Late recurrence of localized pure seminoma in prostate gland:A case report

BACKGROUND Late relapses of early-stage germ cell tumors are rare.Most patients(-85%)with stage I seminoma are cured by radical orchiectomy.The detection of late relapse is challenging given the relative rarity of this phenomenon,and the fact that patients who have completed surveillance are usually not undergoing regular oncologic workup nor imaging.While many treatment options do exist for a patient with late relapse of seminoma,surgery is typically the mainstay as these tumors are generally thought to be more chemo-resistant.CASE SUMMARY In this article,we describe the management of a patient with an early-stage pure seminoma who was subsequently identified to have a recurrence two decades later.We provide a review of the literature not only focused on clinical factors and biology,but also the management of late recurrences specifically in pure seminoma and in prostate gland.CONCLUSION There is a paucity of data and treatment recommendations for this clinical entity,and a multidisciplinary approach emphasizing subspecialty expert consultation and patient education is imperative.

Diagnosis and treatment of primary seminoma of the prostate:A case report and review of literature

BACKGROUND Primary seminoma of the prostate(PSP)is a rare type of extragonadal germ cell tumour that is easily misdiagnosed,owing to the lack of specific clinical features.It is therefore necessary for clinicians to work toward improving the accuracy of PSP diagnosis.CASE SUMMARY A 59-year-old male patient presenting with acute urinary retention was admitted to a local hospital.A misdiagnosis of benign prostatic hyperplasia led to an improper prostatectomy.Histopathology revealed PSP invading the bladder neck and bilateral seminal vesicles.Further radiotherapy treatment for the local lesion was performed,and the patient had a disease-free survival period of 96 mo.This case was analysed along with 13 other cases of PSP identified from the literature.Only four of the cases(28.6%)were initially confirmed by prostate biopsy.In these cases,imaging examinations showed an enlarged prostate(range 6-11 cm)involving the bladder neck(13/14).Of the 14 total cases,11(78.6%)presented typical pure seminoma cell features,staining strongly positive for placental alkaline phosphatase,CD117,and OCT4.The median age at diagnosis was 51(range 27-59)years,and patients had a median progression-free survival time of 48(range 6-156)mo after treatment by cisplatin-based chemotherapy combined with surgery or radiotherapy.The remaining three were cases of mixed embryonal tumours with focal seminoma,which had clinical features similar to those of pure PSP,in addition that they also had elevated serum alpha fetoprotein,beta-human chorionic gonadotropin,and lactose dehydrogenase.CONCLUSION PSP should be considered in patients younger than 60 years with an enlarged prostate invading the bladder neck.Further prostate biopsies may aid in proper PSP diagnosis.Cisplatin-based chemotherapy is still the main primary therapy for PSP.

Clinical significance of VEGF, ER and AR expression in seminoma

To evaluate the expression of vascular endothelial growth factor (VEGF), estrogen receptor (ER) and androgen receptor (AR) in the genesis and development of seminoma. Methods: The expression of VEGF, ER and AR was assayed by means of immuno-histochemical technique in 16 cases of seminoma and 10 cases of prostatic cancer (Pca). Results: The VEGF expression positive rate was significantly higher (P<0.05) in seminoma than in Pca, being 14/16(87.5 %) and (4/10, 40%), respectively. The AR expression positive rate was lower (P>0.05) in seminoma (9/16, 56.2%) than in Pca (9/10, 90%). The ER expression was negative in all the seminoma and Pca patients. Conclusion: In seminoma, the expression of VEGF is significantly increased, which may play a role in the genesis and development of the neoplasm. (Chin J Androl 2002; 16: 349)

Primary Embryonal Lung Carcinoma and Testicular Seminoma in the Same Patient Ten-Years Later: Case-Report and Literature Review

Primary germ cell tumors of lung are extremely rare. The prognosis is usually poor, with various symptoms seriously affecting quality of life. In this paper we describe the unique case of a patient affected by an embryonal carcinoma of lung and a testicular seminoma after ten years. We also report literature about pulmonary extragonadal germ cell tumors.

Immunolocalization of Epidermal Growth Factor in Human Fetal, Adult and Cryptorchid Testes and Seminoma

EGF was localized in human fetal, adult and cryptorchid testis and seminoma using an immunohistochemical method. Leydig cells of adult testes stained intensely for EGF while those of fetal testes showed weak staining reaction. In addition, some spermatogonia and occasional peritubular myoid cells of adult testis stained positively. In cryptorchid testis, there were clusters of Leydig cells interspersed between seminiferous tubules with varying staining intensities. The number of positively stained cells in the cryptorchid testis were fewer than that in adult testes. The decrease in the number of Leydig cells producing EGF may account for the spermatogenesis arrest and infertility associated with this disorder.Intense staining of the cytoplasm of seminoma cells was observed, suggesting that the high production of EGF may be related to their invasive property. In conclusion, EGF is produced by human testis and Leydig cells are the principal source of this cytokine.

Treatment options in stage I seminoma

Seminomas are most commonly diagnosed in clinical stage I(CSI).After orchiectomy,approximately 15%of patients in this stage have subclinical metastases.Adjuvant radiotherapy(ART)delivered to the retroperitoneum and ipsilateral pelvic lymph nodes has been the mainstay of treatment for many years.Although highly efficient,with long-term cancer-specific survival(CSS)rates approaching almost 100%,ART is associated with considerable long-term consequences,particularly cardiovascular toxicity and increased risk of secondary malignancies(SMN).Therefore,active surveillance(AS)and adjuvant chemotherapy(ACT)were developed as alternative treatment options.While AS prevents patient overtreatment,it is associated with strict follow-up regimens and increased radiation exposure due to repeated imaging.Due to equivalent CSS rates to ART,and lower toxicity,one course of adjuvant carboplatin presents the cornerstone of chemotherapy for CSI patients.CSS is almost 100%for patients with CSI seminoma,regardless of the chosen treatment option.Therefore,a personalized approach in treatment selection is preferred.Currently,routine radiotherapy for CSI seminoma patients is no longer recommended.Instead,it should be reserved for patients who are unfit or unwilling for AS or ACT.Identification of prognostic factors for disease relapse allowed for the development of risk-adapted treatment strategy and stratification of patients in low-risk and high-risk groups.Although risk-adapted policy needs further validation,surveillance is currently recommended in low-risk patients,while ACT is reserved for patients with a higher risk of relapse.

Acute inferior myocardial infarction in a young man with testicular seminoma:A case report

BACKGROUND Atherosclerosis represents the main cause of myocardial infarction(MI);other causes such as coronary embolism,vasospasm,coronary-dissection or drug use are much rarely encountered,but should be considered in less common clinical scenarios.In young individuals without cardiovascular risk factors,the identification of the cause of MI can sometimes be found in the medical history and previous treatments undertaken.CASE SUMMARY We present the case of a 34-year-old man presenting acute inferior ST-elevation MI without classic cardiac risk factors.Seven years ago,he suffered from orchidopexy for bilateral cryptorchidism,and was recently diagnosed with right testicular seminoma for which he had to undergo surgical resection and chemotherapy with bleomycin,etoposide and cisplatin.Shortly after the first chemotherapy treatment,namely on day five,he suffered an acute MI.Angiography revealed a mild stenotic lesion at the level of the right coronary artery with suprajacent thrombus and vasospasm,with no other significant lesions on the other coronary arteries.A conservative treatment was decided upon by the cardiac team,including dual antiplatelets therapy and anticoagulants with good further evolution.The patient continued the chemotherapy treatment according to the initial plan without other cardiovascular events.CONCLUSION In young individuals with no cardiovascular risk factors undergoing aggressive chemotherapy,an acute MI can be caused by vascular toxicity of several anticancer drugs.

Meta-Analysis to Determine the Diagnostic Value of 2-¹⁸Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography in Assessing Residual Tumors after Systemic Therapy for Metastatic Seminoma

Background: A meta-analysis was performed to determine the value of 2-18fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for assessing viable tumor residuals after chemotherapy in patients with pure seminoma. Materials and methods: This review included five studies published between 1999 and 2010 with a total of 130 patients who underwent both computed tomography (CT) and FDG-PET scanning for residual tumor detection after systemic therapy. We compared the sensitivity and specificity of FDG-PET and CT (tumor size ≤ or > 3 cm) in identifying vital tumor tissue. Results: On the average, FDG-PET had higher specificity (92% vs. 59%) and sensitivity (72% vs. 63%) as well as a higher positive predictive value (PPV) than the solely size-based CT assessment of residual tumors (70% vs. 28%). PEt also tended to have a higher negative predictive value (93% vs. 86%). Conclusion: The present evaluation of currently available data indicates that FDG-PET is superior to CT in detecting viable tumor residuals after chemotherapy in patients with metastatic seminoma. Its application can thus be recommended.

Testicular Seminoma and Peritonitis about One Case at the Yalgado Ouedraogo University Hospital of Ouagadougou

Introduction: Testicular seminoma is a highly lymphophilic germ cell tumor. It is the most common germ cell tumor in young adults. We are reporting one case of testicular seminoma complicated with an acute generalized peritonitis (AGP), in order to describe the circumstances of diagnosis and discuss about treatment. Observation: It involved a 39-year-old patient, admitted for vague abdominal pains that were evolving since 72 hours with a history of right orchiectomy because of testicular seminoma in 2011. The analysis revealed a peritoneal syndrome, a right inguinal lymphadenopathy of 10 cm diameter and an empty right scrotum. The exploration revealed fistulized necrotic retro-peritoneal lymphadenopathies in the peritoneal cavity and ileal perforation on contact with these lymphadenopathies. Necrosectomy and ileal resections were performed. After the operation, the scanner revealed a conglomeration of retro-peritoneal adenomegalies extending to the right femoral region associated with bilateral pleurisy. The β-HCG and the LDH were 8000 IU/L and 24,500 IU/L, respectively. The seminoma was ranked T3N3M1. The immediate post-operative care was uneventful. The patient was lost from sight for a month and was readmitted in a context of alteration of his general condition. He died before the end of the pre-chemotherapeutic assessment. Conclusion: Scrotal mass is the usual way of revelation of testicular seminoma. In poorly followed-up cases, exceptional complications such as peritonitis may occur and are direct consequences of poor prognosis.

Supraclavicular Neck Mass as Sole Presenting Symptom for Seminoma in an Elderly Male

We report an unusual case of genitourinary malignancy in an otherwise asymptomatic elderly male, which was discovered via workup of a supraclavicular neck mass. We present his clinical workup as well as the pathological workup and how it influenced our decision-making. A review of the literature is also discussed and demonstrates how uncommon it is for seminomas to present in this manner.

Classical seminoma in a 92-year-old patient

Seminoma is a germ cell tumour which primarily affects the testes. Seminomas are treated by orchidectomy with usually excellent outcomes. We report the occurrence of a classical seminoma in a 92-year-old man,who is currently the oldest patient with this histology reported in literature. He presented with a painful,swollen testis. Scrotal ultrasound scan revealed a testicular mass. A left inguinal orchidectomy was carried out and histological examination confirmed the diagnosis of a classical seminoma. Further staging by computerised tomography revealed pulmonary lesions suspicious of metastases. The patient declined further treatment in view of his age and co-morbidities.

Treatment and prognosis of primary mediastinal seminoma

Objective: To investigate the surgical treatment and prognosis of the primary mediastinal seminoma. Methods: Three cases with primary mediastinal seminoma from 1985 were retrospectively studied. They were male, aged 23, 36 and 32 years respectively. The primary symptoms were chest pain and coughing. The chest X-ray examination revealed solid round mass in the anterior mediastinum, with the diameters varied from 3 cm to 18 cm and a smooth clear edge. The diagnosis was not clearly in all three cases, and then operation was performed. Results: There were no operative deaths and complications. The tumor was radically removed in 2 cases and palliatively removed in 1 case. The post-operative pathological diagnosis is seminoma in all three cases. Radiotherapy were performed in 4 weeks after operation. All cases have been followed up to now, with 1 cases of death and 2 cases survival. Conclusion: Primary seminoma of the mediastinum is very rare. Operation is the main treatment for the primary mediastinal seminoma. Seminoma shows a good prognosis.

原发性纵隔精原细胞瘤放化疗后无精子症1例并文献复习

目的探讨原发性纵隔精原细胞瘤放化疗后无精子症患者的诊疗思路。方法通过分析2024年1月北京大学第一医院太原医院诊治的1例原发性纵隔精原细胞瘤放化疗后无精子症患者的诊疗过程,结合相关文献报道,探讨此类患者的临床诊疗策略。结果该例患者通过显微镜下睾丸切开取精术获得精子。结论对于放化疗后无精子症患者,应综合评估患者情况后选择合适的治疗方法,帮助患者合理解决生育问题。

Reduced semen quality in patients with testicular cancer seminoma is associated with alterations in the expression of sperm proteins

Testicular cancer seminoma is one of the most common types of cancer among men of reproductive age.Patients with this condition usually present reduced semen quality,even before initiating cancer therapy.However,the underlying mechanisms by which testicular cancer seminoma affects male fertility are largely unknown.The aim of this study was to investigate alterations in the sperm proteome of men with seminoma undergoing sperm banking before starting cancer therapy,in comparison to healthy proven fertile men(control group).A routine semen analysis was conducted before cryopreservation of the samples(n=15 per group).Men with seminoma showed a decrease in sperm motility(P=0.019),total motile count(P=0.001),concentration(P=0.003),and total sperm count(P=0.001).Quantitative proteomic analysis identified 393 differentially expressed proteins between the study groups.Ten proteins involved in spermatogenesis,sperm function,binding of sperm to the oocyte,and fertilization were selected for validation by western blot.We confirmed the underexpression of heat shock-related 70 kDa protein 2(P=0.041),ubiquinol-cytochrome C reductase core protein 2(P=0.026),and testis-specific sodium/potassium-transporting ATPase subunit alpha-4(P=0.016),as well as the overexpression of angiotensin I converting enzyme(P=0.005)in the seminoma group.The altered expression levels of these proteins are associated with spermatogenesis dysfunction,reduced sperm kinematics and motility,failure in capacitation and fertilization.The findings of this study may explain the decrease in the fertilizing ability of men with seminoma before starting cancer therapy.

Dynamic changes in the expression of apoptosis-related genes in differentiating gonocytes and in seminomas

Apoptosis is an integral part of the spermatogenic process, necessary to maintain a proper ratio of Sertoli to germ cell numbers and provide an adequate microenvironment to germ cells. Apoptosis may also represent a protective mechanism mediating the elimination of abnormal germ cells. Extensive apoptosis occurs between the first and second postnatal weeks, at the point when gonocytes, precursors of spermatogonial stem cells, should have migrated toward the basement membrane of the tubules and differentiated into spermatogonia. The mechanisms regulating this process are not well-understood. Gonocytes undergo phases of proliferation, migration, and differentiation which occur in a timely and closely regulated manner. Gonocytes failing to migrate and differentiate properly undergo apoptosis. Inadequate gonocyte differentiation has been suggested to lead to testicular germ cell tumor （TGCT） formation. Here, we examined the expression levels of apoptosis-related genes during gonocyte differentiation by quantitative real-time polymerase chain reaction, identifying 48 pro- and anti-apoptotic genes increased by at least two-fold in rat gonocytes induced to differentiate by retinoic acid, when compared to untreated gonocytes. Further analysis of the most highly expressed genes identified the pro-apoptotic genes Gadd45a and Cycs as upregulated in differentiating gonocytes and in spermatogonia compared with gonocytes. These genes were also significantly downregulated in seminomas, the most common type of TGCT, compared with normal human testicular tissues. These results indicate that apoptosis-related genes are actively regulated during gonocyte differentiation. Moreover, the down-regulation of pro-apoptotic genes in seminomas suggests that they could represent new therapeutic targets in the treatment of TGCTs.

β2-微球蛋白、白蛋白与碱性磷酸酶比值在睾丸精原细胞瘤中的表达及临床意义

目的探讨β2-微球蛋白(Beta 2-Microglobulin,β2-MG)、白蛋白与碱性磷酸酶比值(albumin toalkaline phosphatase ratio,AAPR)在睾丸精原细胞瘤血清中的表达水平及临床意义。方法回顾性分析2016年1月至2023年8月在右江民族医学院附属医院泌尿外科住院确诊的睾丸精原细胞瘤患者31例为病例组,选取同期在该院进行体检的健康人群39例为对照组,比较两组间β2-MG、AAPR的表达差异。应用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析血清β2-MG、AAPR在睾丸精原细胞瘤的临床诊断价值。结果β2-MG在病例组中表达水平明显高于对照组(P<0.05),AAPR在病例组中表达水平明显低于对照组(P<0.05)。β2-MG、AAPR表达水平与睾丸精原细胞瘤患者的年龄、BMI、肿瘤T分期、淋巴结转移、M分期、隐睾病史及肿瘤直径无明显相关性。ROC曲线显示β2-MG曲线下面积(area under curve,AUC)为0.759,敏感度为82.05%,特异度为61.29%;AAPR的AUC为0.788,敏感度为89.74%,特异度为64.52%;β2-MG联合AAPR的AUC为0.824,敏感度为92.31%,特异度为67.74%。结论β2-MG在睾丸精原细胞瘤患者外周血中表达明显升高,AAPR在睾丸精原细胞瘤患者中表达水平明显降低。β2-MG、AAPR对睾丸精原细胞瘤具有较高的诊断效能,且两者联合诊断效能更佳。

Identification of sumoylated targets in proliferating mouse spermatogonia and human testicular seminomas

Spermatogenesis is regulated by a complex network of posttranslation modifications.Sumoylation(a modification by small ubiquiti like modifiers,or SUMO proteins)was identified as an importa nt cellular event in d iff ere nt cell types.SUMO proteins are highly expressed in the testis,and their role during spermatogenesis has begun to be elucidated.Given the important role of sumoylation in the regulation of mitosis and cancer progress!on in other tissues,the aim of the current study was to identify the targets of SUMO in proliferating mouse spermatog onia and huma n semi noma tissues and to in itially exami ne the level of sumoylation in relation to the proliferative activity of the tissues.Using freshly purified spermatogonia and Cl8-4 spermatogonia cell line,mass spectrometry analysis identified several SUMO targets implicated into the proliferation of spermatogonia(such as heat shock protein 60[HSP60]and prohibitin).Tissue array and western blot approaches showed that SUMO expression is a prominent feature of human seminomas and that the proliferative activity of the tumor tissues was positively correlated with the level of SUMO expression.Down regulation of sumoylati on with si-RNA was not sufficie nt to sign ificantly affect the proliferation of C18-4 spermatogonia;however,SUMO overexpression in creased the proliferation rate of the cells.These data suggest that cells are more sensitive to an elevated level of SUMO,and that this situation may lead to an upregulated cellular proliferation and,possibly,cancer.Mass spectrometry analysis identified around a hundred SUMO targets in seminoma samples.Notably,many of the identified proteins(such as proliferating cell nuclear antigen[PCNA],DNA topoisomerase 2-alpha[Top2A],prohibitin,14-3-3 protein,and others)were implicated in oncogenic transformation and cancer progression.

精原细胞瘤放化疗后继发C型尼曼匹克病1例报道并文献复习

目的报道1例在鞍区精原细胞瘤放化疗后出现C型尼曼-匹克病(Niemann-Pick disease type C,NPC)的病例,加强对尼曼-匹克病(Niemann-Pick disease,NPD)的了解。方法对南部战区总医院内分泌科2021年6月收治的1例鞍区精原细胞瘤切除术、放化疗后逐渐出现垂体功能减退、重度肝损害、肝脾大,激素替代治疗后引起继发性糖尿病的青少年患者长达4年的病史进行回顾性分析。结果本例患者为青少年女性,鞍区精原细胞瘤切除术及放化疗后,逐渐出现不同程度血细胞下降、脂代谢异常、肝功能异常、肝脾增大等,行骨髓穿刺,形态学发现2%尼曼-匹克细胞,最终诊断为NPC。经输血、护肝、胰岛素降糖、激素替代等对症治疗后,各项指标较治疗前好转,精神较入院时稍好转,但患者仍存在黄疸、肝脾大,偶有精神异常。目前继续门诊随访,予对症治疗。结论对于颅内肿瘤术后或放化疗后所致内分泌与代谢相关症状,且同时伴有难以解释的神经、精神、脏器功能异常时,要考虑到NPC的可能性,可通过骨髓穿刺涂片发现尼曼-匹克细胞初步诊断。目前NPC的治疗以对症为主。

腹盆腔精原细胞瘤的CT和MRI影像学表现

目的探讨腹盆腔原发或转移性精原细胞瘤的CT和MRI影像学特征。方法回顾性分析经组织病理学确诊的8例腹盆腔精原细胞瘤患者的临床和影像学资料,结合文献分析其CT和MRI影像学特征,包括部位、形态、直径、密度/信号特点、强化方式、与邻近器官/血管的关系、包膜特点、有无肿大淋巴结等。结果8例患者年龄21~54岁,平均31岁。7例患者以自觉腹部包块伴腹痛就诊,1例以腹胀、腰背疼痛、双腿无力就诊。8例患者中,4例是隐睾原发肿瘤,1例为正常睾丸精原细胞瘤伴腹膜后转移性精原细胞瘤,3例为隐睾精原细胞瘤切除术后腹膜后转移性精原细胞瘤形成。8例病灶在CT/MRI上呈分叶状实性或囊实性肿块,平扫8例病灶密度/信号不均匀,增强为不均匀、渐进性强化,7例包膜均完整,4例有淋巴结转移。结论精原细胞瘤好发于青年,易发生复发转移,其CT和MRI影像学表现具有一定的特征性。

Prognostic value of primary tumor surgery in seminoma patients with distant metastasis at diagnosis:a population-based study

The aims of this study were to determine the prog no stic value of primary tumor surgery and identify optimal can didates for such surgery among patients with semi noma and dista nt metastasis at diag no sis.We ide ntified 521 patients with seminoma and distant metastasis at diagnosis between 2004 and 2014 from the Surveillanee,Epidemiology,and End Results database.Among these patients,434 had undergone surgery,whereas 87 had not.The prognostic value of primary tumor surgery was assessed by Kaplan-Meier methods,log-rank analyses,and multivariate Cox's proportional hazards model.Survival curves and forest plots were also plotted.Survival analysis indicated that patients who underwent surgery had a better 5-year overall survival and cancer-specific survival tha n those who did not.Multivariate analyses dem on strated that primary tumor surgery is an in depende nt prog no stic factor for overall survival and cancer-specific survival,along with age at diagnosis,Mstage,and marital status.In addition,primary tumor surgery still had con siderable prog no stic value in the subgroup of patie nts with lymph node metastasis.Further,forest plots demonstrated that patie nts with Mia stage,N1 or N2-3 stage,and a youn ger age at diagnosis(<60 years)may ben efit from primary tumor surgery.In con elusion,our findings indicate that primary tumor surgery is correlated with improved survival in patients with seminoma and distant metastasis.Furthermore,primary tumor surgery is an independent prognostic indicator for patients with seminoma and distant metastasis.