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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Retroperitoneal lymph node dissection (RPLND) is still the most sensitive and specific method for the detection of lymph node metastases in stage I nonseminomatous testicular carcinoma. In stage II disease, residual malignant tumor and mature teratoma can be removed. Acceptance of this operation, however, has decreased due to the morbidity caused by the open approach. To reduce this morbidity, and to improve the acceptance of RPLND, laparoscopy has been introduced. Clinical data with long-term follow-up are now available which demonstrate the technical feasibility of laparoscopic RPLND. Studies comparing laparoscopy and open surgery show advantages for the laparoscopic approach in terms of reduced blood loss, intraoperative complications and operative time. Mainly minor complications, such as chylous ascites or lymphocele formation, are observed. The conversion rate to open surgery, mainly due to intraoperative bleeding, is acceptable at less than 10%. As in open surgery, antegrade ejaculation can be preserved successfully. RPLND has also been shown to provide adequate oncological results. In stage I disease, lymph node metastasis is found in 25-41% of cases. Patients with histologically proven retroperitoneal tumor receive adjuvant chemotherapy whereas individuals without evidence of retroperitoneal disease do not require additional treatment. Follow-up controls in both groups, without local recurrence, demonstrate the excellent diagnostic accuracy of this procedure. Meanwhile laparoscopic RPLND has also been introduced successfully in the management of stage II disease. Small volume residual tumors can be removed with an acceptable complication rate. However, this operation is technically demanding and should be performed only at institutions with considerable laparoscopic experience. In conclusion, laparoscopic RPLND is a safe method for low-stage germ cell tumors with minimal invasiveness and excellent clinical results. Thus laparoscopy might contribute to a better acceptance of RPLND.
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PMID:Laparoscopic retroperitoneal lymph node dissection for nonseminomatous testicular carcinoma. 1503 41

Choriocarcinoma are germinal tumors from testicular cells in men or foetal trophoblast in women. Cutaneous metastasis are very rare. The authors report a case of angioma-like tumor in a 22-year-old man which was a cutaneous metastasis of a testicular carcinoma. Diagnosis was of course histologic. Testicular echography showed an intra testicular tumor, pulmonary and abdominal CT-scan showed multiple metastases. Orchidectomy and retroperitoneal lymphadenectomy were performed before a general chemotherapy. Patient died 14 months after diagnosis. Only 11 cases of cutaneous metastasis of choriocarcinoma were found in the world literature (7 men and 4 women). All cases showed diagnosis trap for plastic surgeon.
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PMID:[Testicular choriocarcinoma presenting as cutaneous metastasis. A case report and review of the literature]. 1596 45

Retroperitoneal lymph node dissection (RPLND) is the most accurate method to evaluate the presence and extent of retroperitoneal nodal metastases in clinical stage I non-seminomatous germ cell testicular carcinoma. In our Department the open "nerve sparing" RPLND is already the standard surgical treatment for these tumors and laparoscopic technique is employed in surgical treatment of digestive diseases as cholelithiasis, hiatal hernias and gastrointestinal tumors; we report our first experience with laparoscopic RPLND in patients with low stage non-seminomatous germ cell testicular tumors (NSGCTT). A laparoscopic modified template RPLND was performed in 5 high-risk patients with non-seminomatous germ cell clinical stage I tumors by a transperitoneal approach. In 4 of the 5 cases a template dissection was performed. In one pathological stage II tumor a limited lymph node dissection was performed and the patient underwent postoperative chemotherapy. Mean operative time was 190 minutes (range 160-210). No retrograde ejaculation occurred. The mean number of dissected nodes was 21 (range 16-25). At mean follow-up of 16.3 months (range 12-21) the 4 operated patients with pathological stage I NSGCTT are disease free without ejaculatory or urinary dysfunction. Our preliminary experience suggests that laparoscopic RPLND for stage I NSGCTT is feasible and safe for surgeons largely trained in either laparoscopic digestive surgery or open RPLND for whom the learning curve of that minimally invasive approach is lower than expected.
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PMID:Laparoscopic retroperitoneal lymphadenectomy for stage I non-seminomatous testicular tumors. 1633 55

A variety of benign and malignant masses can be found in the inguinal canal (IC). Benign causes of masses in the IC include spermatic cord lipoma, hematoma, abscess, neurofibroma, varicocele, desmoid tumor, air, bowel contrast material, hydrocele, and prostheses. Primary neoplasms of the IC include liposarcoma, Burkitt lymphoma, testicular carcinoma, and sarcoma. Metastases to the IC can occur from alveolar rhabdomyosarcoma, monophasic sarcoma, prostate cancer, Wilms tumor, carcinoid tumor, melanoma, or pancreatic cancer. In patients with a known malignancy and peritoneal carcinomatosis, the diagnosis of metastases can be suggested when a mass is detected in the IC. When peritoneal disease is not evident, a mass in the IC is indicative of stage IV disease and may significantly alter clinical and surgical treatment of the patient. A combination of the clinical history, symptoms, laboratory values, and radiologic features aids the radiologist in accurately diagnosing mass lesions of the IC. Supplemental material available at radiographics.rsnajnls.org/cgi/content/full/28/3/819/DC1.
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PMID:The inguinal canal: anatomy and imaging features of common and uncommon masses. 1848 Apr 86

Serous tumours of the testis and paratestis are rare, with fewer than 50 cases reported in the literature. The majority of the reported cases have been borderline serous tumours, and these tend not to recur or metastasize. Conversely, serous carcinomas can metastasize but this is often a late event. The presence of invasion in an otherwise borderline tumour has also been associated with the development of metastatic disease several years later, thus highlighting the importance of extensive sampling of all cases of borderline serous tumours. We report a case of a young man diagnosed with serous carcinoma of the testis, occurring 18 years after first diagnosis of a testicular germ cell tumour in the contralateral testis. This pattern has not previously been reported.
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PMID:Metastatic serous carcinoma of the testis: a case report and review of the literature. 2158 50

The aim of this report is to contribute to the clinical understanding of choroid metastasis from testicular carcinoma. A young male patient presented with loss of vision in his left eye with ptosis and proptosis. Fundoscopy revealed bullous retinal detachment with dark hazy vitreous. The preliminary diagnosis of choroid carcinoma with vitreous involvement was made by an ophthalmologist. Later in the physical examination, there was a firm painless left testicular swelling. Testicular tumor markers were raised. Based on ultrasonography, MRI and PET-CT, a clinical diagnosis of left testicular carcinoma metastasizing to the left choroid and vitreous was made. A mixed germ cell tumor was reported on histopathological examination. After cisplatin-based chemotherapy, serum tumor markers normalized and vision improved. Exceptional choroidal and vitreous metastases with absence of other visceral and bony involvement constituted the presenting sign. Although rare, testicular carcinoma must be considered to metastasize to the eye, especially if loss of vision is the chief complaint.
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PMID:Choroid Metastasis from Testicular Carcinoma: A Rare Entity. 2396 74

The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 39-year-old, previously healthy man presented with a left testicular mass, confirmed on ultrasound. He underwent left inguinal orchiectomy, which disclosed testicular carcinoma composed of 90% choriocarcinoma, 9% seminoma, and 1% teratoma. Imaging revealed numerous metastases in the lungs, liver, and brain. Prechemotherapy levels of serum tumor markers were alpha-fetoprotein (AFP) 2.0 ng/mL, human chorionic gonadotropin (hCG) 151,111 IU/L, and lactate dehydrogenase 588 U/L. He received four courses of etoposide, ifosfamide, and cisplatin chemotherapy, given without bleomycin because of the anticipated need for postchemotherapy thoracic surgery. He had an incomplete response to induction chemotherapy. The serum hCG level was 8.1 IU/L, and there were residual lesions in the liver and lungs whereas the brain metastases had nearly resolved. His Eastern Cooperative Oncology Group performance status was zero. He had no symptoms of ototoxicity or peripheral neurotoxicity. Repeat serum hCG levels after chemotherapy were 12.3 IU/L at 2 weeks and 325 IU/L at 4 weeks. He was referred to discuss optimal ongoing treatment.
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PMID:Role of High-Dose Chemotherapy With Autologous Stem-Cell Rescue in Men With Previously Treated Germ Cell Tumors. 2799 70

Advances in therapeutic results due to chemotherapy in metastatic non-seminomatous germinal cell tumors of the testes are stimulating investigations that assess the role of chemotherapy as an adjuvant to surgery and/or radiotherapy in early stages of disease. In current series, complete responses are obtained in 70-80% of patients with metastatic disease; the relapse rate is 15-20%. Toxicity is significant but acceptable. The current literature reveals that surgery and/or radiation to the periaortic lymph nodes for clinical Stage I disease results in a 2+ year disease-free survival rate of about 90%. For clinical Stage II disease, the rate is about 50%. Patients with non-seminomatous testicular carcinoma Stage II are at significant risk to develop distant metastases and are candidates for an intergroup protocol that randomizes patients to receive either adjuvant combination chemotherapy or combination chemotherapy at first recurrence. All patients with testicular cancer should be considered curable. This requires careful assessment and monitoring, and can best be approached in controlled clinical trials.
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PMID:Testicular Cancer: Risk Factors and the Role of Adjuvant Chemotherapy. 2960 54

Testicular carcinoma recurrences represent a rare finding (1-6% in non-seminomatous germ cell tumours). However, cases of recurrence have been described many years later. We report a case of late recurrence of embryonic testicular carcinoma, after 26 years, with pulmonary metastases. Following evidence of increase of alpha-fetoprotein (AFP), the patient underwent a total body computed tomography scan that exhibited two pulmonary nodules, one in upper left lobe and other in left hilar region with multiple mediastinal and retrocrural lymph node enlargements All consolidations showed increased sugar uptake value at PET CT. Biopsies of lung consolidations confirmed diagnosis of recurrence of testicular carcinoma.
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PMID:Pulmonary metastasis: very late relapse of testicular embryonal carcinoma. 3226 17


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