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Germ-Cell Cancer of the Testis and Related Neoplasms
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
A number of patients with germ-cell tumors present with symptoms from extra-gonadal disease. The most common symptoms in this situation are lumbar backache secondary to metastatic para-aortic lymphadenopathy. Where this disease is bulky there may be obstruction of the ureters(s) leading to hydronephrosis, bowel obstruction, or inferior vena cava occlusion (secondary to either tumor or vascular thrombus). Patients may also present with the signs and symptoms of deep vein thrombosis or pulmonary emboli. Patients with metastatic germ cell tumors (GCT) may present with lung metastases, manifested by chest pain, dyspnea, cough, or hemoptysis. Metastatic disease in the lung can be rapidly progressive, particularly in the choriocarcinoma syndrome,20 in which widespread vascular dissemination is common. Rarely, patients present with an inguinal lymph-node mass—usually a result of previous inguinal/scrotal surgery with resulting anomalous lymphatic drainage—or with a cervical nodal mass. Symptoms can arise due to involvement of the brain (e.g. headaches and fits) and bone (pain) though these represent a small proportion of presentations.
Ovarian cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Stephanie Nougaret, Helen Addley, Evis Sala, Anju Sahdev
The 5-year survival rate in the US for epithelial carcinomas ranges from 90% to 17% for stage I to stage IV, respectively. For GCTs, this varies from 98% to 69% for stage I to stage IV, respectively, and for stromal tumours, from 95% to 35% for stage I to IV, respectively (63). Aside from increasing stage and histological type, the relative survival rates are adversely affected by increasing age at presentation and poor physical status, residual disease at surgery, and high CA-125 serum levels (64). Prognostic factors in malignant germ cell tumours are FIGO stage, residual disease, histological type, and elevation of serum tumour markers. Advanced FIGO stage and non-dysgerminoma/immature teratoma histology are associated with a significantly increased risk of treatment failure. Non-dysgerminoma/immature histology and bulky residual disease after salvage surgery are significantly associated with a worse overall survival (65,66).
Andrology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
The Klinefelter’s syndrome is the most frequent sex chromosome abnormality. Testosterone levels may be normal or low. Germ cell presence and sperm production are variable in men with Klinefelter’s mosaicism, 46,XY/47,XXY. These patients have 50 times higher risk of germ cell tumours which usually contains non-seminomatous germ cells and present at an earlier age and seldom are gonadal in location.
Primary Mediastinal Germ Cell Tumors (PMGCT): A Real-world Analysis From A Tertiary Cancer Care Center in India
Published in Cancer Investigation, 2023
Aparna Sharma, Rohit Reddy, Raja Pramanik, Ranjit Kumar Sahoo, Seema Kaushal, K.P. Haresh, Sunil Kumar, Lalit Kumar, Atul Sharma, Atul Batra
Patients with primary extra gonadal germ cell tumors (EGGCT), a less commonly encountered subset of germ cell tumors, present with a mediastinal tumor in the absence of a gonadal primary (1). EGGCT is an uncommon entity and constitutes only around 1–5% of all germ cell tumors (2). Patients with EGGCT present as midline tumors extending variably from the pineal gland to the coccyx; the most common primary site being anterior mediastinum (50–70%) followed by retroperitoneum (30–40%) (3) and intracranial locations. Moreover, extragonadal GCTs are frequent in young children (sacrococcyx location). Furthermore, primary mediastinal germ cell tumors (PMGCT) constitute 12–16% of all mediastinal malignancies (4). They are broadly classified into two subtypes: seminomatous germ cell tumor, and nonseminomatous germ cell tumor (NSGCT) subtype that includes embryonal carcinoma (EC), teratomas (mature or immature), yolk sac carcinoma (YST) and choriocarcinoma and mixed histologies (2). Though EGGCT appear morphologically similar to the gonadal counterparts, they are clinically, molecularly and embryological distinct (5).
Balancing efficacy with long-term side-effects: can we safely de-escalate therapy for germ cell tumors?
Published in Expert Review of Anticancer Therapy, 2023
The long-term effects of chemotherapy and/or radiotherapy in managing germ cell tumors are significant. While the results with the current standard options in terms of cancer control are very good, the price being paid in terms of long-term side effects is considerable. In some areas of research such as metastatic seminoma, viable alternatives exist (single-agent carboplatin, the potential use of retroperitoneal lymph node dissection as a chemotherapy-sparing approach). These would reduce long-term side effects but may be at the risk of increased recurrence and death. The difficulty of insisting on randomized controlled trials before practice change can occur is that the trials would require thousands of patients and recruitment would take 5–10 years. An alternative would be agreed data capture of new treatments aided by online long-term follow-up recording allowing late effects to be identified.
Metastatic testicular choriocarcinoma presenting as eyelid swelling and ptosis
Published in Orbit, 2022
Tharsica Sivagnanasithiyar, Linda Okafor, Guy Faust, Hardeep Singh Mudhar, Samantha Sii, Christopher Knapp, Raghavan Sampath
Neoplasms of the testes only constitute 1% of all malignant tumours in men and most commonly affect younger age groups.4 Testicular cancers may be categorized into germ cell tumours and non-germ cell tumours. Of the germ cell tumours (95%) which comprise several subtypes, they may be broadly split into seminoma and non-seminomatous germ cell tumours with choriocarcinomas being the rarest and most aggressive form. In males’ choriocarcinomas are typically mixed germ cell in origin.4,5 Testicular choriocarcinoma is a rare cause of metastases to the ocular components and a review of the literature was performed identifying a handful of cases mostly with choroidal metastases (supplementary table 1). Drami-Gavazi et al. reported a case of gestational choriocarcinoma metastasizing to the medial rectus which was first case report of its kind.6