PMID- 29794869
OWN - NLM
STAT- MEDLINE
DCOM- 20190715
LR  - 20190715
IS  - 1532-0979 (Electronic)
IS  - 0147-5185 (Linking)
VI  - 42
IP  - 8
DP  - 2018 Aug
TI  - The Clinical Significance of a Small Component of Choriocarcinoma in Testicular 
      Mixed Germ Cell Tumor (MGCT).
PG  - 1113-1120
LID - 10.1097/PAS.0000000000001088 [doi]
AB  - The clinical significance of limited choriocarcinoma in a malignant mixed germ 
      cell tumor (MGCT) is unknown. Men with a MGCT with </=5% choriocarcinoma at radical 
      orchiectomy (RO) between 2000 and 2016 from our consult service were studied. Of 
      50 men in our cohort, we had clinical information for 30 men. Median follow-up 
      was 41 months (1 to 168 mo). Median tumor size was 4.5 cm (1.1 to 8.0 cm). In 
      total, 22/30 (73%) cases were pT1, 6/30(20%) cases were pT2, and 2/30 (7%) cases 
      were pT3. In total, 4/30(13%) cases had lymph node metastases and 2/30 (7%) cases 
      had distant metastases at the time of RO. In 30 cases with RO we had information 
      on immediate postorchiectomy treatment: 14/30 (46.7%) active surveillance, 4/30 
      (13.3%) retroperitoneal lymph node dissection, 10/30 (33.3%) chemotherapy 
      (chemotherapy), 1/30 (3.3%) retroperitoneal lymph node dissection followed by 
      chemotherapy, and 1/30 (3.3%) resection of a distant metastasis. Preoperative 
      serum human chorionic gonadotropin (hCG) levels ranged between 0.1 and 
      60,715 mIU/mL (mean, 4796; median, 485). One patient had an hCG level of 
      6367 mIU/mL and another 60,715 mIU/mL with the remaining cases <5000 mIU/mL. In 
      total, 4/30 (13%) patients had elevated serum markers after surgery, 3 of them 
      normalized following chemotherapy while the fourth one continued to have elevated 
      serum alpha fetoprotein levels after chemotherapy. All patients were alive at 
      last follow-up. In total, 7/30 (23.3%) patients subsequently developed metastatic 
      disease to lymph nodes or distal organs, the histology of the metastasis 
      consisted mainly of teratoma and yolk sac tumor. Embryonal carcinoma was present 
      in 2 metastatic sites. One lung metastasis was suggestive for choriocarcinoma. 
      Definitive choriocarcinoma was not present in any of the metastasis. A small 
      component of choriocarcinoma in a MGCT is typically associated with relatively 
      low-level elevations of serum hCG levels, and is not associated with aggressive 
      disease. The presence of limited choriocarcinoma (</=5%) does not add to the 
      prognostic information provided by standard TNM staging, which uses levels of 
      serum markers (hCG, alpha fetoprotein, lactate dehydrogenase) as surrogates for 
      extent of disease.
FAU - Hassan, Oudai
AU  - Hassan O
AD  - The Johns Hopkins Medical Institutions, Baltimore, MD.
FAU - Epstein, Jonathan I
AU  - Epstein JI
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Surg Pathol
JT  - The American journal of surgical pathology
JID - 7707904
RN  - 0 (AFP protein, human)
RN  - 0 (Chorionic Gonadotropin)
RN  - 0 (alpha-Fetoproteins)
RN  - Testicular Germ Cell Tumor
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Chemotherapy, Adjuvant
MH  - Choriocarcinoma, Non-gestational/blood/*secondary/therapy
MH  - Chorionic Gonadotropin/blood
MH  - Humans
MH  - Lymph Node Excision
MH  - Lymphatic Metastasis
MH  - Male
MH  - Metastasectomy
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - Neoplasms, Complex and Mixed/blood/*secondary/therapy
MH  - Neoplasms, Germ Cell and Embryonal/blood/*secondary/therapy
MH  - Orchiectomy
MH  - Testicular Neoplasms/blood/*pathology/therapy
MH  - Time Factors
MH  - Treatment Outcome
MH  - Tumor Burden
MH  - Young Adult
MH  - alpha-Fetoproteins/metabolism
EDAT- 2018/05/26 06:00
MHDA- 2019/07/16 06:00
CRDT- 2018/05/26 06:00
PHST- 2018/05/26 06:00 [pubmed]
PHST- 2019/07/16 06:00 [medline]
PHST- 2018/05/26 06:00 [entrez]
AID - 10.1097/PAS.0000000000001088 [doi]
PST - ppublish
SO  - Am J Surg Pathol. 2018 Aug;42(8):1113-1120. doi: 10.1097/PAS.0000000000001088.