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PubMed1990

Clinical stage 1 testicular cancer: the role of modified retroperitoneal lymphadenectomy.

A total of 85 patients underwent modified retroperitoneal lymphadenectomy for clinical stage I nonseminomatous germ cell tumor of the testis from 1982 to 1989. The technique was a modified bilateral dissection via a thoracoabdominal approach. A full bilateral dissection was done above the level of the inferior mesenteric artery but unilateral dissection was performed below the inferior mesenteric artery using a template method. Of the 85 patients 64 had pathological stage A and 21 had stage B1 disease. Relapses have occurred in 4 of 64 stage A cancer patients (6%) and 3 of 21 stage B1 cancer patients (15%). Antegrade ejaculation was preserved without pharmacological therapy in 75 of 85 patients (88%) and 5 others were converted to antegrade ejaculation with imipramine. Therefore, 80 of 85 patients (94%) have recovered antegrade ejaculation. With a median followup of 38 months 7 relapses have been noted. We conclude that modified retroperitoneal lymph node dissection allows for preservation of ejaculation, decreases concern about retroperitoneal understaging and represents the preferred alternative to surveillance protocols for patients with low stage testicular cancer.

Adolescent↗
PubMed1983

Inguinal node metastases from testicular tumors in patients with prior orchiopexy.

Testicular tumors in patients who have had the lymphatics disrupted by prior scrotal or inguinal surgery can metastasize primarily to the ipsilateral inguinal nodes in addition to the usual retroperitoneal pattern. Whether routine inguinal node dissection along with retroperitoneal node dissection is warranted in patients with testicular tumors and prior scrotal surgery is controversial due to the small numbers of such cases reported in the literature. We report on 2 patients who had undergone previous orchiopexy and who presented with inguinal and testicular masses. Both patients underwent retroperitoneal lymph node dissection and inguinal node dissection with hemiscrotectomy and metastatic tumor was in each lymphatic area. Ipsilateral inguinal along with bilateral retroperitoneal node dissection should be considered in the primary therapy of any patient with a nonseminomatous testicular tumor who has had prior scrotal and certain inguinal procedures.

Adult↗
PubMed1996

Teratoma in the orchiectomy specimen and volume of metastasis are predictors of retroperitoneal teratoma in low stage nonseminomatous testis cancer.

PURPOSE: We determined whether teratomatous elements in the orchiectomy specimen predict for teratoma in the retroperitoneum in patients who have not received chemotherapy. MATERIALS AND METHODS: We retrospectively reviewed the records of patients with clinical stages A, B and B2 nonseminoma who underwent retroperitoneal lymph node dissection. RESULTS: Teratomatous elements in the orchiectomy specimen predict for retroperitoneal teratoma. CONCLUSIONS: When deciding on treatment for low stage nonseminoma, the presence or absence of teratoma in the orchiectomy specimen should be considered to minimize double therapy.

Humans↗
PubMed1982

Lymphography in the diagnosis of non-seminoma tumours of the testis.

In a series of 86 lymphograms correlated to histological findings after retroperitoneal lymph node dissection or to laparotomy findings, reliability proved to be 78%. The reliability of lymphograms evaluated as positive was 88%, while that of negative lymphograms was 74%. Retroperitoneal lymph node metastases were detected with the aid of lymphography in 58% of the patients. It was impossible to establish a node size above which metastases could be demonstrated with certainty by lymphography.

Humans↗
PubMed1982

Necessary extent of lymph node dissection in testicular tumours. A histopathological investigation.

The findings of a prospective topographic histopathological study of the lymphatic spread of testicular tumours are reported. The study includes 150 patients, 9 of whom were subjected to exploratory laparotomy while 141 patients underwent retroperitoneal lymph node dissection. Lymphatic spread occurs in accordance with a quite definite pattern, atypical metastases were observed in only 3 of the 150 patients. The material was analyzed with respect to the possibilities of using limited unilateral dissections. The results show that by observing appropriate safety precautions, including frozen section histology, limited unilateral dissections can be used more frequently.

Humans↗
PubMed1996

[Study of twenty-three cases of pediatric testicular tumors].

Twenty-three cases of testicular tumor (10; malignant, 13; benign) in childhood are reported. The age at diagnosis was between 3 months old and 8 years old. Twelve patients visited the clinic within a month of first appearance of symptoms. All but one patient received high orchiectomy. One patient had resection of tumor because of its benign property. Eight of the 10 patients with malignancies received 30-50Gy of retroperitoneal radiation, including one patient (stage IIa) with retroperitoneal lymph node dissection. Two patients (stage I and IIa) with post-operative metastasis in lungs, brain and mediastinal lymph nodes were treated with chemotherapy repeatedly, but they died. Our latest therapy is; 1) high orchiectomy recommended for benign and stage I malignant testicular tumors in childhood, 2) retroperitoneal radiation and/or lymph node dissection limited for patients with stage II malignancy, and 3) Systemic chemotherapy for stage III malignant tumors. At least three years of follow up would be needed. Those who received radiation or chemotherapy should be followed longer.

Age of Onset↗
PubMed1990

Paratesticular rhabdomyosarcoma: results of therapy in 18 cases.

The management of paratesticular rhabdomyosarcoma has evolved more slowly than that for testicular germ cell tumors, mainly due to its lower incidence and the lack of standardized treatment protocols. With gradual refinements in staging and therapy the prognosis has improved. Between 1960 and 1988, 18 patients 2 to 18 years old were treated at the Children's Hospital. Management consisted of inguinal orchiectomy, staging evaluation and retroperitoneal lymph node dissection, followed by chemotherapy and radiotherapy according to the stage of the disease. In 11 patients (61%) the disease was confined to the scrotum, while 7 presented with spread to the retroperitoneal lymph nodes, including 3 children with more distant metastases. Histological study revealed predominantly embryonal characteristics except for 1 alveolar cell type. Chemotherapy consisted of actinomycin D in 2 patients, vincristine, actinomycin D and cyclophosphamide in 2, pulse vincristine, actinomycin D and cyclophosphamide in 10, and doxorubicin plus vincristine, actinomycin D and cyclophosphamide in 4. A total of 17 patients remain free of disease (median followup 4 years) with 1 death. The actuarial survival without relapse and over-all survival rate are 89 and 94%, respectively. We conclude that paratesticular rhabdomyosarcoma represents a favorable subgroup of rhabdomyosarcoma.

Actuarial Analysis↗
PubMed1994

[Laparoscopic retroperitoneal lymph node excision in clinical stage I non-seminomatous testicular cancer].

Modified retroperitoneal lymph node dissection for stage I testicular tumors has been described by Weissbach. For performing laparoscopic retroperitoneal lymphadenectomy within these boundaries, we have developed a two-step procedure. In the first step, a ventral approach is used. The colon is dissected free, then the spermatic vein is excised, and the borders of dissection are defined. Removal of retroaortic and retrocaval nodal tissue is technically not feasible from the ventral approach. Therefore, in the second step, a lateral approach is employed, which is the key to success since it allows for easy transection of the lumbar vessels. Thus complete lymph node dissection can be realized. Between August 1992 and June 1993 this procedure was performed in 11 patients. In 7 patients, the tumor was on the right side and in 4 on the left. Conversion to open surgery was necessary in two patients because of uncontrollable bleeding and a large metastasis, respectively. Microscopic metastases were detected in two other patients. No major complications occurred; no blood transfusions were required. So far, the results have been encouraging.

Adult↗
PubMed1987

Primary chemotherapy for clinical stage II nonseminomatous germ cell tumors of the testis: a follow-up of 50 patients.

Fifty patients with clinical stage II nonseminomatous germ cell tumor of the testis (NSGCTT) were treated with primary chemotherapy followed by a retroperitoneal lymph node dissection (RPLND) in selected patients. The study population included 34 patients with retroperitoneal masses and elevated levels of serum biomarkers (alpha-fetoprotein [AFP] and beta-human chorionic gonadotropin [BHCG] ), five with needle aspiration biopsy-proven retroperitoneal metastases but normal levels of biomarkers, and 11 in whom there were rising levels of serum biomarkers but no radiographic evidence of retroperitoneal metastases. Forty-eight patients (96%) achieved a complete response (CR), with a mean disease-free survival of 132 weeks (range, 55 to 273 weeks). Two patients developed recurrent disease. One died and one achieved a second CR with further therapy (48 + weeks). Postchemotherapy RPLND was required in 11 patients (22%). Patients with embryonal carcinoma had a lower frequency of RPLND (8%) than patients with teratomatous elements in their primary tumor [36%, P = .014]. To reduce the frequency of double therapy (surgery +/- chemotherapy), we propose individualized therapy. Patients presenting with clinical stage II embryonal carcinoma of the testis should receive primary chemotherapy. Patients with clinical stage II NSGCTT and teratomatous elements in their primary tumor continue to require an RPLND. Those patients with intermediate volume disease (greater than 2 cm less than or equal to 5 cm in maximum diameter) may be treated with an RPLND only. Patients with higher volume teratomatous elements (greater than 5 cm less than or equal to 10 cm in maximum diameter) are likely to require the combination of chemotherapy and surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1975

Orchioblastoma or infantile embryonal carcinoma: pediatric testis tumor.

A case of orchioblastoma in a two-and-one-half-year-old boy treated with orchiectomy and lymph node dissection is presented. Review of previously reported cases of orchioblastoma and embryonal cell carcinoma in boys reveals that these tumors differ in histologic appearance, but their pathophysiologic behavior and prognosis are similar. As with embryonal cell carcinoma, retroperitoneal lymph node dissection has improved the survival of patients with orchioblastoma.

Castration↗
PubMed1996

Simultaneous retroperitoneal, thoracic, and cervical resection of postchemotherapy residual masses in patients with metastatic nonseminomatous germ cell tumors of the testis.

PURPOSE: We report our experience with simultaneous resection of residual masses above and below the diaphragm in patients with metastatic nomseminomatous germ cell tumor (NSGCT) of the testis. MATERIALS AND METHODS: Twenty-four patients underwent simultaneous resection of residual postchemotherapy masses in the retroperitoneum and chest, including three who also had radical neck dissection. All had been heavily pretreated with chemotherapy and five had undergone previous retroperitoneal lymph node dissections (RPLNDs). RESULTS: The combined procedure was performed with no mortality and low morbidity. The median length of the procedure was 5 hours 45 minutes, median blood loss 500 mL, and median length of hospital stay 9 days. Complications included one patient with chylous ascites and one with a prolonged air leak, both of which resolved with conservative management. Eighteen patients had similar pathologic findings in all sites: 13 with necrosis only and five with teratoma only. Six patients had discordant pathology in the abdomen and chest, including one with viable tumor in the chest only and two with viable tumor in the abdomen only. The overall actuarial 5-year survival rate for all patients was 79%. CONCLUSION: Simultaneous resection of neck, chest, and abdominal residual masses after chemotherapy for germ cell tumors is both a feasible and safe alternative to staged excision in selected patients who require surgical intervention at multiple sites and fulfills the objective of rendering patients disease-free in a single operative procedure.

Adolescent↗
PubMed1996

Primary chemotherapy in patients with nonseminomatous germ cell tumors of the testis and biological disease only after orchiectomy.

PURPOSE: We assessed the efficacy of primary chemotherapy in patients with nonseminomatous germ cell tumors of the testis and elevated serum tumor markers as the only evidence of disease after orchiectomy. MATERIALS AND METHODS: We analyzed the outcome of 20 patients with biological disease only who received cisplatin-based (16) or carboplatin-based (4) chemotherapy as primary treatment following orchiectomy. RESULTS: Serum tumor markers returned to normal levels in all 20 patients. One patient required subsequent surgery for recurrent retroperitoneal mature teratoma. Two patients experienced a relapse with active disease, 1 of whom died of progressive germ cell tumor. Of the patients 19 remained free of disease 18 to 116 months after the end of treatment. CONCLUSIONS: Since results with primary retroperitoneal lymph node dissection suggest that elevated serum tumor markers usually reflect systemic metastases rather than retroperitoneal disease, primary chemotherapy seems to be the most appropriate strategy to consider in patients with biological disease only following orchiectomy.

Adolescent↗
PubMed1994

The management of patients with nonseminomatous germ cell tumors of the testis with serologic disease only after orchiectomy.

Management of patients with nonseminomatous germ cell tumors of the testis who have persistently elevated serum tumor marker levels (alpha-fetoprotein and/or human chorionic gonadotropin) following orchiectomy and no clinical evidence of disease is controversial. We reviewed our experience with 15 such patients at our cancer center between March 1977 and November 1991. Group 1 (11 patients) underwent initial retroperitoneal lymph node dissection and group 2 (4 patients) received primary chemotherapy. All group 1 patients required subsequent chemotherapy for retroperitoneal disease or persistent marker elevation, whereas only 1 of the 4 who received primary chemotherapy required later surgery. We conclude that tumor marker elevation in this setting is usually indicative of systemic tumor, which is best treated primarily by initial chemotherapy.

Adult↗
PubMed1994

Retroperitoneal tumor eleven years after initial treatment of testicular cancer.

Presented is a case report of retroperitoneal tumor eleven years after orchiectomy for testicular cancer. Complete remission was achieved with combined chemotherapy and retroperitoneal lymph node dissection. Histologic examination revealed that primary testicular tumor was pure choriocarcinoma and that the retroperitoneal tumor was likely embryonal cell carcinoma without foci of choriocarcinoma. It is difficult to determine whether the retroperitoneal tumor is a late recurrence of testicular cancer of a primary extragonadal germ cell tumor.

Adolescent↗
PubMed1992

[A case of retroperitoneal Castleman's disease associated with bladder tumor and a review of 59 cases in Japan].

We present a case of retroperitoneal Castleman's disease associated with bladder tumor. The patient was a 62-year-old man, who underwent partial cystectomy under a diagnosis of bladder tumor in 1989. Subsequently, recurrent bladder tumor was detected and he consulted the outpatient clinic at our University Hospital in November, 1990, at which time computerized tomography (CT) revealed a retroperitoneal tumor. From February, 1991 four courses of combined chemotherapy (methotrexate, vinblastine, pirarubicin, cisplatin) were administered for the tumor. The tumor reduction rate after the chemotherapy was 60% on CT, and retroperitoneal lymph node dissection and left nephroureterectomy were performed in July, 1991. Histological examination revealed Castleman's disease, hyaline-vascular type. Fifty-nine reported cases of retroperitoneal Castleman's disease in Japan are reviewed.

Castleman Disease↗
PubMed1993

Monitoring of emission as direct intraoperative control for nerve sparing retroperitoneal lymphadenectomy.

An intraoperative test to identify emission relevant lumbar postganglionic nerves during nerve sparing retroperitoneal lymph node dissection is presented. The neurophysiological course of the ejaculation into the posterior urethra, the emission, is described. A retroperitoneal nerve sparing procedure was done for nonseminomatous testicular tumors bilaterally in 7 patients with pathological stage I disease and unilaterally in 4 with pathological stage IIa disease. While the isolated lumbar nerves were electrostimulated, the seminal vesicles and bladder neck were monitored by suprapubic transvesical sonography. Simultaneously, endoscopy of the posterior urethra was performed and time code was registered. Emission began with bladder neck closure, propulsive contraction of the seminal vesicles in the periphery and opening of the paracollicular region. Then, complete contraction of the seminal vesicles was associated with closure of the prostatic urethra and ended in the separate secretion from the ductuli prostatici and ejaculatorii. Descending from nerve L1 to L3, their importance for emission usually increased. For intraoperative monitoring of emission transvesical sonography alone is sufficient. In 2 patients this method allowed us to identify the relevant nerves within the retroperitoneal residual mass (fibrosis) after chemotherapy.

Adolescent↗
PubMed1984

[Bilateral primary germ cell tumors of the testis: report of two cases and review of the literature].

Bilateral germ cell tumors of the testis are not common. The contralateral tumor may develop simultaneously or sequentially. In both cases, bilateral involvement is postulated to represent two primary tumors. Case 1: A 47-year-old male was seen with a painless nodular mass in the right testis. Physical examination revealed hard swelling of both testes besides a nodule in the right testis. He underwent bilateral radical orchiectomy; and, microscopical both tumors proved to be seminoma. Although bipedal lymphangiography was negative for nodal metastases, postoperative irradiation to the pelvic and para-aortic lymph nodes was given to a total dose of 5,800 rad. The patient was alive 15 years after treatment for bilateral testicular tumors. Case 2: A 53-year-old male presented with painless left scrotal swelling. Physical examination showed not only an enlarged hard testis in the left scrotum but also a palpable hard mass in the right testis. Bilateral radical orchiectomy was performed and pathological examination revealed pure seminoma in both testes; a 1 cm mass in the right testis and almost completely replaced tumor in the left testis. Evaluation including retroperitoneal lymph node dissection revealed no metastatic disease. Postoperatively, the patient received 1,900 rad of irradiation to the retroperitoneal space. He is well one year after surgery and has no evidence of recurrence or metastasis. Previous reports of bilateral germ cell testicular tumors are reviewed and the incidence, age, predisposing factors, interval between the first and second tumors, histology, pathogenesis, prognosis, and management are discussed.

Age Factors↗