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Concept: Mediastinal germ cell tumor

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OBJECTIVE: We investigated the efficacy and toxicity of a docetaxel, ifosfamide and nedaplatin regimen as salvage therapy for patients with advanced testicular germ cell tumor. METHODS: Eleven patients with advanced germ cell tumor refractory or relapsed after cisplatin-based chemotherapy were treated using docetaxel, ifosfamide and nedaplatin. The docetaxel, ifosfamide and nedaplatin regimen comprised docetaxel (75 mg/m(2)) on Day 1, ifosfamide (2 g/m(2)) on Days 1-3 and nedaplatin (75 mg/m(2)) on Day 2 of a 3-week cycle. RESULTS: Ten (91%) of the 11 patients achieved favorable responses, including complete response in one case and partial response in nine cases. Nine (81%) of the 11 patients have continued to show no evidence of disease after docetaxel, ifosfamide and nedaplatin therapy followed by subsequent surgical resection, with a median follow-up period of 52 months. One patient died of the disease 3 months after completing docetaxel, ifosfamide and nedaplatin chemotherapy. One patient was lost to follow-up with a status of alive with disease. Ten (91%) of the 11 patients developed Grade 4 leukopenia, which was managed using granulocyte colony-stimulating factor. No patients developed sensory neuropathy or renal dysfunction. CONCLUSIONS: The docetaxel, ifosfamide and nedaplatin regimen was efficacious and well-tolerated as salvage chemotherapy for patients with advanced germ cell tumor.

Concepts: Cancer, Oncology, Chemotherapy, Testicular cancer, Germ cell tumor, Puberty, Germ cell, Mediastinal germ cell tumor

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Primary non-seminomatous germ cell tumours of anterior mediastinum are uncommon. Endodermal sinus tumour of the anterior mediastinum (yolk sac) is a rare but lethal neoplasm. We present a case of an 18-year-old man who presented with chest pain, cough and haemosputum with markedly raised serum α-fetoprotein (AFP) levels above 112 000 ng/mL. Chest roentgenogram and CT showed a giant anterior mediastinal mass. CT guided biopsy revealed a diagnosis of endodermal sinus tumour. After the completion of chemotherapy, extensive surgical resection was carried out along with the right lung metastastectomy. Five years postresection follow-up the patient is disease free with normal serum tumour markers. This is the longest survival ever reported of such tumours with highest AFP level (>112 000 ng/mL) and lung metastasis.

Concepts: Cancer, Oncology, Pneumonia, Heart, Germ cell tumor, Mediastinal tumor, Mediastinum, Mediastinal germ cell tumor

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Therapeutic options for clinical Stage I nonseminomatous germ cell tumor include active surveillance, adjuvant chemotherapy and retroperitoneal lymph node dissection (RPLND). Lymphovascular invasion (LVI) determines risk of recurrence, as those without LVI have 15% risk of relapse on surveillance while those with LVI have a 50% risk. This stratifies patients into high risk(LVI+) and low risk(LVI-) groups which direct treatment recommendations. Surveillance is preferred for those with low risk disease, and is an option for those with high risk disease, as at least half are over-treated with other options. Adjuvant chemotherapy is an option for all patients as it can eradicate micrometastatic disease and reduce recurrence by at least 90%. RPLND benefits patients with low volume retroperitoneal disease with a cure rate of RPLND alone at approximately 70%. All three treatment modalities have similar survival rates approaching 100% but differing potential morbidities, which, along with patient preferences and compliance, should guide treatment decisions.

Concepts: Medicine, Cancer, Oncology, Cure, Germ cell tumor, Germ cell, Mediastinal germ cell tumor

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The objective of this study was to analyze the clinical outcomes of TIP (paclitaxel, ifosfamide and cisplatin) incorporated into induction chemotherapy for patients with metastatic germ cell tumor (GCT) characterized by unfavorable clinical features. This study included 37 patients, who were categorized into intermediate- or poor-risk GCT according to the International Germ Cell Consensus Classification (IGCCC). All 37 patients received two cycles of bleomycin, etoposide and cisplatin (BEP) followed by several cycles of TIP. Following treatment with TIP, 25 patients achieved the normalization of serum tumor markers. In addition, surgical resection of the residual tumors following TIP was performed in 17 patients who were pathologically diagnosed with no viable cancer cells. At a median follow-up of 36 months, 31 patients were alive, including 27 with no evidence of disease, whereas the remaining six died of disease progression. The 5-year disease-free survival (DFS) and overall survival (OS) rates in these 37 patients were 72.9 and 85.3 %, respectively. Despite the lack of a significant predictor of OS, univariate analysis identified the presence of a choriocarcinoma element and IGCCC as significant predictors of DFS, of which only the presence of a choriocarcinoma element appeared to be independently associated with DFS. In this series, treatment-related death did not occur, although 27 patients had at least one adverse event corresponding to grade 3≤. Collectively, it would be of worth to pursue the significance of the early incorporation of TIP into induction chemotherapy for patients with intermediate- or poor-risk metastatic GCT in the future.

Concepts: Cancer, Disease, Oncology, Lung cancer, Chemotherapy, Testicular cancer, Germ cell tumor, Mediastinal germ cell tumor

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The International Germ Cell Cancer Collaborative Group (IGCCCG) criteria prognosticate survival outcomes in metastatic testicular germ cell tumor (MT-GCT), but how the initial risk changes over time for those who survived since curative treatment is unknown.

Concepts: Cancer, Oncology, Tumor, Neoplasm, Testicular cancer, Germ cell tumor, Germ cell, Mediastinal germ cell tumor

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Up to 50% of patients diagnosed with stage I non-seminomatous germ cell tumors (NSGCT) harbor occult metastases. Patients are managed by surveillance with chemotherapy at relapse or adjuvant treatment up-front. Late toxicities from chemotherapy are increasingly recognised. Based on a potential biological role in germ cells/tumors and pilot data, our aim was to evaluate tumor expression of the chemokine CXCL12 alongside previously proposed markers as clinically useful biomarkers of relapse.

Concepts: DNA, Gene, Cancer, Oncology, Lung cancer, Germ cell tumor, Germ cell, Mediastinal germ cell tumor

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Owing to its exquisite chemotherapy sensitivity, most patients with metastatic germ cell tumors (GCTs) are cured with cisplatin-based chemotherapy. However, up to 30% of patients with advanced GCT exhibit cisplatin resistance, which requires intensive salvage treatment, and have a 50% risk of cancer-related death. To identify a genetic basis for cisplatin resistance, we performed whole-exome and targeted sequencing of cisplatin-sensitive and cisplatin-resistant GCTs.

Concepts: DNA, Gene, Cancer, Oncology, Chemotherapy, Germ cell tumor, Germ cell, Mediastinal germ cell tumor

2

Although rising incidence rates of testicular germ cell tumors have been well documented in white men, relatively little is known about rates in men of Hispanic origin. In the current study, the authors compared germ cell tumor trends between men of Hispanic and non-Hispanic origin as a function of age at diagnosis.

Concepts: Oncology, United States, Testicular cancer, Germ cell tumor, White American, Hispanic and Latino Americans, Germ cell, Mediastinal germ cell tumor

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This overview of the 4 edition of the WHO Classification of thymic tumors has two aims. First, to comprehensively list the established and new tumour entities and variants that are described in the new WHO Classification of thymic epithelial tumors, germ cell tumors, lymphomas, dendritic cell and myeloid neoplasms, and soft tissue tumors of the thymus and mediastinum; second, to highlight major differences in the new WHO Classification that result from the progress that has been made since the 3 edition in 2004 at immunohistochemical, genetic and conceptual levels. Refined diagnostic criteria for type A, AB, B1-B3 thymomas and thymic squamous cell carcinoma are given and will hopefully improve the reproducibility of the classification and its clinical relevance. The clinical perspective of the classification has been strengthened by involving experts from radiology, thoracic surgery and oncology; by incorporating state-of-the-art PET/CT images; and by depicting prototypic cytological specimens. This makes the thymus section of the new WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart a valuable tool for pathologists, cytologists and clinicians alike. The impact of the new WHO Classification on therapeutic decisions is exemplified in this overview for thymic epithelial tumors and mediastinal lymphomas, and future perspectives and challenges are discussed.

Concepts: Cancer, Oncology, Anatomical pathology, Tumor, Neoplasm, Squamous cell carcinoma, Thymus, Mediastinal germ cell tumor

0

Malignant ovarian germ cell tumors are rare, and often treatable with surgery and chemotherapy. Few data are available for treatment of platinum-resistant tumors.

Concepts: Medicine, Cancer, Oncology, Ovarian cancer, Germ cell tumor, Teratoma, Germ cell, Mediastinal germ cell tumor