Unusual primary secreting germ cell tumor of the spine. Case report

The authors describe a young man with a rare primary spinal germ cell tumor that secreted beta-human chorionic gonadotropin. The tumor was resected, and six courses of adjuvant chemotherapy consisting of cisplatin, bleomycin and etoposide were administered together with irradiation to the craniospinal area. An additional dose of radiation was delivered to the tumor site after the first four chemotherapy sessions. The patient was well without any neurological deficit or iatrogenic sequela 33 months after diagnosis. The occurrence of this rare tumor located primarily in the spine warrants attention in pathological studies of spinal tumors in young patients.     

Extragonadal germ cell tumour

We report a rare case of extragonadal germ cell tumour in a 55-year-old man. He presented with a painless mass in right inguinal region, a few days after hernioplasty for right direct inguinal hernia, which caused diagnostic difficulties and treatment problems.     

Imaging of intrathoracic metastases of nonseminomatous germ cell tumors

Radiologic imaging is crucial in the evaluation of intrathoracic metastatic nonseminomatous germ cell tumors. Helical CT is the workhorse of radiologic staging and is sensitive in the detection of parenchymal nodules and mediastinal lymphadenopathy. CT may also demonstrate other less common sites of metastatic disease. Although, currently, no radiologic procedure is effective in distinguishing viable tumor or teratoma from residual fibrosis and necrosis, cross-sectional imaging remains essential in the presurgical evaluation of potential metastatic disease. FDG PET and CT-guided needle biopsy may be useful in select, high-risk patients.     

Susceptibility alleles for testicular germ cell tumour: a review

Family history is among the strongest and most consistent of the risk factors for testicular germ cell tumour (TGCT). Brothers of affected cases have an 8- to10-fold relative risk and fathers/sons have a risk between four and sixfold. The familial relative risk of TGCT is higher than for most other cancer types, which rarely exceeds four. The high relative risk suggests that inherited susceptibility to TGCT may account for a substantial fraction of TGCT cases. The search for TGCT susceptibility genes has proven difficult and a recent genome-wide linkage study for TGCT susceptibility loci demonstrated no statistically significant regions of linkage with all LOD scores less than two. Moreover, a previous report of linkage to a region on Xq27 was not replicated. The results from genetic linkage analysis demonstrate that TGCT susceptibility is likely to be due to several genes, each with a modest effect on disease risk. The Y chromosome, which cannot be analysed by genetic linkage, carries a number of testis- and germ cell-specific genes. We recently demonstrated that a deletion on the Y chromosome known as 'gr/gr' is a rare, low-penetrance allele that is associated with susceptibility to TGCT. Based on the evidence from the linkage search the 'gr/gr' deletion represents one of possibly many TGCT susceptibility alleles, and new and emerging technologies will be employed in future work to identify these genes.     

Abdominal pain as a presenting symptom of male germ cell tumour

Twenty-three patients who presented with abdominal pain and were found to have germ cell tumours have been reviewed. The overall survival of these patients was no different from the survival of those presenting with testicular swellings. Intra-abdominal germ cell tumour remains an important differential diagnosis of abdominal pain in men.     

Interstitial cell tumour and germ cell tumour with carcinoma in situ in rabbit testes

Simultaneous occurrence of a well-demarcated interstitial cell tumour and an intratubular seminoma-like tumour, which was beginning to invade peritubular areas, in the contralateral testes of a 3-year-old Dutch-Belted rabbit is described. Morphological hallmarks of carcinoma in situ, which have not been reported previously for the rabbit, were observed in association with the seminoma. These observations indicate that carcinoma in situ, preceding a seminoma-like tumour, occurs in the rabbit and that the rabbit may serve as a practically useful animal model for studying testicular germ cell neoplasia.     

Bilateral primary germ cell tumors of testis

Bilateral primary germ cell tumors of the testis are rare, but their incidence is likely to rise since the prognosis of metastasized nonseminoma tumors of the testis has improved with polychemotherapy and surgery. Every patient with a tumor of the testis requires lifelong frequent follow-up. Delay in diagnosis and treatment can be prevented. The treatment of bilateral primary germ cell tumors of the testis is highly individual and depends on the histologic diagnosis of the first and the second tumors, metastaticgrowth, and previous treatment.     

Primary non seminomatous germ cell tumour with liver metastasis

Introduction

Categorised as poor-risk disease, primary mediastinal non-seminomatous germ cell tumours (PMNSGCT) with metastasis have a dismal survival rate.

Case Report

We report herein a case of PMNSGCT with liver metastasis that underwent primary chemotherapy followed by staged resection of the mediastinal disease and resection of the liver metastasis from a difficult anatomical position, the caudate lobe.

Conclusion

Primary mediastinal non-seminomatous germ cell tumour with metastasis has a poor prognosis. Recurrence is common in this group of patients even after chemotherapy and radical resection.     

Testicular germ cell tumor seven years after a retroperitoneal germ cell tumor.

A 44-year-old male was diagnosed in August 1980 as having a retroperitoneal germ cell tumor (classic seminoma with anaplastic areas). After treatment with cisplatin-based chemotherapy, he reached complete clinical and pathological remission. Eighty-eight months later, in December 1987, he was diagnosed as having a testicular mixed germ cell tumor (embryonal carcinoma with anaplastic seminoma areas) after right orchiectomy. The potential mechanisms by which the latter tumor could have developed are discussed.     

Fear of risks of cure in the treatment of a giant germ cell tumour

A delay of treatment of a giant germ cell tumour because of fear of therapy and lacking knowledge of prognosis is presented. Based on this case, the possible pitfalls and limitations of self-detection programmes are discussed and recommendations for the improvement of general knowledge of testicular tumours are given.     

Metastatic testicular germ cell tumour: The role of salvage surgery

To assess the clinical characteristics of metastatic testicular germ cell tumour, response to chemotherapy and outcome of salvage surgery for residual mass were analyzed. Patients with complete response were carefully watched. Salvage surgery was performed in 14 patients after chemotherapy. Resected specimens showed 7 necrosis/fibrosis, 5 teratoma, 1 cancer, and 1 benign schwannoma. Only necrosis/fibrosis was found in cases without teratoma in the primary tumour. Existence of teratomatous elements in a primary tumour suggests that cancer or teratoma is present in the residual tumour. Furthermore, tumour reduction rate could not predict their presence in resected specimens.