Mixed germ-cell testicular tumor in a liver transplant recipient.
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The development of malignancies after solid organ transplants is a well-known complication. Cancer is associated with significant consequences for the organ transplant patient. It is expected that cancer will surpass cardiovascular complications as the leading cause of death in transplant patients within the next few years. We report on a 36-year-old male patient who developed mixed germ-cell testicular tumor seven years after liver transplantation for alcoholic cirrhosis. He was treated with orchiectomy, retroperitoneal lymph node dissection and post-operative chemotherapy.Keywords:
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You have accessJournal of UrologyPenile & Testicular Cancer: Penile & Testicular Cancer III (MP73)1 Apr 2019MP73-01 TEMPLATE VERSUS BILATERAL POSTCHEMOTHERAPY RETROPERITONEAL LYMPH NODE DISSECTION IN PATIENTS WITH TESTICULAR CANCER Andreas Hiester*, Alessandro Nini, Anna Fingerhut, Robert große Siemer, Christian Winter, Peter Albers, and Achim Lusch Andreas Hiester*Andreas Hiester* More articles by this author , Alessandro NiniAlessandro Nini More articles by this author , Anna FingerhutAnna Fingerhut More articles by this author , Robert große SiemerRobert große Siemer More articles by this author , Christian WinterChristian Winter More articles by this author , Peter AlbersPeter Albers More articles by this author , and Achim LuschAchim Lusch More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557153.05812.65AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: This study aims to evaluate the oncological and functional outcome of bilateral versus unilateral template resection in patients with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for non-seminoma. METHODS: Between 2003 and 2018, 504 RPLNDs have been performed in 434 patients. The database of consecutive patients was queried to identify 171 patients with PC-RPLND after 1st line chemotherapy for a non-seminoma with or without bilateral template resection. Re-Do´s, late relapse, salvage patients and thoraco-abdominal approaches were excluded. Indication for a template resection was a unilateral residual mass mainly less than 5 cm as published (Heidenreich et al. 2009). Descriptive statistics were used to report preoperative features, post-operative outcomes and patterns of recurrence. Kaplan-Meier analyses were used to describe recurrence- and cancer specific mortality-free survival rates. RESULTS: 90 and 81 patients underwent unilateral and bilateral resection, respectively. Median size of residual mass was 7 cm for bilateral and 4 cm for unilateral template resection. Clinical stage II and III were present in 31% and 69% of patients, respectively. Median follow-up was 14.5 months (IQR 3.3 – 37.6). Recurrences were observed in 5 and 18 patients for the unilateral and bilateral approach, respectively. Only five recurrences occurred in the retroperitoneum, 3 in-field and 1 outside-field recurrence after a bilateral approach, and only one outside field in a template approach. The 1- and 2-year recurrence-free survival rates were 91% and 91%, 77% and 72% for patients treated with unilateral template and bilateral resection, respectively (p<0.0008). Median time to recurrence was 9.5 and 9 months in template and bilateral PC-RPLND group, respectively. As expected, adjunctive procedures were performed in 56 patients (33%) and were significantly more frequent in bilateral PC-RPLND group (44% vs. 22%, p<0.002). High-grade complication rate (Clavien-Dindo ≥ III) was 3% and 9% in unilateral template and bilateral PC-RPLND group, respectively (p=0.2). In 87% and 44% nerve-sparing was achieved in unilateral and bilateral approaches, respectively. In patients with complete follow-up data, the preservation rate of antegrade ejaculation was significantly higher in the unilateral group. CONCLUSIONS: Unilateral template PC-RPLND in the 1st line setting is oncologically safe when the residual mass is < 5 cm. Nerve-sparing and preservation of antegrade ejaculation with a unilateral resection is significantly better. Source of Funding: none Düsseldorf, Germany© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1064-e1064 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreas Hiester* More articles by this author Alessandro Nini More articles by this author Anna Fingerhut More articles by this author Robert große Siemer More articles by this author Christian Winter More articles by this author Peter Albers More articles by this author Achim Lusch More articles by this author Expand All Advertisement PDF downloadLoading ...
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Testicular cancer represents approximately 1% of all cancers diagnosed in males. The prevalence of bilateral testicular germ cell tumor cases varies from 1% to 5%. Intratubular germ cell neoplasia (ITGCN) is a precursor for almost all testicular germ cell tumors (TGCT) and is one of the highest risks of developing contralateral testicular cancer. The radical orchiectomy is still preferred for the treatment of testicular cancer. However, in some cases like solitary testis, bilateral cancer or if the tumor size is under 30% percent of the testicular extent, organ-sparing surgery can be an option. There are just a few published reports of metachronous contralateral testicular cancer, developed after orchiectomy with the histopathology of the intratubular germ cell neoplasia.
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A germ-cell tumour (GCT) of the testis is a chemosensitive tumour with high cure rates even in advanced disease.Radical inguinal orchiectomy is the initial procedure used to diagnose it which helps to risk-stratify these patients.However, in patients with life-threatening metastases, primary chemotherapy was attempted in a few studies, followed by delayed orchiectomy.The aim of this review is to study the histopathological findings of delayed orchiectomy and the retroperitoneal lymph node dissection (RPLND) specimens, to assess difference and concordance in response rates in histological types of GCTs in pathological specimens.Overall, 352 patients received initial chemotherapy followed by orchiectomy, and 235 of them had undergone RPLND.Delayed orchiectomy specimens had viable tumour in 74 (21%) patients, scarring/necrosis in 171 patients (48.5%), and teratoma in 107 (30.3%) patients.RPLND specimens had residual disease in 36 (15.3%) patients, scarring/necrosis in 100 patients (42.5%), and teratoma in 99 patients (42.3%).Patients with seminoma who underwent delayed orchiectomy had complete disappearance of tumour in 81.3% of cases, and in non-seminomatous GCT, it was 43.4%.These results raise the question of the existence of a blood-testis barrier in patients with advanced GCT and argue against the testis as a sanctuary site.
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BackgroundHistorically, retroperitoneal lymph node dissection (RPLND) has been used in the therapy of both low-stage and high-stage testicular cancer after chemotherapy. As other therapies have developed, the role of RPLND has also evolved.MethodsThe authors review the current indications for RPLND in the therapy of testicular cancer.ResultsMetastatic testicular cancer can be cured in 50% to 75% of cases by surgical removal using RPLND, depending on the volume of metastasis. In postchemotherapy disease, the surgical removal of teratoma or carcinoma also confers a therapeutic benefit to the patient.ConclusionsThe therapeutic capability of RPLND in low-stage testicular cancer is underappreciated. In postchemotherapy disease, this therapeutic capability is retained if the patient has carcinoma or teratoma in the metastatic tumor. In postchemotherapy disease, efforts continue to appropriately select patients preoperatively who have only fibrosis and necrosis in the specimen and therefore do not derive therapeutic benefit from RPLND.
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Purpose of review Robotic-assisted retroperitoneal lymph node dissection (R-RPLND) is an emerging surgical option for testicular cancer with less morbidity than open RPLND. We outline the operative technique used at our center and review contemporary evidence in the advancement of R-RPLND. Recent findings R-RPLND is being applied effectively beyond clinical stage I testicular cancer to treat low-volume, clinical stage II disease in both the primary and postchemotherapy setting. Compared with the open approach, R-RPLND offers shorter hospitalization and less blood loss with comparably low complications and oncologic control. Summary With ongoing adoption and optimization of R-RPLND, future studies will assess long-term oncologic outcomes and disseminate R-RPLND in the treatment of testicular cancer.
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Testicular cancer is a malignancy that impacts young men worldwide. The modern treatment of testicular cancer has evolved due to innovations in medical approaches and surgical techniques. The retroperitoneal lymph node dissection (RPLND) is an integral component in the treatment of testicular cancer. We aim to highlight the advances in surgical approaches and oncologic considerations noted over the past century. Once recognized as a highly morbid procedure, innovations in the understanding of anatomy and minimally invasive approaches have greatly improved patient outcomes. In addition to surgical approaches, we describe oncologic principles associated with modern dissection templates for both non-seminomatous germ cell tumors as well as more recent indications for surgery in seminomatous germ cell tumors. The overall goal of this review is to provide a summary in the utility and recent advances in RPLND techniques.
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