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European Journal of Cancer (Oxford,... May 2024Approximately 30% of patients with clinical stage I non-seminoma (CSI-NS) relapse. Current risk stratification is based on lymphovascular invasion (LVI) alone. The...
BACKGROUND
Approximately 30% of patients with clinical stage I non-seminoma (CSI-NS) relapse. Current risk stratification is based on lymphovascular invasion (LVI) alone. The extent to which additional tumor characteristics can improve risk prediction remains unclear.
OBJECTIVE
To determine the most important prognostic factors for relapse in CSI-NS patients.
DESIGN, SETTING, AND PARTICIPANTS
Population-based cohort study including all patients with CSI-NS diagnosed in Denmark between 2013 and 2018 with follow-up until 2022. Patients were identified in the prospective Danish Testicular Cancer database. By linkage to the Danish National Pathology Registry, histological slides from the orchiectomy specimens were retrieved.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
Histological slides were reviewed blinded to the clinical outcome. Clinical data were obtained from medical records. The association between prespecified potential prognostic factors and relapse was assessed using Cox regression analysis. Model performance was evaluated by discrimination (Harrell's C-index) and calibration.
RESULTS
Of 453 patients included, 139 patients (30.6%) relapsed during a median follow-up of 6.3 years. Tumor invasion into the hilar soft tissue of the testicular hilum, tumor size, LVI and embryonal carcinoma were independent predictors of relapse. The estimated 5-year risk of relapse ranged from < 5% to > 85%, depending on the number of risk factors. After internal model validation, the model had an overall concordance statistic of 0.75. Model calibration was excellent.
CONCLUSION AND RELEVANCE
The identified prognostic factors provide a much more accurate risk stratification than current clinical practice, potentially aiding clinical decision-making.
Topics: Male; Humans; Prognosis; Neoplasm Staging; Testicular Neoplasms; Neoplasm Recurrence, Local; Prospective Studies; Cohort Studies; Chronic Disease; Seminoma; Orchiectomy
PubMed: 38531266
DOI: 10.1016/j.ejca.2024.114025 -
F&S Reports Mar 2024To investigate whether the minimal cyclophosphamide equivalent dose (mCED), a novel approach for estimating alkylating agent exposure, is associated with the sperm...
Association of the minimal cyclophosphamide equivalent dose and outcome of microdissection testicular sperm extraction in patients with persistent azoospermia after chemotherapy.
OBJECTIVE
To investigate whether the minimal cyclophosphamide equivalent dose (mCED), a novel approach for estimating alkylating agent exposure, is associated with the sperm retrieval rates by microdissection testicular sperm extraction (mTESE) in azoospermic postchemotherapy cancer survivors.
DESIGN
A retrospective cohort study conducted between 2002 and 2017.
SETTING
An academic medical center.
PATIENTS
A total of 28 azoospermic postchemotherapy cancer survivors who underwent mTESE.
INTERVENTIONS
Chemotherapy exposure and mCED calculation.
MAIN OUTCOME MEASURES
The primary outcome was the association between the mCED and sperm retrieval rate using mTESE. The mCED value for each patient's regimen received was estimated using the lowest recommended dosing regimen from the range of recommended doses at the time of administration.
RESULTS
Spermatozoa were successfully retrieved in 11 (39.3%) of the patients. Age at the time of receiving chemotherapy and mCED were significant factors associated with sperm retrieval. An mCED of <4,000 mg/m had a higher sperm retrieval rate (10/14, 71.4%) than an mCED of >4,000 mg/m (0/8, 0). The hormone levels were not significantly different when comparing patients with and without successful sperm retrieval. Seminoma, nonseminomatous germ cell tumor, and acute lymphoblastic leukemia had favorable sperm retrieval rates-100% (2/2), 66.7% (2/3), and 66.7% (2/3), respectively-although the numbers of patients in each group were small.
CONCLUSION
Among this cohort of patients with cancer who required chemotherapy regimens, successful sperm retrieval by mTESE was only noted among cancer survivors receiving an mCED of <4,000 mg/m.
PubMed: 38524218
DOI: 10.1016/j.xfre.2023.11.005 -
Cancer Reports (Hoboken, N.J.) Mar 2024Testicular cancer (TC), comprising merely 1% of male neoplasms, holds the distinction of being the most commonly encountered neoplasm among young males. (Review)
Review
BACKGROUND
Testicular cancer (TC), comprising merely 1% of male neoplasms, holds the distinction of being the most commonly encountered neoplasm among young males.
RECENT FINDINGS
Most cases of testicular neoplasms can be classified into two main groups, namely germ cell tumors representing approximately 95% of the cases, and sex cord-stromal tumors accounting for about 5% of the cases. Moreover, its prevalence is on the rise across the globe. TC is a neoplastic condition characterized by a favorable prognosis. The advent of cisplatin-based chemotherapeutic agents in the latter part of the 1970s has led to a significant enhancement in the 5-year survival rate, which presently surpasses 95%. Given that TC is commonly detected before reaching the age of 40, it can be anticipated that these individuals will enjoy an additional 40-50 years of life following successful treatment. The potential causes of TC are multifactorial and related to different pathologies. Accurate identification is imperative to guarantee the utmost efficacious and suitable therapy. To a certain degree, this can be accomplished through the utilization of blood examinations for neoplastic indicators; nonetheless, an unequivocal diagnosis necessitates an evaluation of the histological composition of a specimen via a pathologist.
CONCLUSION
TC is multifactorial and has various pathologies, therefore this review aimed to revise the prenatal and postnatal causes as well as novel diagnostic biomarkers and the therapeutic strategies of TC.
Topics: Humans; Male; Adult; Middle Aged; Testicular Neoplasms; Prevalence; Neoplasms, Germ Cell and Embryonal; Biomarkers
PubMed: 38507271
DOI: 10.1002/cnr2.2052 -
Archives of Pathology & Laboratory... Mar 2024Steroidogenic acute regulatory (StAR) protein is a mitochondrial transport protein with a critical regulatory role for steroid hormone production. The tissue...
CONTEXT.—
Steroidogenic acute regulatory (StAR) protein is a mitochondrial transport protein with a critical regulatory role for steroid hormone production. The tissue distribution of StAR expression is limited to few human normal tissues.
OBJECTIVE.—
To assess the diagnostic and prognostic value of StAR immunohistochemistry analysis.
DESIGN.—
A tissue microarray containing 19 202 samples from 152 different tumor types and subtypes and 608 samples of 76 different normal tissue types was analyzed by immunohistochemistry.
RESULT.—
StAR immunostaining occurred in 198 (1.2%) of the 17 135 analyzable tumors. StAR expression was observed in 27 of 152 tumor categories, 9 of which included at least 1 strongly positive case. The highest rate of StAR positivity occurred in Leydig cell tumors of the testis and the ovary (100%), steroid cell tumors of the ovary (100%), adrenocortical carcinomas (93%) and adenomas (87%), Sertoli-Leydig cell tumors (67%) and granulosa cell tumors of the ovary (56%), as well as seminomas (7%). Nineteen other tumor entities showed-a usually weak-StAR positivity in less than 6% of cases. A comparison with preexisting Melan-A (a melanocyte antigen) data revealed that StAR was more often positive in adrenocortical neoplasms and in Leydig cell tumors while StAR (but not Melan-A) was negative in Sertoli cell tumors.
CONCLUSIONS.—
Our data provide a comprehensive overview on the patterns of StAR immunostaining in human tumors and suggest a diagnostic utility of StAR immunohistochemistry for supporting a diagnosis of Leydig cell tumors or of normal or neoplastic adrenocortical tissue.
PubMed: 38484775
DOI: 10.5858/arpa.2023-0281-OA -
Neurology(R) Neuroimmunology &... May 2024Kelch-like protein-11 (KLHL11)-IgG is associated with rhombencephalitis and seminoma. It has not previously been described as a neurologic immune checkpoint inhibitor...
OBJECTIVES
Kelch-like protein-11 (KLHL11)-IgG is associated with rhombencephalitis and seminoma. It has not previously been described as a neurologic immune checkpoint inhibitor (ICI)-related adverse event (nirAE) or in association with esophageal adenocarcinoma.
METHODS
We describe a 61-year-old man with metastatic esophageal adenocarcinoma treated with folinic acid, fluorouracil, oxaliplatin (FOLFOX), and nivolumab, who subsequently developed diplopia, vertigo, and progressive gait ataxia after 8 weeks of treatment.
RESULTS
Owing to a concern for ICI-associated myasthenia gravis, nivolumab was held and he was treated with prednisone and pyridostigmine. EMG showed no neuromuscular junction dysfunction, and acetylcholine-receptor antibodies were negative. Brain MRI was unrevealing. Murine brain tissue immunofluorescence assay revealed KLHL11-IgG in both serum and CSF, confirmed by cell-based assay. Tumor histopathology demonstrated poorly differentiated, highly proliferative adenocarcinoma with increased mitotic figures and cytoplasmic KLHL11 immunoreactivity. He was initiated on 6 months of cyclophosphamide in addition to FOLFOX for post-ICI-associated KLHL11-IgG rhombencephalitis.
DISCUSSION
We report KLHL11-IgG rhombencephalitis associated with poorly differentiated esophageal cancer as a novel nirAE. Tumor staining revealed KLHL11 immunoreactivity, supporting a cancer-antigen-driven ICI-associated paraneoplastic syndrome. Recognition of novel nirAEs can expedite treatment and potentially prevent progressive neurologic disability.
Topics: Male; Humans; Animals; Mice; Middle Aged; Nivolumab; Immune Checkpoint Inhibitors; Encephalitis; Adenocarcinoma; Testicular Neoplasms; Brain Stem; Immunoglobulin G; Esophageal Neoplasms
PubMed: 38484218
DOI: 10.1212/NXI.0000000000200218 -
Cureus Feb 2024Neutropenic enterocolitis (NEC), also referred to as typhlitis, is a condition associated with a high mortality risk and primarily manifests in immunocompromised...
Neutropenic enterocolitis (NEC), also referred to as typhlitis, is a condition associated with a high mortality risk and primarily manifests in immunocompromised patients. It is characterized by ulceration, edema, and hemorrhage affecting the bowel wall. The underlying cause of NEC is postulated as an immunocompromised condition that facilitates bacterial infiltration through compromised bowel mucosa. The high mortality rate is attributable to bowel necrosis, culminating in perforation and sepsis. This report describes a case involving a patient with metastatic seminoma who exhibited seizure-like activity, fever, bacteremia, and NEC. The patient underwent treatment involving broad-spectrum antibiotics and filgrastim. The patient's neutropenia resolved leading to discharge on oral antibiotics. The case reported is unique, as it links NEC to and seminoma. has not been previously associated with NEC.
PubMed: 38481902
DOI: 10.7759/cureus.54077 -
Oncology Letters Apr 2024Spontaneous rupture and hemorrhage of mediastinal germ cell tumors is a rare occurrence. In the current report, the case of a 20-year-old male patient who was admitted...
Spontaneous rupture and hemorrhage of mediastinal germ cell tumors is a rare occurrence. In the current report, the case of a 20-year-old male patient who was admitted with chest tightness and dyspnea is presented. An urgent chest CT scan revealed a large tumor in the right anterior mediastinum, measuring ~12 cm in diameter, with associated intratumoral hemorrhage. An emergency thoracotomy was performed to excise the lesion, which revealed that the bleeding was caused by a ruptured tumor. Postoperative pathological findings revealed a mediastinal mixed germ cell tumor consisting of four pathological types: Embryonal carcinoma, seminoma, yolk sac tumor and immature teratoma. Postoperatively, the patient showed marked improvement in the symptoms of dyspnea. However, the follow-up outcome was poor, and the patient succumbed 2 months after surgery. To the best of our knowledge, there are no reports of rupture and hemorrhage involving >4 mixed germ cell tumors. In the present report, the experience of the treatment of the patient is summarized, and literature was reviewed to improve clinicians' awareness of the disease.
PubMed: 38476210
DOI: 10.3892/ol.2024.14316 -
Radiology Case Reports Apr 2024[This corrects the article DOI: 10.1016/j.radcr.2022.06.038.].
[This corrects the article DOI: 10.1016/j.radcr.2022.06.038.].
PubMed: 38463691
DOI: 10.1016/j.radcr.2023.12.038 -
Asian Journal of Surgery Jun 2024
Topics: Humans; Seminoma; Male; Mediastinal Neoplasms; Hyperplasia; Granuloma; Adult; Inflammation; Chronic Disease; Tomography, X-Ray Computed
PubMed: 38443257
DOI: 10.1016/j.asjsur.2024.02.005 -
Oncology Letters Apr 2024Testicular seminoma is a relatively rare malignant tumor, with the most common site of recurrence and metastasis being the retroperitoneal lymph nodes. Since seminoma is...
Testicular seminoma is a relatively rare malignant tumor, with the most common site of recurrence and metastasis being the retroperitoneal lymph nodes. Since seminoma is highly sensitive to radiotherapy and chemotherapy, even if it metastasizes, its cure rate is still >95%. However, the long-term toxicity and side effects of radiotherapy and chemotherapy cannot be ignored. Iodine-125 seeds represent a low-energy radioactive source that kills tumor cells while protecting the surrounding normal tissues, and brachytherapy using iodine-125 seeds has been widely used for the treatment of various malignancies. In addition, carboplatin can be used as an alternative to cisplatin-based combination chemotherapy to reduce the incidence of pulmonary toxicity, neurological damage and renal toxicity. In the present study, a case in which iodine-125 seeds were implanted for the treatment of retroperitoneal metastatic seminoma is reported. The patient was diagnosed with postoperative recurrence of seminoma that metastasized to the retroperitoneal lymph nodes. Since the tumor was large and surrounded blood vessels, surgical intervention and external radiotherapy were not considered. Moreover, considering the potential long-term toxic side effects of standard chemotherapy, a treatment plan for the patient using iodine-125 seed implantation combined with carboplatin (AUC7) therapy was finally formulated. No disease recurrence or toxic reactions occurred during the 3-year follow-up after treatment. The present case therefore demonstrated the antitumor efficacy and reduced toxicity of iodine-125 seeds combined with carboplatin for treating seminoma.
PubMed: 38426154
DOI: 10.3892/ol.2024.14289