42,5 ml (20-150 ml). No hubo complicaciones intra ni postoperatorias. El tiempo medio de hospitalización fue de 33,6 h. El número medio de nodos linfáticos resecados fue de 27,4 (24 a 32). Con un promedio de seguimiento de 134 meses, no ha habido recurrencia retroperitoneal ni diseminación a distancia. Discusión: La vía extraperitoneal es una alternativa de acceso para la disección linfática retroperitoneal en pacientes con cáncer testicular. Permite evitar potenciales lesiones intestinales y es factible de realizar en pacientes con cirugía abdominal previa.extraperitoneal.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0718-40262013000100003&nrm=is

Oncologic outcomes following surgical management of clinical stage II sex cord stromal tumors

Objective To investigate the clinical history of patients with clinical stage II sex cord stromal tumors who underwent RPLND at our institution. Methods Our prospectively maintained testicular cancer database was queried to identify patients who presented with or developed clinical stage II sex cord stromal tumors and underwent RPLND at our institution between 1980 and 2018. Demographic, clinical and pathological characteristics were reviewed. Kaplan-Meier curves were graphed to assess recurrence-free and overall survival. Results Fourteen patients were included in the study with a median age of 44.2 years. Four patients presented with clinical stage II disease and 10 patients developed metastatic disease during follow-up of initial clinical stage I disease with a median time to metastasis of 2.7 years (range: 0.4-19.5 years). Of the 10 patients with orchiectomy pathology data available, all patients had at least 1 risk factor on testis pathology (mean: 2.9 risk factors). Nine patients received treatment prior to referral to our institution. All patients recurred post-RPLND at Indiana University. Median recurrence-free survival was 9.8 months. Twelve patients died of disease with a median overall survival of 14.4 months. Conclusions Metastatic sex cord stromal tumors are rare and are more resistant to standard treatment modalities than metastatic germ cell tumors. Patients presenting with sex cord stromal tumors should consider prophylactic primary RPLND in the setting of one or more pathological predictor of malignancy