Results of retroperitoneal lymph node dissection after chemotherapy in patients with pure seminoma in the orchidectomy specimen but elevated serum α-fetoprotein

Matthew Peterson, Stephen Beck, Richard Bihrle, Lawrence Einhorn, Richard Foster

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

OBJECTIVE To determine the incidence of necrosis, teratoma, and active cancer in specimens at retroperitoneal lymph node dissection (RPLND) after chemotherapy in patients who presented with a pure seminoma primary tumour and an elevated serum α-fetoprotein (AFP) level at diagnosis who underwent surgery. PATIENTS AND METHODS A retrospective review of the Indiana University testis cancer database from 1980 to 2004 was performed to identify all patients with metastasic germ cell cancer, pure seminoma in the orchidectomy specimen, and an elevated AFP level. In all, 42 patients were identified; two with nonseminomatous germ cell cancer in the contralateral testicle were excluded. RESULTS RPLND pathology in the 40 patients showed necrosis in 13 (32.5%), teratoma in 12 (30%), and cancer in 15 (37.5%). The histological subtype of the 15 cancer specimens at RPLND was pure seminoma in two, embryonal in three, yolk sac in seven, variant in one, and mixed elements in two (one with seminoma and yolk sac, and one with embryonal and variant). In all, 20 patients presented with a serum AFP level of <1000 μg/mL with nine (45%) having teratoma only in the retroperitoneum in contrast to 20 patients with an AFP level of >1000 μg/mL with three (15%) having teratoma only in the retroperitoneum (P = 0.04). The level of serum AFP did not predict for active cancer in the retroperitoneum (P = 0.5). CONCLUSIONS RPLND in patients after chemotherapy who presented with pure seminoma in the orchidectomy specimen and an elevated AFP do not have a high probability of finding necrosis only in the RPLND specimen. In fact, the prevalence of persistent cancer is higher compared with the general group of patients that have RPLND after chemotherapy.

Original languageEnglish
Pages (from-to)176-178
Number of pages3
JournalBJU International
Volume104
Issue number2
DOIs
StatePublished - Jul 2009

Fingerprint

Fetal Proteins
Seminoma
Orchiectomy
Lymph Node Excision
Drug Therapy
Serum
Teratoma
Neoplasms
Yolk Sac
Necrosis
Germ Cell and Embryonal Neoplasms
Testicular Neoplasms
Testis
Databases
Pathology
Incidence

Keywords

  • AFP
  • Seminoma
  • Testis cancer

ASJC Scopus subject areas

  • Urology

Cite this

@article{208a67fc8a0e4cc2bf2199d3ac2b4bd8,
title = "Results of retroperitoneal lymph node dissection after chemotherapy in patients with pure seminoma in the orchidectomy specimen but elevated serum α-fetoprotein",
abstract = "OBJECTIVE To determine the incidence of necrosis, teratoma, and active cancer in specimens at retroperitoneal lymph node dissection (RPLND) after chemotherapy in patients who presented with a pure seminoma primary tumour and an elevated serum α-fetoprotein (AFP) level at diagnosis who underwent surgery. PATIENTS AND METHODS A retrospective review of the Indiana University testis cancer database from 1980 to 2004 was performed to identify all patients with metastasic germ cell cancer, pure seminoma in the orchidectomy specimen, and an elevated AFP level. In all, 42 patients were identified; two with nonseminomatous germ cell cancer in the contralateral testicle were excluded. RESULTS RPLND pathology in the 40 patients showed necrosis in 13 (32.5{\%}), teratoma in 12 (30{\%}), and cancer in 15 (37.5{\%}). The histological subtype of the 15 cancer specimens at RPLND was pure seminoma in two, embryonal in three, yolk sac in seven, variant in one, and mixed elements in two (one with seminoma and yolk sac, and one with embryonal and variant). In all, 20 patients presented with a serum AFP level of <1000 μg/mL with nine (45{\%}) having teratoma only in the retroperitoneum in contrast to 20 patients with an AFP level of >1000 μg/mL with three (15{\%}) having teratoma only in the retroperitoneum (P = 0.04). The level of serum AFP did not predict for active cancer in the retroperitoneum (P = 0.5). CONCLUSIONS RPLND in patients after chemotherapy who presented with pure seminoma in the orchidectomy specimen and an elevated AFP do not have a high probability of finding necrosis only in the RPLND specimen. In fact, the prevalence of persistent cancer is higher compared with the general group of patients that have RPLND after chemotherapy.",
keywords = "AFP, Seminoma, Testis cancer",
author = "Matthew Peterson and Stephen Beck and Richard Bihrle and Lawrence Einhorn and Richard Foster",
year = "2009",
month = "7",
doi = "10.1111/j.1464-410X.2009.08697.x",
language = "English",
volume = "104",
pages = "176--178",
journal = "BJU International",
issn = "1464-4096",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Results of retroperitoneal lymph node dissection after chemotherapy in patients with pure seminoma in the orchidectomy specimen but elevated serum α-fetoprotein

AU - Peterson, Matthew

AU - Beck, Stephen

AU - Bihrle, Richard

AU - Einhorn, Lawrence

AU - Foster, Richard

PY - 2009/7

Y1 - 2009/7

N2 - OBJECTIVE To determine the incidence of necrosis, teratoma, and active cancer in specimens at retroperitoneal lymph node dissection (RPLND) after chemotherapy in patients who presented with a pure seminoma primary tumour and an elevated serum α-fetoprotein (AFP) level at diagnosis who underwent surgery. PATIENTS AND METHODS A retrospective review of the Indiana University testis cancer database from 1980 to 2004 was performed to identify all patients with metastasic germ cell cancer, pure seminoma in the orchidectomy specimen, and an elevated AFP level. In all, 42 patients were identified; two with nonseminomatous germ cell cancer in the contralateral testicle were excluded. RESULTS RPLND pathology in the 40 patients showed necrosis in 13 (32.5%), teratoma in 12 (30%), and cancer in 15 (37.5%). The histological subtype of the 15 cancer specimens at RPLND was pure seminoma in two, embryonal in three, yolk sac in seven, variant in one, and mixed elements in two (one with seminoma and yolk sac, and one with embryonal and variant). In all, 20 patients presented with a serum AFP level of <1000 μg/mL with nine (45%) having teratoma only in the retroperitoneum in contrast to 20 patients with an AFP level of >1000 μg/mL with three (15%) having teratoma only in the retroperitoneum (P = 0.04). The level of serum AFP did not predict for active cancer in the retroperitoneum (P = 0.5). CONCLUSIONS RPLND in patients after chemotherapy who presented with pure seminoma in the orchidectomy specimen and an elevated AFP do not have a high probability of finding necrosis only in the RPLND specimen. In fact, the prevalence of persistent cancer is higher compared with the general group of patients that have RPLND after chemotherapy.

AB - OBJECTIVE To determine the incidence of necrosis, teratoma, and active cancer in specimens at retroperitoneal lymph node dissection (RPLND) after chemotherapy in patients who presented with a pure seminoma primary tumour and an elevated serum α-fetoprotein (AFP) level at diagnosis who underwent surgery. PATIENTS AND METHODS A retrospective review of the Indiana University testis cancer database from 1980 to 2004 was performed to identify all patients with metastasic germ cell cancer, pure seminoma in the orchidectomy specimen, and an elevated AFP level. In all, 42 patients were identified; two with nonseminomatous germ cell cancer in the contralateral testicle were excluded. RESULTS RPLND pathology in the 40 patients showed necrosis in 13 (32.5%), teratoma in 12 (30%), and cancer in 15 (37.5%). The histological subtype of the 15 cancer specimens at RPLND was pure seminoma in two, embryonal in three, yolk sac in seven, variant in one, and mixed elements in two (one with seminoma and yolk sac, and one with embryonal and variant). In all, 20 patients presented with a serum AFP level of <1000 μg/mL with nine (45%) having teratoma only in the retroperitoneum in contrast to 20 patients with an AFP level of >1000 μg/mL with three (15%) having teratoma only in the retroperitoneum (P = 0.04). The level of serum AFP did not predict for active cancer in the retroperitoneum (P = 0.5). CONCLUSIONS RPLND in patients after chemotherapy who presented with pure seminoma in the orchidectomy specimen and an elevated AFP do not have a high probability of finding necrosis only in the RPLND specimen. In fact, the prevalence of persistent cancer is higher compared with the general group of patients that have RPLND after chemotherapy.

KW - AFP

KW - Seminoma

KW - Testis cancer

UR - http://www.scopus.com/inward/record.url?scp=67650613917&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67650613917&partnerID=8YFLogxK

U2 - 10.1111/j.1464-410X.2009.08697.x

DO - 10.1111/j.1464-410X.2009.08697.x

M3 - Article

VL - 104

SP - 176

EP - 178

JO - BJU International

JF - BJU International

SN - 1464-4096

IS - 2

ER -